Sex Sigma

There is no limit to where we can and should implement objective quality improvement measures.


If you are impressed by all the beeping electronic marvels and the brushed chrome lobbies in a modern hospital, you may naturally think of health care as a cutting edge industry. But these glitzy exteriors hide an embarrassing truth: healthcare professionals have been living in the dark ages. Clinging to ill-defined, quaint notions such as "trust" and "professionalism," the hoary leaders of hospitals and medical practices have often failed to adopt scientific principles of management--the same principles that have led to astonishing advances in other industries.

Fortunately, the health care industry is finally coming to its senses. Many physicians, hospital administrators, and medical societies, including the American Medical Association, now em-brace the scientific study of quality improvement or "QI." In fact, completing a "QI project" has become not just a mark of honor for a physician, but in some cases a requirement for maintain-ing medical certification.

The science of quality improvement began in the late 1800s, with Frederick Taylor's now-canonical Principles of Scientific Management. Since then, Taylorism has spawned an endless stream of textbooks, trademarks, seminars, and certifications. The central tenet remains the same: there is "one best way" to accomplish a task, and deviations from this approach represent defects.

Yet the science of quality improvement remains an enigma to many of the nearly one million physicians, three million nurses, and seven million other healthcare workers in the US. How can we ensure that the members of such groups gain adequate experience with quality im-provement principles? Given that lives are at stake, we don't want them trying out such tech-niques for the first time when patient's lives are on the line. How can we enable healthcare per-sonnel to gain such experience in a safe, non-threatening environment?

We believe that quality improvement should begin at home, and specifically, in bed. Why? To begin with, many people who inspect this domain see substantial room for improvement. Second, sex is an utterly necessary activity, in which the very perpetuation of the species is at stake. Finally, the enormous economic impact of sex is both immediate and undeniable. Indeed, in view of how much time people spend on sex, it is amazing that it has so rarely been subjected to systematic quality improvement techniques.

You should strive to codify your findings, both for your own reference and for the sake of future generations.

As rather experienced hands in this domain, we are tempted to lay out in detail the key elements of a new and highly effective sexual quality improvement programs. In the interests of fostering individual creativity, however, we have resisted this impulse. In what follows, we outline only the broad parameters of such a program, leaving the more delicate features to the reader's imagination.

The first step is to choose a quality improvement methodology. For this purpose, we have selected one of the most widely touted methodologies of the past few decades: Six Sigma. First developed at Motorola in the 1980s, Six Sigma represents a form of statistical process control. It turns out that this technique that was originally developed for the manufacture of electronic devices is now one of the most popular quality improvement approaches used by hospitals.

Because we have chosen sex as our quality improvement exemplar, we have tentatively dubbed our process Sex Sigma™. Its goal is to achieve measurable and reproducible improvements in sexual performance. Like industrial processes such as etching a microchip or riveting an airplane, sex exhibits features that can be measured, analyzed, improved, and controlled.

For our purposes, one of the most tantalizing features of Six Sigma is its rigid hierarchy. Participants work at various levels of authority, including "champions" responsible for enterprise-wide implementation, "black belts" who provide in-house coaching, "green belts" who do the grunt work on the ground, and novice "white belts" who merely observe. Everyone at all levels must commit to the process, particularly those functioning in leadership capacities. If those on top are not fully committed or fail to buy in, failure is inevitable.

At the heart of Six Sigma is the Plan-Do-Check-Act cycle. This concept has been refined and developed into the DMAIC ("duh-may-ick") methodology, an acronym that should be repeated through the process as a kind of mantra. By attending appropriately to each of DMAIC's elements in the proper order, the cost-effective design and implementation of a Sex Sigma project are virtually guaranteed, providing the greatest bang for the organization's buck. The components of DMAIC are as follows:

Presented by

Richard Gunderman & Mark Baskin

Richard Gunderman, MD, PhD, is professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department, at Indiana University. His most recent book is X-Ray Vision. Mark Baskin, MD, is a radiology resident at Indiana University.

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