Lean Six Sigma Projects & Lean Six Sigma Projects & Value Stream Mapping in Value Stream Mapping in

Action!Action!

CPT Sylvia BeadyCPT Sylvia BeadyChief, Ancillary ServicesChief, Ancillary Services

R.W. Bliss Army Health CenterR.W. Bliss Army Health CenterFt. Huachuca, AZFt. Huachuca, AZ

ObjectivesObjectives

An introduction to the basic definition and An introduction to the basic definition and steps of Lean Six Sigma (LSS)steps of Lean Six Sigma (LSS)

An overview of how the LSS tools works in An overview of how the LSS tools works in other part of the healthcare services other part of the healthcare services besides the laboratory (i.e. radiology & besides the laboratory (i.e. radiology & pharmacypharmacy

A live demonstration of value stream A live demonstration of value stream mapping (VSM) simulationmapping (VSM) simulation

Basic Definitions: The Keys to LSSBasic Definitions: The Keys to LSS

Example 1Example 15S Overview: Taking Action!5S Overview: Taking Action!

SortSort Set in Order Set in Order

(simplified)(simplified) Shine (sweep)Shine (sweep) StandardizeStandardize SustainSustain Anchoring Success in the Lab

Anchoring Success

Shipping Lean Six Sigma Shipping Lean Six Sigma – Improving Efficiencies– Improving Efficiencies

To create and maintain an organized, To create and maintain an organized, clean, safe, and high-performance clean, safe, and high-performance workplaceworkplace

PURPOSE:PURPOSE:

Why Implement 5S?Why Implement 5S? Enables anyone to distinguish between Enables anyone to distinguish between

normal & abnormalnormal & abnormal It’s the foundation for continuous It’s the foundation for continuous

improvement, zero defects, cost improvement, zero defects, cost reduction & safe work areareduction & safe work area

It’s a systematic way to improve the It’s a systematic way to improve the workplace, processes, & products workplace, processes, & products through employee involvementthrough employee involvement

Minimize Minimize Non-Value AddedNon-Value Added:: eliminate eliminate waste that does not add value to the waste that does not add value to the process or productprocess or product

What is ”Value What is ”Value Added”Added”

Value Added:Value Added: any activity that any activity that increasesincreases the the form or function of the product. (These are form or function of the product. (These are things the customer is willing to pay for)things the customer is willing to pay for)

Non-Value Added:Non-Value Added: any activity that does not any activity that does not add value to the form or function or is not add value to the form or function or is not necessary. necessary. Customer is not willing to pay for non-value added.Customer is not willing to pay for non-value added. Non-value added activities should be eliminated Non-value added activities should be eliminated

simplified, reduced or integrated into other activitiessimplified, reduced or integrated into other activities

1S: SORT1S: SORTGoal:Goal: Remove all items from the Remove all items from the workplace that are not needed for workplace that are not needed for current production or taskscurrent production or tasks

It does It does notnot mean that you remove mean that you remove only the items that you know you will only the items that you know you will never neednever need

It does It does notnot mean that you simply mean that you simply arrange things in a neater fashionarrange things in a neater fashion

When you sort, you leave only the When you sort, you leave only the bare essentials – “When in doubt, bare essentials – “When in doubt, move it out”move it out”

The goal is to Set in Order:The goal is to Set in Order:

Ensures what is needed for a Ensures what is needed for a job is in place and easy to job is in place and easy to find, use, and put back!find, use, and put back!

• Find ways to prevent Find ways to prevent the need for future the need for future cleaning!cleaning!

2S: SET IN ORDER:2S: SET IN ORDER:

Cleanliness: get the area looking clean and new

Make it a habit:Make it a habit:

Assign responsibilities

Make cleaning and organizing part of regular work duties

Perform regular 5S audits and post results

Prevention (take it to the next level): Prevention (take it to the next level): Make it difficult to Make it difficult to NOTNOT put things away put things away

3S: SHINE3S: SHINE

Goal: Creating a consistent way of implementing the tasks performed daily, including Sort, Set in order, & Shine.

It should be obvious at a glance when an item is not in its designated place

Doing “the right things the right way, every time”

4S: STANDARDIZE4S: STANDARDIZE

This takes discipline on everyone’s part. Sustain, make it a habit to follow the procedures

Practice, practice, practice!Practice, practice, practice!

Teamwork! Personal Teamwork! Personal accountability!accountability!

““Sustain” ties Sort, Set in Sustain” ties Sort, Set in order and Shine together.order and Shine together.

5S: SUSTAIN5S: SUSTAIN

With 5S, ANYONE should be able to tell With 5S, ANYONE should be able to tell the difference between normal & abnormalthe difference between normal & abnormal

Celebrate accomplishment & continue Celebrate accomplishment & continue improvingimproving

Make time each week to brainstorm & Make time each week to brainstorm & implement improvement suggestionsimplement improvement suggestions

SUMMARYSUMMARY

Example 2:Example 2: DMAIC DMAIC

Define – Measure – Analyze – Improve Define – Measure – Analyze – Improve – Control (DMAIC)– Control (DMAIC)

A structured, data-based problem-A structured, data-based problem-solving process. That meanssolving process. That means

Doing specific activities in a specific Doing specific activities in a specific sequence (that’s the “structured” & sequence (that’s the “structured” & “process” parts“process” parts

Gathering data in nearly every phase to Gathering data in nearly every phase to help you make decisions (the “data-help you make decisions (the “data-based” part)based” part)

Making sure that the solutions your Making sure that the solutions your team decides to use will eliminate the team decides to use will eliminate the cause of the problem you’re trying to fix cause of the problem you’re trying to fix (the “problem-solving” part)(the “problem-solving” part)

Tracking TAT in Radiology

Radiology Unverified ReportsRadiology Unverified Reports Turn-around Time (TAT) Turn-around Time (TAT)

Unverified Reports TATUnverified Reports TAT

Objective:Objective:

Benefits:Benefits:

Project Project Team:Team:

Schedule:Schedule:

The purpose of this project is to improve the unverified reports TAT within SOP guidelines of 3 working days. Providers and Patients will receive timely reports and minimize delays in patient care.

