Conference article

A Large Scale Six Sigma Program at the Hospital Group of Skaraborg

Svante Lifvergren
Hospital Group of Skaraborg, Sweden

Alexander Chakhunashvili
Hospital Group of Skaraborg, Sweden

Bo Bergman
Chalmers University of Technology, Sweden

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Published in: 10th QMOD Conference. Quality Management and Organiqatinal Development. Our Dreams of Excellence; 18-20 June; 2007 in Helsingborg; Sweden

Linköping Electronic Conference Proceedings 26:33, p.

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Published: 2008-02-15


ISSN: 1650-3686 (print), 1650-3740 (online)


The challenges of healthcare today are astronomical – from a patient safety; accessibility and medical quality points of view. More (and more expensive) treatment possibilities are available; the proportion of elderly people in the population is growing; people’s awareness of the curing possibilities is increasing and; as a consequence; the cost of healthcare is also increasing. Not until recently the potential of utilising concepts from the quality movement has been recognised in healthcare. Although some early insights have been voiced; see e.g. [Curing healthcare] it is not until the nineties an awareness of the possibilities offered by the industrial quality movement has been realised.

In Sweden; a wave of new quality improvement initiatives has started to come into sight during the last years. A typical case is the Skaraborg Hospital Group; where since 2003 systematic quality initiatives have been taken.

The Skaraborg Hospital Group; (SkaS); is situated in the Western Region of Sween and serves a population of 260 000. The group consists of four hospitals – the hospitals of Lidköping; Skövde; Mariestad and Falköping. The services offered by SkaS include acute and planned care in a large number of specialities. In total there are more than 700 beds and around 4700 employees at SkaS. SkaS shares a responsibility together with the local authorities and the primary care units for the entire healthcare chain of integrated care.

In the mid nineties; the concept of process improvement found its way into Swedish healthcare. However; a more profound knowledge of process orientation from a system’s point of view was not attained. Instead; the concept was more often used as a tool to map processes and it seldom led to sustainable improvements (Eriksson; 2005). At the same time; the leading institute for advocating system changes in healthcare processes internationally - the Institute for Healthcare Improvement (IHI); US - started a lot of initiatives to improve the American Healthcare system. Some of these initiatives; e.g. The Collaborative Breakthrough series; have heavily influenced Swedish improvement efforts in healthcare since then. Still; according to Olsson et al (Olsson; 2005); most improvement projects in Swedish healthcare start from a co-worker’s and not a patient’s perspective. Also; the results of the efforts are not known or even measured. Even more; experiences from e.g. SkaS show that there is poor knowledge about how variation affects quality and how to reduce unwanted variation in healthcare processes. From a SkaS point of view; it was felt that stronger improvement initiatives were needed.

In 2004 the first author; a physician - eventually also Development Director and member of the top management team of SkaS with a responsibility for the hospital-wide Quality Improvement efforts - followed a course on Quality-driven Organisation Development provided by Chalmers University of Technology for health care professionals with leadership; organisation development or quality management roles in their organizations. Applying some tools from the Six Sigma toolbox created a taste for more and an insight in the power of variation reduction for quality and productivity improvement. Together with two more persons in the health care system of SkaS; one quality physician and one economist – both of them on the executive staff for SkaS; the first author of this paper was given the opportunity to attend a regular Black Belt course at the Chalmers University of Technology. They were all eager to get the chance to investigate the variation reduction ideas further in order to learn in what sense and to what extent the ideas were applicable to Swedish healthcare.


Six Sigma; Healthcare; Black Belt project; variation; change; learning


Bergman; B. and Klefsjö; B. (2003). Quality from Customer Need to Customer Satisfaction; Studentlitteratur; Lund.

Berwick D.; Blanton Godfrey A. and Roessner J. (1990). Curing Healthcare; John Wiley & Sons; San Fransisco

Eriksson; Nomie (2005). Friska vindar i sjukvården - stöd och hinder vid förändringar i professionella organisationer; PhD dissertation; Förvaltningshögskolan; Göteborgs Universitet. (A PhD dissertation on process oriented work at SkaS and at Ryhov Hospital in Jönköping)

Magnusson; K.; Kroslid; D. and Bergman; B. (2003). Six Sigma; the Pragmatic Approach; Studentlitteratur; Lund.

Olsson J; Kammerlind P; Thor J; Elgh M: Surveying Improvement Activities in Health Care on a National Level – The Swedish Internal Collaborative Strategy and Its Challenges; Quality Management in Healthcare; Vol 12; 2005 No 4; pp 202-216

The Breakthrough Series (2003): IHI’s Collaborative Model for Achieving Breakthrough Improvement; IHI Boston

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