The focus of Six Sigma is on meeting the requirements of customers. Even a small number of defects or complaints can mean the death of a product or service. If the airlines set a 99% success goal so that only one out of a hundred fell out of the sky before reaching its destination the customer would not be happy at all. If you processed 250,000 credit card bills monthly and operated at 4 sigma there would be 1,550 angry customers with inaccurate credit card bills. For the future of your services, here is the problem:

• One unhappy customer will tell nine to ten people about their dissatisfaction.
• A dissatisfied customer will only tell five people if the problem is handled satisfactorily.
• Even if there are serious problems a third of customers will never tell you. So the complaints you get are just the tip of the iceberg.
• Of the silent third, you can lose more than two-thirds as your customers.

In short, setting high goals may be a matter of survival for your business. It is even more important in healthcare where error can mean death.