Problem-Solving Structure
DMAIC (Define, Measure, Analyze, Improve, and
Control): This structure comes to us from Motorola
(the founders of the Six Sigma methodology) and is
now used by hundreds of healthcare organizations
(including hospitals, pharmaceutical companies,
insurance companies, and bio-tech labs) to lead a
cross-functional team to the root cause(s) of variation,
defects, and non-value-added costs. This method is
commonly used in a project structure that can take
3-6 months. Organizations have realized millions of
dollars in savings using this technique.
If the cause is glaringly obvious or just requires a
change in the process flow, other structures, such as
a Kaizen Event Workshop, might
be used. Select the structure that
aligns to the problem. You don't
need a cannonball to kill a flea,
but you also don't want to slay a
dragon with a pea shooter. When
in doubt, use the DMAIC structure.
The Define phase of the DMA-
IC structure starts with problem
definition. A problem is defined
as a question or situation that calls
for a solution. The first step is to clearly define the
problem by quantifying the frequency of occurrence
and the impact when it occurs. This is harder than it
sounds. Most people want to solve the problem be-
fore it is even defined. Some even write their theories
as to the cause in the problem definition. For exam-
ple, I once had a Green Belt in healthcare write the
following problem statement: Because workers are
allowed to work 12-hour shifts, 15% of patients are
given the wrong medications, leaving the patient and
organization at risk. The team assumed that the cause
of the problem was exhausted workers and said so
right in the problem statement. This is not uncom-
mon; we all have our theories as to the cause and
we want to solve the problem as quickly as possible.
I have learned that it is best to approach the problem
with as little bias as possible and let the DMAIC struc-
ture lead you to the best solution. More often than
not our theories are symptoms but
not the root cause.
The Measure and Analyze
phases of the DMAIC structure
involve baselining a key perfor-
mance metric of the problem so
there is something to measure
the improvement against. In the
previous example the key metric
might be the number of errors in
the dose or the method of admin-
istering medications. The goal will be to reduce or
eliminate those errors.
Additionally, this is the phase where the focus
shifts from the effects of the problem to the possible
causes. These are called factors, and the best way to
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M E A S U R E A N A L Y Z E I M P R O V E C O N T R O L D E F I N E
DMAIC Model
Problem Statement:
Because workers are
allowed to work 12-hour
shifts, 15% of patients are
given the wrong medica-
tions, leaving the patient
and organization at risk.
P R O B L E M S O L V I N G I N H E A L T H C A R E
