Together, senior executives worked with other technology and medical staff to create maps of all major (and many minor) processes the hospital typically undertook. An outsider can't begin to decipher the maps depicting the project, packed as they are with multiple ovals, rectangles, squares and colored arrows zinging between the shapes. But Virtua staff found, for example, that more than 1,000 paper forms were used in clinical processes. Reforming the workflow and adding technology reduced the number to 200 forms, all of which will be electronic in a new clinical information system.

"Putting IT on top of a fragmented process doesn't solve anything," Miller adds. "Doing flow-charting underneath IT-that's the winner."

Virtua includes a clause in its contracts that says vendors must help with process mapping before any new software is rolled out.

In addition to the C-suite involvement with the IT project managers, a group of clinicians makes sure that the development meets specifications. Miller, Saunders and Campanella all attend monthly Six Sigma update meetings. That commitment is nonnegotiable, says Miller. The meetings are "not something we delegate to other people. We're there."

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