Page 217 - Lean six sigma demystified

Chapter 5 Redu C ing d efe C t S with Six Sigm a 195

Core Score

In Marcus Buckingham’s book, The One Thing You Need to Know, there’s a sec-
tion on knowing your core score. What’s the one thing you need to know about
your business?

Core Score for Prisons

Buckingham interviewed General Sir David Ramsbotham who was in charge of
Her Majesty’s prisons. He says that he knew he couldn’t make wardens change. In
order to make things happen, he had to change the way they measured success.
• Old metric. Number of escapees
• New metric. Number of repeat offenders

The old goal was to keep prisoners in, but the General started thinking: Who
is a prison designed to serve? Answer: the prisoner! “The main purpose of a prison
should be to serve the prisoner. By which I mean that we must do something for
the prisoner while he is in prison so that when he is released back into society he
is less likely to commit another crime.” Armed with this new score, he turned the
prison world upside down.

Core Score for Health Care

In the old world of health care, the measure was based on outcomes: Did the
patient get better no matter how long it took? I am coming to believe that the
new world of health care is measured on speed.
• Door-to-doctor time in the Emergency Room of under 30 minutes

• ED length of stay of less than 2 hours

• ED-to-nursing floor for admitted patients of under 30 minutes
• Length of stay of 2 to 3 days based on diagnosis
• Discharge-to-disposition (patient transferred) of under 60 minutes
Most of these times can run two to four times longer at present. Patients are
used to being served in minutes everywhere else; why not in health care? Of
course, health care will need a few metrics of patient safety as well.

• ED returns within 7 days
• Hospital returns within 30 days
• Poor outcomes (infection, death, etc.)