How preparedness improves with Lean Six Sigma

“Congratulations on passing your Lean Six Sigma certification exam,” said a dear friend and emergency preparedness colleague. And then, in that voice used by people who love you but can’t understand you, she added, “Soooo, what are you going to do with it?”

“First,” I responded, “I’m going home and celebrating. This is the most intellectually challenging thing I’ve done since maybe calculus in college. Then, I’m going to change how we do preparedness.”

Having completed the first of those two tasks, let me explain how we’re going to change preparedness using the discipline and tools of Lean Six Sigma (LSS).

Six Sigma is the scientific process of the pursuit of perfection in business. It grew up in the automobile manufacturing industry in Japan, which is why those cars are so popular worldwide, but the concept has spread to healthcare and other industries.  Lean is working smarter. I will explain each in more detail as I connect them to preparedness.

I can tell I am already in danger of losing many of you; you have no use for the scientific pursuit of perfection in a business where we don’t even have half the data we need to make decisions! Let me detour slightly to explain how this kind of thinking is important in our business.

To oversimplify, there are two kinds of problems: complicated, and complex. Complicated problems are like assembling an Audi R-8 (my son’s favorite car). Each of the roughly 30,000 individual parts must be made within very tight tolerances, so they all fit together, and so that they perform as designed. To you and me, that seems very tedious and boring. We want our sportscars to work, and we appreciate the diligent bolt-tighteners as much as we do the talented designers, but all we want to do is drive them, preferably fast and on winding roads that we haven’t driven on before.

Complex problems are what we love. They’re the kind you haven’t faced before, and where much of the information you need to solve the problem isn’t available, but you have to make decisions anyway. A fire chief arrives at an apartment building with flames showing. No one has fought that fire, in that building, with those contents, in this weather, before. The Chief isn’t even sure of the building’s construction, or of possible alterations, or of what dangerous materials might be inside. There is no knowable mathematical formula to apply, and if there was, we wouldn’t have the numbers to plug into it. Those are the problems we like to face.

Some people refer to complex problems like these as “edge of chaos” problems, implying that there is a chaos nearby with unsolvable problems. That sounds a lot more like fun, doesn’t it?

But once the Chief decides the appropriate strategy, based on limited experience and guts, and orders the roof vented, then everything that needs to be done by the firefighters becomes complicated, not complex. The truck company knows where and how to vent the roof, because they have practiced this hundreds of times. They know, based on the construction of the building and the amount of fire, that they are going to trench cut the roof just ahead of the fire. They know exactly what tools to bring, because they applied a version of the scientific method in years of training. Their precise cuts stop the spread of fire, and let the heat and smoke escape, so their colleagues can gain entry, rescue occupants, and fight the fire.

Six Sigma is a process that can apply to tactics like roof ventilation and the one thousand other tactics used by firefighters, EMTs, cops, Search and Rescue technicians, and everyone who puts on a uniform and ventures forth to slay the beast. We strive to be the best at what we do, and to incorporate new tools and techniques as they are proven to be superior. The Six Sigma process can help us get there faster.

Six Sigma is also the process that will help us with the many other processes involved in preparedness. It will sharpen our risk assessments, our planning process, our training development, and even our exercises. It will help us with optimum crew assignments, resource locations, and 9-1-1 call processing. It will help increase the throughput of Emergency Departments before the next mass casualty incident. It can help determine the optimum staffing for hospital decon teams. 

For a taste of what Six Sigma can do, take FEMA’s IS-45 “Continuous Improvement (CI) Overview” online. It’s a one-hour, jargon-free (almost) teaser of the process. You will instantly recognize how exercises fit into this process.

While the concept is simple, the execution is not. Six Sigma involves rigorous formulas and high-level math to analyze. For example, a regression analysis can tease out the proportion of delayed 9-1-1 dispatches that are attributed to volume, to call type, to operator experience level, and even to the length of time since that operator’s last break. One of the formulas is X2 = ∑ (O-E)2 / E. Computer software does the processing, but a Lean Six Sigma expert needs to select the right program. And, of course, a subject matter expert in preparedness needs to be a part of the improvement process. That’s my goal – to bring together the process owners – 9-1-1 call center managers, police and fire chiefs, healthcare leadership – with the Six Sigma experts to make the magic happen.

Six Sigma’s process involves these five steps:

Define the problem. 

Measure the situation. This involves getting reliable data in sufficient quantity to make confident inferences.

Analyze the data. This is where the high-level math gets done.

Improve. The analysis will identify causes of the problem. It’s up to us to develop solutions and try them out. It may take multiple attempts to find the combination of solutions that delivers the best results.

Control. The hard part is maintaining the improved process. It requires regular monitoring and a “control plan” to bring the process back into line when the results stray in the wrong direction.

Lean is working smarter. Lean involves ways to improve workflow and minimize errors and waste. We already adopt many of these techniques. Firefighters always store their gear in neat racks, so it’s easy to find and don before they mount the apparatus. When nurses found ways to run IV lines outside of patient rooms during COVID, so they didn’t have to gown and glove just to change IV bags, that’s Lean. We can do better, and that will help us minimize costly errors (and injuries) as well as get our jobs done faster and more safely. It will also reduce the expense of broken and missing equipment.

You’ll be hearing more from me on Lean and Six Sigma projects that improve preparedness and the delivery of public safety. If you are a LSS practitioner, please reach out so we can build the teams necessary to make real improvement. If you are a process owner – a 9-1-1 center director, a fire or police chief, a healthcare facility or coalition leader – and you want to talk about measurable improvement, please contact me.