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For 10 years, Academic Medical Hospital's chief of staff had struggled to decrease the amount of time patients spend waiting in the ER. Now the hospital has adopted the Six Sigma to streamline emergency-care activities and reduce patient wait time. At the completion of the pilot study, the statistical significance of the results as well as deep-rooted implementation resistance from several key stakeholders in the hospital and the medical school cause concern. This case can be used to teach Six Sigma methodology, to critique the effectiveness of the application of the phases and tools, and to deal with the statistical significance issues and the implementation concerns.