Six Sigma at Academic Medical Hospital (a)

17 Pages Posted: 21 Oct 2008

See all articles by Robert Landel

Robert Landel

University of Virginia - Darden School of Business

Dee San

University of Virginia Health System's Performance Improvement

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For 10 years, Academic Medical Hospital's chief of staff had struggled to decrease the amount of time patients spend waiting in the ER. Now the hospital has adopted the Six Sigma to streamline emergency-care activities and reduce patient wait time. At the completion of the pilot study, the statistical significance of the results as well as deep-rooted implementation resistance from several key stakeholders in the hospital and the medical school cause concern. This case can be used to teach Six Sigma methodology, to critique the effectiveness of the application of the phases and tools, and to deal with the statistical significance issues and the implementation concerns.



Rev. Apr. 21, 2017

Six Sigma at Academic Medical Hospital (A)


Jane McCrea was excited about the improvement results she had reviewed for an upcoming meeting. Her Foundations Team had just completed a month-long pilot study of the impact of the numerous new patient-flow process steps and communications protocols in the Emergency Department (ED) at Academic Medical Hospital (AMH). The ED Wait Time Project was one of the first of Six Sigma improvement projects underway at AMH led by Black Belts, who, like McCrea, were full-time project leaders and experts in Six Sigma methodology and statistical tool application. Lobby wait times had been reduced to comply with the team's established service time. Physician wait time had also improved but was not yet exhibiting significant change. Preliminary feedback from staff members and some physicians about the trial patient-flow-process changes and the day-to-day service time results was positive.

Nevertheless, as McCrea prepared to brief the members of her Foundations Team on the results of the pilot, she was concerned. The statistical aspects of the ED project had gone well overall but had not been without missteps that she thought would always be part of Six Sigma. She knew that the team would want to dig into the pilot results to examine their statistical significance at the next team meeting. Although McCrea agreed that the data analyses and pilot design challenges were important considerations, she still thought that, at this point, it was more essential to focus on another component of the project where success was of critical importance to the long-term outcome of the project: stakeholder acceptance and ED Wait Time Project sponsorship.

At the start of the ED Wait Time Project, many of the emergency medicine physicians were reluctant to agree to a Six Sigma initiative in emergency care. Some believed that the patient care environment simply did not lend itself to process experimentation, not even in the walk-in/wheelchair patient care area that was the main focus of the ED project. Now at the beginning of the final phase of the team's work, McCrea knew that its project sponsor had not been successful in garnering the necessary physician support and acceptance that would be critical for sustaining the new process once the ED Foundations Team completed its next final phase of work. Furthermore, there were many other aspects of ED patient care that McCrea and the ED staff believed needed to be addressed in the spirit of continuous improvement, even after the Foundations Team had completed this particular project.

Academic Medical Hospital and Six Sigma

. . .

Keywords: continuous improvement, Six Sigma, implementing change, project management

Suggested Citation

Landel, Robert and San, Dee, Six Sigma at Academic Medical Hospital (a). Darden Case No. UVA-OM-1058. Available at SSRN:

Robert Landel (Contact Author)

University of Virginia - Darden School of Business ( email )

P.O. Box 6550
Charlottesville, VA 22906-6550
United States


Dee San

University of Virginia Health System's Performance Improvement ( email )

1400 University Ave
Charlottesville, VA 22903
United States
434-243-9901 (Phone)

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