As a certified Green Belt in Six Sigma, I was pleased to see the article entitled “From Factory to Faculty” [March/April 2010, by Bruce J. Bellande, PhD, FACME, CCMEP] in your publication. For those who are not familiar with the manufacturing world, Six Sigma is often an unknown term. And many of those who are familiar with it understand it to be something that doesn’t really relate to their own professional field. However, the Six Sigma quality-improvement methodologies are slowly working their way out of the traditional industrial setting and into many different types of businesses. I am excited to see that it is being used more frequently in continuing medical education operations and the healthcare setting in general.

This growth in utilizing Six Sigma outside of manufacturing is a logical move. The description of the process, broken down to simplest terms, is to remove errors (defects) and (multiple) variables in a process to produce the highest-quality product. In Six Sigma, a defect is defined as any process output that does not meet customer specifications, or that could lead to creating an output that does not meet customer specifications.1 It is great to see that healthcare professionals are seeing the value in this process for the treatment of patients. Achieving “Six Sigma” in industry means that a process is 99.99966 percent free of defects. What a wonderful goal that is to have in our healthcare system that is responsible for the care of patients, and not just the processes used to improve the quality of material items.

I believe the Bridge to Quality initiative, as described in Bellande’s article, will help to reinforce the role of Six Sigma in the healthcare setting. It should bring value to all stakeholders involved: administrators, clinicians, teachers, learners, and patients. And there should be a shift in thinking, regardless of the group, to a systems model, including that (1) all work occur in a system of interconnected processes, (2) variation exists in all processes, and (3) understanding and analyzing the variation are keys to success. 2, 3

My own personal experience with Six Sigma was specifically within CME operations. It included analyzing the educational activity marketing process and reviewing and improving the grant-writing process. Both of these projects not only provided process improvements but also resulted in bringing about teamwork from the various stakeholders who were involved in or affected by the processes. I am sure that the Bridge to Quality initiative will have the same result, and, in the end, all stakeholders, even though from different groups, will be successful in working together “to get to where they want to go” in the overall improvement of patient outcomes.

Here we are now in late 2010, when a workshop is to take place on the Indiana University School of Medicine campus to take the initiative to Level 6 (patient health) on Moore’s seven-level CME outcomes scale. I am looking forward to hearing the results from this next step in the new direction that is being taken together by all those involved in the Bridge to Quality initiative. Regards to all involved for moving in a new direction and using new methodologies in the area of performance improvement in patient outcomes!

Sandra T. Weaver, MS
Vice President, Strategic Alliances
CME Peer Review

1. Antony, J. (2008, January 8). Pro’s and on’s of six sigma: an academic perspective. Retrieved from
2. Snee, R.D. (1190). Statistical thinking and its contribution to total quality. The American Statistician, 44(2), 116-121
(Stable URL:
3. Snee, R.D. (2000). Impact of six sigma on quality engineering. Quality Engineering, 12(2), 9-14

Related Article:
From Factory to Faculty