QUERI – Quality Enhancement Research Initiative

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Quality Improvement Methods

12. DMAIC (Define, Measure, Analyze, Improve, Control)

a. Definition: The improvement process is often cyclic and it is helpful to define the sequence of steps involved. DMAIC represents improvement as five steps: Define, Measure, Analyze, Improve and Control. Pronounced De-MAY-ick. By considering all these steps clearly and in sequence, the success of an intervention or quality improvement project is more likely. DMAIC becomes the project structure for a Six-Sigma improvement effort (see Section 39). The Lean approach uses PDSA (See Section 33) which is similar to DMAIC.

b. Literature: Most books on Six-Sigma have at least one chapter on DMAIC. Also see:

  • Shankar, Rama. Process Improvement Using Six Sigma: A DMAIC Guide. ASQ Quality Press, 2009.
  • Kumar, Sameer, and Kory M. Thomas. "Utilizing DMAIC six sigma and evidence-based medicine to streamline diagnosis in chest pain." Quality Management in Healthcare 19.2 (2010): 107-116.

c. Example: A hospital unit was concerned about the quality indicators they had recorded for a particular diagnosis. These quality indicators demonstrated a quality gap that needed to be closed. Recent research indicated that the hospital unit should add a step to their current procedures for these patients. In using the DMAIC approach, a first step would be to clearly identify the current state and to quantify current performance. Also, the hospital unit would need to determine output variables to analyze and set a target for these which they would like to achieve. These are the "define" and the "measure" steps, respectively. Next would be an analysis of the factors that might cause the problem and implementation of tests of changes to determine their impact on the output variables. Finally, the unit had to put in place procedures to be certain that the changes were consistently followed and for ongoing measurement of the results.

d. Steps: DMAIC is itself a set of steps regarding a quality (or other) improvement project.

1) Define the key metrics for measuring success and achieving goals of the effort, perhaps a certain quality level. It is important to write down these objectives for later reference, thereby creating a charter for the improvement effort.

2) Measure: Implement a measurement of the key elements, determine past levels which become a baseline to determine if a significant improvement has occurred

3) Analyze: Identify the opportunities for improvement of each metric. This may include determination of the root causes of problems in quality or other aspects

4) Improve: Identify creative solutions, redesign the relevant processes so as to achieve the goals, and implement the change.

5) Control: Measure the improvement and report the results so as to sustain success. Ideally, the change created by DMAIC is self-sustaining and no monitoring is necessary. If necessary, the improvement project may loop back to the second step, measure, and repeat the following three steps.