Restorative Quality Improvement: Novel Application of Six Sigma in a Skilled Nursing Facility.

BACKGROUND: Six Sigma is a quality improvement (QI) method used in hospitals, but not typically in nursing homes (NHs), to reduce service variability and expenditures. LOCAL PROBLEM: The existing QI process for functional maintenance program (FMP) charting/auditing in an urban NH allowed variability and lost revenue. METHODS: A single-group pre/posttest design with analysis of variance and t-test analysis was used to implement Six Sigma for the FMP process. INTERVENTION: Phases of Define, Measure, Analyze, Improve, and Control addressed performance objectives of FMP capacity; staff retention; congruence between prescribed, performed, and charted FMPs; and month-end summaries of resident status on FMPs. RESULTS: With the existing staff, capability was increased by 17 residents ($200 000 revenue) and 90% to 100% charting congruence was achieved. Limited success was attributed to lack of skill diffusion, team communication, manager availability, and project prioritization. CONCLUSIONS: Six Sigma was moderately successful when applied in a single NH for QI.