Have You Ever Used Stealth Sigma?

By:  DM Kashmer MD MBA MBB FACS (@DavidKashmer)


You took a job at a place where they don’t use Six Sigma…now what?


Ut-oh…you’ve entered an organization and it’s one that doesn’t use Six Sigma…but that’s one of your favorite toolsets!  Maybe you use Lean techniques and Six Sigma ones, routinely, together.  After all, you know very well that the Six Sigma process is really just a collection of effective tools put together in the best manner to achieve great outcomes. You know that it’s not so much that Six Sigma is the only way to get things done; however, you know it’s a highly effective process and that it complements Lean so well. Again, the problem is, your organization doesn’t use Six Sigma and maybe even says “We don’t do that here”.  It could be that the new place uses Lean by itself or some other process, which, of course, is infinitely better than having no process at all!

Have you ever been in that situation or heard about it? If you have, then read on for some advice about how to operate with the tools of Six Sigma effectively in an organization that “doesn’t use Six Sigma”.

BIG DISCLAIMER:  By the way…Lean, TQM, and other toolsets are, in fact, great!  Each has an important role in reducing waste, improving quality, and focusing on patient safety.  The question here is:  how do you use the Six Sigma toolset that compliments Lean and other tools so very well in an organization that hasn’t seen those Six Sigma tools before?  After all, Lean and Six Sigma are like peanut butter and jelly…


Don’t call what you’re doing Six Sigma.


I have learned this from entering several organizations that outright say “we don’t use the Six Sigma process”. Like I said above, practitioners who utilize the Six Sigma tools know that they are merely a set of statistical tools strung together in perhaps the best possible manner. More important even than the math behind Six Sigma is its ability to influence culture and produce positive change. Whichever way you look at it, I have found, over time, that entering an organization that practices something like Lean (to the exclusion of all else) often means that I can’t call what I’m using “Six Sigma”.  Sometimes this technique of “doing Six Sigma” without advertising it in any way is called “Stealth Sigma”.


Why bother with Stealth Sigma? People seem to react to the term “Six Sigma”. They have preconceived notions about it. Often, it’s not a body of knowledge they have attained and it’s sort of math intensive. They are interested in the sometimes more soft vocabulary of Lean. The Six Sigma body of knowledge, is, again, often fairly math heavy. Talking about things like data distributions doesn’t go down well in the organization that is focused on less quantitative tools.


Instead, don’t ever package or use a term for exactly which tools you’re doing. Use terms like “quality improvement project” and other terms like “statistical process control”. Again, let me recommend, whatever you do, call the process you are using something other than “Six Sigma”.


Enlist others.


Although you may be using the statistical tools and knowledge behind them, try to focus on bringing people together over important issues. Give them the background on devices you are using like project charters etc. There is no need to ever give them the overview of the fact that you are using the DMAIC process or other tools. Just walk them through it and show them the data. Often, they won’t ever realize that you are helping them perform their first ever Six Sigma project.


Celebrate successes.


When there is a success in a project, highlight it greatly. Again, I recommend doing this to make staff feel good about the quality project they’ve just done. Once they are on the other side of it they will start to feel that Six Sigma (or whatever you’ve called it) isn’t so bad.


Highlight tampering versus under controlling.


One of the powerful elements of Six Sigma is its ability to generate statistically useful conclusions. You can guard against tampering (and under-controlling) with hospital systems. Other quality systems don’t do that so well.  I recommend highlighting the risk of type 1 and type 2 error.  Highlighting decision-related issues like that helps differentiate the tools you know and use from others that the organization is currently using.  It shows what the tools can do for you and the the organization you’ve joined.


One thing I have seen in hospital settings is that we, as staff, are sometimes so eager to do better for the patients that we tamper with systems that are already effective or ones which we haven’t adequately characterized.  (More on type 1 and type 2 errors here.)


At the very least, the samples on which we base our decisions can be very poor. This leads to organizations that lurch from one problem to the next rather than truly repairing problems. It’s a problem, but by no means the worst one you can have.  I add this commentary because, in the set of problems your organization can have, I think this is a fairly good one.


It shows that people are trying, they are interested in making improvements, and they just need some guidance to understand when to intervene and when not to. So, when you use Six Sigma in an organization that does not have, believe in, or utilize the Six Sigma body of knowledge, highlight the benefits of using the statistical tools themselves rather than attributing them to the Six Sigma body of knowledge.  The tools can help protect you from tampering with systems and also under-controlling for problems.


In conclusion, let me share with you that I’ve been in organizations that use only the Lean toolset or only a similar quality improvement toolset. Those organizations can achieve remarkable outcomes and do very well. However, it’s worth noting that when utilizing some of the quantitative Six Sigma tools in organizations like that, it is important to perform what is often called “Stealth Sigma”. This means it’s important to call what we are doing statistical process control or use some other term. Remember to highlight early successes and try to get the team rallied around a certain important fact only to quickly celebrate their achievement when they get to the other side of their first Six Sigma project…whether they know they’ve done a Six Sigma project or not!