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Transcript of Applying Lean Six Sigma to your Compliance - hcca-info.org Lean Six Sigma Difference...

  • 2/20/2014

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    ApplyingLeanSixSigmatoyourComplianceProgram

    JohnKalb,JD,CHC,CCEPOperationalExcellenceExecutive/ComplianceOfficerKootenaiHealth

    April2,2014

    1

    Content

    LeanSixSigmasgoalsofreducingwasteandvariationcanhelpimproveorganizationalcompliance

    Anoverviewoftheapplicationofthemethodologytounderstandhowitsupportsacultureofcompliance

    Learnspecifictoolsthatcanbeappliedthroughoutyourorganizationtoincreasestandardizationandcompliance

    2

    LeanSixSigmaLeadershipCulture

    HonorandRespectPeople yourpeoplehavegoodideasrecognizeandrewardthemforthat allowthemtocontributethroughcollaborationandempowerment

    HonorTheCustomer theyarethereasonweexist figureoutwhattheywantandmakeimprovementsandcreatestandardsaroundwhattheywant

    HonorStandards itisthesustainplantokeepthingsincompliance documentwhatyoudo,dowhatyoudocumentandproveitinpractice

    Errorproofpracticestoensureminimalregulatoryintervention

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    TheLeanSixSigmaDifference ChangeinCulture

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    LSSSystemFocus

    Peoplearenotperfectandwillmakemistakes

    Systemfactorscausemanynegativeevents/issues

    Reliableoutcomesareobtainablewiththerightmixofpeopleandprocesses

    TraditionalIndividualFocus

    Peoplewhomakemistakesarepoorperformers

    Systemsperformancewillimprovebyremovingpoorperformers

    So,WhatAreSomeOfTheBarriersToCompliance?

    PoorCommunication FlawedTeamwork Nocollaboration RushedProcedures TimePressure Policiesthatarehardtofollow InadequateInterfaces Lackoferrorprevention

    expectationsoraccountability

    TheLeanSixSigmaDifference ChangeinCulture

    5

    LeanEliminateWaste/ImproveFlow

    Reducecycletime

    Lowercomplexity

    Analysisofphysicallayout

    KnownSolutions

    3 5daydeployment/

    implementation

    SixSigmaReducedefects&variability

    Highcomplexity

    Unknownrootcauses/solutions

    DatadrivencontrolStrategy

    4 8monthprojects

    OverviewofLeanSixSigmaMethodology

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    After

    Before WorkTime(valueadd)

    WaitandOtherTime(novalue)

    WorkTime(valueadd)

    WaitandOtherTime(novalue)

    Samevalue,LesstimeandResource!

    SixSigma+

    EliminatewasteinandaroundProcesses Lean

    EliminatedefectsinProcesses=BusinessImprovement

    ProcessImprovement

    BenefitsofLeanSixSigma

    7

    1 93.32% 99.38% 99.98% 99.999%

    7 61.63% 95.73% 99.97% 99.998%

    10 50.08% 93.96% 99.96% 99.997%

    40 25.08% 77.82% 99.00% 99.986%

    100 0.10% 52.23% 97.70% 99.996%

    300 0.00% 15.43% 93.26% 99.898%

    700 0.00% 0.20% 84.97% 99.762%

    1000 0.00% 0.00% 79.24% 99.661%

    3000 0.00% 0.00% 50.15% 98.985%

    #ofprocesssteps

    3 4 5 6Lean reducesteps&waste

    SixSigma reducedefects&variability

    LeanProcessesthatOperateatSixSigma

    Repeatability

    Flow

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    RolledThroughputYieldPatientAistreatedin3Steps

    RolledThroughputYieldistheProbabilityThattheProcesstotreatthePatientWillProduceZeroDefects

    PatientA

    Treatment

    YRT =(0.80)(0.70)(0.90)=.504=50.4%

    Triage DiagnosticTesting

    RolledThroughputYield=ProductoftheFirstPass Yields

    Diagnosis

    YFP=80% YFP=70% YFP=90%

    Howreducingstepsreducesdefects

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    ItstartedinJapanattheToyotaMotorCompany1902: SakichiToyodaoftheToyotagroup,inventedanautomatedloomthatstoppedanytimeathreadbroke.1908:HenryFordinventsthemovingassemblylineandraisesthedailywageto$5.00;continuousflowasaproductionmethodiscreated.

    Thethingistokeepeverythinginmotionandtaketheworktothemanandnotthemantothework.Thisistherealprincipleofourproductionandconveyorsareonlyoneofmanymeanstoanend. HenryFord:TodayandTomorrow

    Severaldecades laterTaiichiOhno,aproductionengineerattheToyotaMotorCompanyappliedthesameconceptashesoughttoeliminatewaste,ornonvalueaddedactivities,withintheToyotaorganization.Inadditiontostoppingproductionateverydefect(Jidoka),heemployedanotherkeyconcept,JIT(justintime).Together,JidokaandJITarethepillarsoftheToyotaProductionSystem,supportedbyafoundationofHeijunka(levelloading)thebasisofLean.

    ABriefHistoryoftheToyotaProductionSystem Lean

    10

    WhereDoesLeanComeFrom?

