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Applying Six Sigma to Continuous Health Improvement

Six Sigma, especially combined with Lean methodology,  has been touted as the "Big Bang" approach to boost an ailing company's fortunes and viabillity  as well as overhaul its business and operational processes.  But can we apply some of the Six Sigma tools and methods for Contiuous Improvement at a more personal level, for health management?

The answer - Of course we can.

Whilst we all new that the benefits of Six Sigma were not only confined to business, I had not envisaged 3 months ago that I would be using a health improvement tool as a practical means of applying Six Sigma methods, as well as a providing myself and other "right-brain thinkers" (I hope) an opportunity to delve into the mysteries of SPC (Statistical Process Control) . Neither did I  imagine I would be writing a blog on the topic.

In preparation for some "healthy" discussion (sorry) on the subject, QualityHelp has developed, tested and applied a basic tool in MS Excel, to monitor, analyse and hopefully improve the health of people suffering from Diabetes Type 2.  We are hoping that the tool may also prove useful for those in the high risk category of contracting this form of the disease.

Before proceeding, let me quite clear - we are not proposing that this or any health monitoring tools be classified as a solution or cure for health issues, including any form of Diabetes. We do suggest that it may assist with healt management, and should be always be used in conjunction with professional medical advice and treatment.

If you haven't done so already, you might want to read the article on Applying Statistical Control to Health Monitoring to get an explanation on how the tool works. The tool is freely available for download in our SmartGuides index. Samples of the output progress reports and charts can be viewed in our Dashboard index (in the front page News block).


I'm hoping to attrack two streams of feedback and discussion here:

1.  How much Six Sigma methodology is being practiced in the tool and how it is applied?  I'm looking forward to reader's thoughts on this.

2.  How useful or effective is the tool in managing Diabetes (Type 2), and how might it be improved?

We are hoping to get a few more volunteers to test the tool and share their charts though our Dashboards, and hopefully their experiences.  This may lead to a third discussion stream for Healthtracker tool users to support each other in their Continuous Health Improvement programme. The crictical enhancement to version 5 of the template was the Analysis (Self-Assessment) and Health Improvement Plan. Of course this can be done externally to the spreadsheet, but the intention is to encourage the important process of reflecting on the charted outcomes and possible causes, discussing with others (family and friends), and tweaking the remediation plans.  At the very least, my own personal experience is that using the tool creates a lot of focus on the  disease and symptons.



Looks good so far, KenD but I think we need to start logging suggestions for improvements to the tool (and the online containers).  To start with, we should add a hidden area to accumulate additional daily notes and observations.  This is about analysing overnight results and suggesting adjustments and improvements to individual health regimens..

Dashboards and daily reports are more than just tracking and publishing results and outcomes. Their intent is also to provide a widely available, and  interactive tool for team interaction for the good of the processes involved, as well as the desired outcomes.

The second point I wanted to make was that the individual Healthtracker dashboards and reports will be hidden from the public, through use of Internal page containers.  The Sample user results will remain public and occasionally updated to reflect improvements to the tracker template.

I totally agree.  It's important to track and respond to both design defects and continuous improvement suggestions that improve to effectiveness of the tool itself.  From a user''s perspective, I have already incorporated the daily notes into the Plan tab, but letf this area visible in the generated report.  My reasoning is that the report may provide remote support from colleagues, and the notes give further insight into the user's daily habits and own ideas on causes and solutions. In any case, the whole report and dashboard is now only available through a user logon.

On another enhancement that I have already rolled into version 5, is a second control chart, as illustrated below:


The issue I was finding with the 1st Control Chart was that it was using up to 3 daily glucose tests to provide an average, or smoothed result. In other words, if the morning (fasting) test was way unexpectedly outside the UCL and LCL, then a second or third text could be taken at favourable intervals throughout the day.  This was fine for the monthly trending on daily means, but a missed opportunity to track the trend in the morning benchmark tests.

This second control chart focuses exclusively on the daily benchmark test, taken before breakfast.  This is just as critical in the long run to drive stability in overall glucose level flucuations.

There are now two versions (5a and 5b) of the Healthtracker template, to hopefully cover International and USA units for blood glucose levels. Version 5a of the Healthtracker uses the international units  (mmols/L), wilst the new Version 5b uses mg/dL. The latest versions can also be downloaded from our Smartguides section.

Note also that we have made the date formats generic. We hope to merge the two templates for Version 6.

The current tracker looks at weight reduction as a critical focus area for health improvement and diabetes control.  After some research and reading some good books on controlling Diabetes, I'm seeing a good case to add waistsize as an important target for health improvement. I'm discussing this with some of my colleagues and my Diabetes support groups, and will consider waistsize for inclusion in the next template update.  Do readers and members have a view on this?

We've been working hard to keep enhancing the HealthTracker tool, and have released a new version for the start of April. Version 6a (and the USA Version 6b) now contain a new section and control chart for tracking waist measurement (in different units).  I'm sure many people, including health professionals would agree with the added benefits of focusing on levels of accumulated body fat through a combination of better diet, combined with focused efforts to reduce both weight and waistline to recommended levels.

In version 6b, we've also corrected the deficiency and changed the unit of weight from metric to avoirdupois (aka pounds).


If anyone was wondering why we substituted "stomach" for "waist" on the spreadsheet, it was purely to ensure that waist measurements were taken correctly. Many people (guys particularly) wear their trousers below a "pot belly", with a tendency to mistake the waist measurement for the "belt" size.

Your waist size should be taken just above the navel (after relaxing and breathing out).


Most people would agree that health improvement plans for many ailments like diabetes, take a lot of time, effort and perseverence. Whilst getting the right medicines in the right doses might contain the situation, reversing our unhealthy habits and their impact will probably take months (if not years) to achieve desired benefits. After all, it may have taken many years of poor diet and insufficient physical exercise to get many of us to our current state of health.

It makes sense then that we track the impact of our monthly plans over several months to a year, to put our progress into perspective.  In Version 7 of our HealthTracker template, we now have 4 additional bar charts with accumulated monthly data (copied across from each completed monthly spreadsheet). See the new Monthly Trends tab in the live HealthTracker dashboard to see how this works.

Both variations of the new versions are available from our Smart Guides or the HealthTracker project documents.

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