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The film library of a film-based radiology department is a mission-critical component of the department that is frequently underappreciated and under-staffed. A poorly performing film library causes operational problems for not only the radiology department, but for the institution as a whole. Since Six Sigma techniques had proved successful in an earlier CT throughput improvement project, the University of Texas M.D. Anderson Cancer Center Division of Diagnostic Imaging decided to use Six Sigma techniques to dramatically improve the performance of its film library. Nine mini-project teams were formed to address the basic operating functions of the film library. The teams included film library employees, employees from other sections of radiology, employees from stakeholders outside of radiology, and radiologists and referring physicians, as appropriate to the team's mission. Each Six Sigma team developed a process map of the current process, reviewed or acquired baseline quantitative data to assess the current level of performance, and then modified the process map to incorporate their recommendations for improving the process. An overall project steering committee reviewed recommendations from each Six Sigma team to assure that all of the teams' efforts were coordinated and aligned with the overall project goals. The steering committee also provided advice on implementation strategies, particularly for changes that would have an immediate effect on stakeholders outside of the radiology department. After implementation of recommendations, quantitative data were collected again to determine if the changes were having the desired effect. Improvement in both quantitative metrics and in employee morale have been experienced. We continue to collect data as assurance that the improvements are being sustained over the long haul. Six Sigma techniques, which are as quantitatively-based as possible, are useful in a service-oriented organization, such as a film library. The primary problem we encountered was that most of the important film library customer services are not automatically captured in the RIS or in any other information system. We had to develop manual data collection methods for most of our performance metrics. These collection methods were burden-some to the frontline employees who were required to collect the data. Additionally, we had to invest many hours of effort into assuring that the data were valid since film library employees rarely have the educational background to readily grasp the importance of the statistical methods employed in Six Sigma. One of the most important lessons we learned was that film library employees, including supervisory personnel, must be held accountable for their performance in a manner that is objective, fair and constructive. The best methods involved feedback collected by the employees themselves in the ordinary course of their duties. Another important lesson we learned was that film library employees, as well as stakeholders outside of the film library, need to understand how important the film library is to the smooth functioning of the entire institution. Significant educational efforts must be expended to show film library employees how their duties affect their film library co-workers and the institution's patients. Physicians, nurses and employees outside of the film library must do their part too, which requires educational efforts that highlight the importance of compliance with film library policies.
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