    ThebasicphilosophyofLeanistoprovidethecustomerwith

    Whattheywant

    Whentheywantit

    Usingtheabsoluteminimumresources

    1978

    1996

    1943 1978

    Value anactivitythatadministerscareorprovidesaserviceorinformationtomeetcustomer/patientneedsandrequirements(usuallysomethingthatthecustomer/patientiswillingtopayfor)

    ValueStreamMap Agraphicmapofstepsthatoccurfromarequestforaproductorservicetodeliveryoftheproductorservice.Similartoaprocessmapbutwithgreateramountofdetail suchastimetaken,resourcesconsumed,inventoryetc.

    Valueadded astep,activityoraprocessthatisperceivedtoaddvalue tothecustomer/patient;ittransformstheproductorservice

    Nonvalueadded astep,activityorprocessthattakestime,resourcesand/orspacebutdoesnotcontributetoaddingvalueorsatisfyingcustomer/patientneeds

    ValueEnablingorNonValueAddedEssential astep,activityorprocessthatdoesnotaddvaluebutmustbedone,usuallyrequiredeitherbecauseofregulationsorasaprerequisitetocompletingavalueaddedstep

    Muda=Waste anythingthattakesresourcesbutcreatesnovalueforthecustomer,usuallyanexcessiveorunwantedstep,resource,oractivity

    TAKTTime therateatwhichacustomer/patientdemandsaproductorservice TAKTTimeisNOT Cycletime

    Pull usedtodescribethecustomer/patientgeneratingthedemandforservice/productasopposedtotheproducerpushingtothecustomer/patient

    Kaizen/Kaizenevent aRapidCycleImprovement 35dayswhereactualchangesaremade(Action)i.e.processesarechanged,equipmentismovedetc.

    KeyTerms

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    LeanThinkingProcess

    Thecontinuousmovementofproducts,servicesandinformationfromendtoendthroughtheprocess

    Definevalueinfromthecustomersperspectiveandexpressvalueintermsofaspecificproduct

    Nothingisdonebytheupstreamprocessuntilthedownstreamcustomersignalstheneed

    Thecompleteeliminationofwastesoallactivitiescreatevalueforthecustomer

    2Mapthe

    ValueStream

    3EstablishFlow

    4Implement

    Pull

    5WorktoPerfection

    1SpecifyValue

    Mapallofthestepsvalueadded&nonvalueaddedthatbringaproductofservicetothecustomer

    The5stepstoLeanThinking

    FourRulesofLean1. Workactivitiesarespecifiedto:

    Content whatisbeingdone Sequence inwhatorder Timing howlongshouldittake Outcome whataretheexpectedmeasurableresults

    2. Allconnectionsmustbesimpleanddirect3. Pathwaysaresimpleandinvolveasfewstepsandpeopleas

    necessary4. ContinuousImprovementbythosedoingtheworkandas

    closetotheproblemaspossible Assigncorrectiveactionandimprovement Followuponthepreviousdaysactionitems

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    TOYOTA

    Just

    -in-T

    ime

    Single Piece Flow

    Pull Production

    TAKT Time Production

    Autonomation

    Stopping at Abnormalities

    Level Loading

    Sequencing

    Jidok

    a

    Heijunka

    ToyotaProduction System

    ToyotaProductionSystem

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    ToyotaProductionSystem:Jidoka

    AndonBoards(CallLights) Sounds(Machinewarnings)

    ReasonstoStopaProcess:

    DefectiveMaterial(RapidResponseTeam)

    MaterialShortage(FlashSterilization)

    EquipmentBreakdown

    Makeeverythingvisibletoeveryone: Exposewaste Makestandardsclear Improveefficiency

    TheLeanToolkit BasicLeanTools

    IdentifyingandEliminatingWaste ValueStreamMapping(VSM) RootCauseAnalysisUsing5Whys 5S SpaghettiMapping TaktTime StandardWork LevelLoading&Sequencing SinglePieceFlow DailyActionReview

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    The8TypesofMuda(DOWNTIME)

    DefectsWork that contains errors, rework, mistakes or lacks

    something necessary

    Medication error Wrong patient Wrong procedure

    Scrap Rework Correction

    OverproductionProducing more than the customer/ patient needs

    right now

    Medications given early or testing ahead of time to suit schedule

    Treatments done to balance hospital staff or equipment workload

    Writing or entering the same information many times

    Making copies of chart notes that are not used

    Producing more to avoid set-ups Batch process resulting in extra output Copies of reports that are sent

    automatically

    WaitingIdle time created when material, information,

    people, or equipment is not ready

    Waiting for Bed assignments Testing & Treatment, Discharge Patient lab test results

    Waiting for parts Waiting for inspection Waiting for information Waiting for others at meetings

    Non-Utilized Resources

    Resources that either not be used at all or not being utilized to their full potential

    Staff not be utilized at their skill level Empty Beds due to no staff

    Excess Inventory on shelves

    Transportation/ Motion

    Movement of people that does not add value

    Searching for patients Searching for meds and/or charts Gathering tools / supplies Handling paperwork

    Searching for equipment Sorting through materials Reaching for tools Waling to fax or copier machine many

    times a day

    InventoryMore materials, parts, or

    products on hand than the customer/ patient needs

    right now

    Bed assignments Pharmacy overstock / Lab oversupplies Specimens waiting analysis Patients in beds past discharge time

    Raw materials Work in process Finished goods Paperwork in process

    Missing Information / Confusion

    People are not sure about the best way to perform

    work tasks

    Variation in practice patterns Unclear orders Unclear systems for reporting/

    communicating Patients scheduled with incorre