gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Implementation of the Six Sigma Zero Defect Quality Concept in the preparation for neurosurgical procedures

Implementierung des Six-Sigma-Null-Fehler-Qualitätskonzeptes in die neurochirurgische OP-Vorbereitung

Meeting Abstract

  • corresponding author S.B. Sobottka - Klinik für Neurochirurgie, Universitätsklinikum Dresden
  • G. Reiss - Klinik für Neurochirurgie, Universitätsklinikum Dresden
  • M. Eberlein-Gonska - Abteilung Qualitätsmanagement, Universitätsklinikum Dresden
  • A. Töpfer - Lehrstuhl für Marktorientierte Unternehmensführung, Technische Universität Dresden, M+M Consulting GmbH
  • D. M. Albrecht - Medizinischer Vorstand, Universitätsklinikum Dresden
  • G. Schackert - Klinik für Neurochirurgie, Universitätsklinikum Dresden

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocP 109

The electronic version of this article is the complete one and can be found online at:

Published: April 11, 2007

© 2007 Sobottka et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: An optimal and error-free preparation for surgical procedures is essential to eliminate the occurrence of preventable adverse events during neurosurgical interventions. Nowadays, this task has to be fullfield in much shorter time windows owing to reasons of economy, thus increasing the risk for quality deficits in medical care. The Six Sigma concept is a new quality management system that we have applied to improve patient safety in the process of neurosurgical preoperative work-up.

Methods: Six Sigma is a methodology to manage process variations that are prone to defects, and to systematically eliminate those defects by controlling the variations in the given process. A defect is defined as an unacceptable deviation from the mean or goal to be achieved. The basic methodology consisting of the following five phases (DMAIC), was applied to the process of neurosurgical preoperative work-up starting from the first patient-contact reaching to the beginning of surgery: (1) Define process improvement goals consistent with patient safety demands, (2) measure the process, (3) analyze process data, (4) improve and optimize the process, and (5) institute control mechanisms.

Results: Define: Six principal requirements were defined as critical to quality (CTQs) for improving patient safety: (1) 100% completeness of surgical documents at 4 p.m. the day before surgery, (2) Completeness of surgery schedule 48 h prior to surgery, (3) zero hospital admission days without treatment or work-up, (4) 100% surgeon satisfaction with preparation for surgery, (5) 100% documentation and prompt relay of changes in surgery schedule, and (6) no preoperative OR waiting time owing to insufficient preparation for surgery. Measure: Nine CTQ relevant measurement categories were specified and measured for the initial status quo during a 4 week period. Analyze: The relationship and causality of factors were verified using Ishikawa diagrams and a cross-functional process analysis. Improve: Based on the analysis, the processes were optimized to a target state, and were implemented in the clinical routine. Control: Since the optimization the processes were continuously measured and control mechanisms were instituted to ensure that possible variations are corrected before they could result in quality defects.

Conclusions: To our knowledge the Six Sigma concept has been used for the first time in the German health care system and in a Neurosurgical department worldwide. It seems to be very effective in improving patient safety and may be adapted to a wide spectrum of quality issues in neurosurgery.