From the limited details of the Lewis Blackman case, there are three at least processes issues identified. Failure to recognize an acute abdomen, failure to meet the family/patient communication expectations, and failure to recognize clinical deterioration. Two of these processes lend themselves to a sigma six process. Although there are many clinical practice guidelines for diagnosis of acne abdomen, the clinical evaluation data is difficult to quantify and is subjective. The other two processes are better candidates for six sigma. Customer satisfaction and response is a common measurement for most industries, especially service industries. In healthcare it a publicly reported metric. There are many additional metrics that could provide internal
