title: Application of Six Sigma methodology to a cataract surgery unit.
abstract: OBJECTIVE
  The article's aim is to focus on the application of Six Sigma to minimise intraoperative and post-operative complications rates in a Turkish public hospital cataract surgery unit.
  
  
  METHODS
  Implementing define-measure-analyse-improve and control (DMAIC) involves process mapping, fishbone diagrams and rigorous data-collection. Failure mode and effect analysis (FMEA), pareto diagrams, control charts and process capability analysis are applied to redress cataract surgery failure root causes.
  
  
  RESULTS
  Inefficient skills of assistant surgeons and technicians, low quality of IOLs used, wrong IOL placement, unsystematic sterilisation of surgery rooms and devices, and the unprioritising network system are found to be the critical drivers of intraoperative-operative and post-operative complications. Sigma level was increased from 2.60 to 3.75 subsequent to extensive training of assistant surgeons, ophthalmologists and technicians, better quality IOLs, systematic sterilisation and air-filtering, and the implementation of a more sophisticated network system.
  
  
  CONCLUSIONS
  This article shows that Six Sigma measurement and process improvement can become the impetus for cataract unit staff to rethink their process and reduce malpractices. Measuring, recording and reporting data regularly helps them to continuously monitor their overall process and deliver safer treatments.
  
  
  CONCLUSIONS
  This is the first Six Sigma ophthalmology study in Turkey.
authors.affiliation: Department of Healthcare Mangement, Uskudar University, Istanbul, Turkey. totaner@yahoo.com
authors.forename: Mehmet Tolga
authors.initials: MT
authors.lastname: Taner
mesh_terms: D002387:Cataract Extraction / Q000379:methods / Q000592:standards*; D017598:Efficiency, Organizational; D006801:Humans; D019300:Medical Errors / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D058996:Quality Improvement / Q000458:organization & administration; D060891:Root Cause Analysis; D017749:Total Quality Management / Q000458:organization & administration* / Q000592:standards; D014421:Turkey; D057188:Workflow