Chief, Ancillary ServicesAssistant Chief, Ancillary ServicesNCOIC RadiologyRadiologistsRadiology Technician

Measurement: In progress Measurement: In progress Analyze: TBDAnalyze: TBD

Improvement: TBDImprovement: TBD Control: TBD Control: TBD

D M A I C

Baseline Data Baseline Data D M A I C

Base line information

1434 – unverified studies

140 – unread

12 dictated status

Data period: 11/1/02 – 9/30/06

FY07 unverified status are tracked separately

High Level Map Project OutputHigh Level Map Project OutputD M A I C

Low Level Process MapLow Level Process Map (1 of 2)(1 of 2)

D M A I C

Radiology Study Process(With Severity Scores)

HCP orders a study

HCP send Pt to Rad

Pt shows up @ Rad

Rad staff check-in

Pt

Rad staff checks

validity of order

Return to HCP via

telephone

Rad staff determines if exam is done T or

sched

Pt rec’d prep info & scheduled

Pt examined

No

Yes

NoYes

BB: CPT Beady

Tech or Clerk takes Pt to exam

Rm

Images Taken

Process Images

QC Check

Not O.k.

O.k.

Retake

Images sent to Radiologist

Radiologist checks validity

Start

Not O.k.

O.k.Radiologist Evaluate Film

Return to step 1

Priors Needed (this is standard)

No

Yes Tech request prior images from

originating facility

Proceed to Radiologist read films

Prior images received

Yes

No

Sub Process for later

A

A

Radiologist reads & dictate films/

reviews priors

Fwd to transcription for editing of texts

(dictation)

Radiologist receives, reviews, corrects, & electronically signs

Power-scribe sends completed rpt to CHCS & AHLTA

Power-scribe sends alert to ordering HCP

HCP reviews report

Stop

•Pt may not show (1)

• Pt may show w/o order (2)

• non-valid order (3)

•What % problem? 1-2%

• ~30/month on average (4)

• 98-99%

• ~10% found invalid by Radiologist

• only 2 cassette readers (5)

• 1 down- slows down process

• TAT (7)

• non-responsive facilities

• delay in treatment/diagnosis

• occasional problem w/ upload (5)

• HCP notification

• DINPACS, CHCS, AHLTA

• checks & balance in place (7)

• outside script

Low Level Process MapLow Level Process Map (2 of 2)(2 of 2)D M A I C

Measure Phase – Data CollectionMeasure Phase – Data Collection (1 of 2) (1 of 2)

D M A I C

Measure Phase – Data CollectionMeasure Phase – Data CollectionD M A I C

Note: FY07 Tracking data; no decrease in baseline data report between Nov 2002 – Sep 2006

Analyze Phase - StatusAnalyze Phase - StatusD M A I C

Example 3:Example 3: Lean + Six Sigma Lean + Six Sigma

• Process Flow Process Flow

• DMAIC DMAIC

Fishing for Success in Pharmacy

Baseline GOAL units

Wait Time 25 90 %

Satisfaction Survey Report 36 90 %

Project Y’s

Purpose:

Improve efficiency in pharmacy, wait time and patient satisfaction report card

Project Goal: 90% improvement in wait time within 30

minutes90% patient satisfaction survey report card

FishboneFishbone

Define Phase: Define Phase:

Efficiency

Method

Lack of/limited Information to patients

TV (Tom)

Increased patient Wait time

Improving Pharmacy Efficiency – “Producing Results with Little Waste”Improving Pharmacy Efficiency – “Producing Results with Little Waste”[Define Phase: 5M’s & 1P]

Grey Cart (Lisa)

Key Box

Flammable Storage

Red Bins

Shred it: Move to new side (Tom)

Key Control Interview Rm

Mother Nature (environment)

Copy Rm

Q-Matic estimated Wait Time vs. transaction time

Data South Printer location

Zebra Printers

Machine

Help w/ Office Supply

Stop Pick-point Support

Exemption from duty (golf cart)

Prepackaging (volunteers)

Materials

(???) Service after P2K

Safety (ECC)

Prepacks (fast mover)

Men

(personnel)

LCD Screen

Mail boxes

Schedules (2wk/4wk/6wk)

Sign in board posted

Staff office (mbr teams: 58,59,60,61

Cork board (break room)

Measurement

Faxed orders not rec’d or incomplete

Macessan software – more steps & more training

Staff shortage per day

Patient complaintsIncreased Staff workflow

System failure (audio care, computer)

Current Current Process Process FlowFlow

Lean Tool Box:Lean Tool Box:

Process Observation:

Process Flow chart:

Window #3Window #1 Window #2 Window #4 Window #5 Window #6

Ba

ker

Ce

llDoor

Admin Area

Supply Office

Sterile Room

Staff Work Stations

Rx

Sh

elf

Fill

Sta

tion

Rx

Sh

elf

Fa

x

Rx

Sh

elf

Rx

Sh

elf

Rx Shelf Rx Shelf

Rx

Sh

elf

Rx

Sh

elf

Rx

Sh

elf

Fill S

tation

1

3

2

4

5

6

7

8

Refill Refill

2

13

Refill B

ins

Refill Bins

2

1

3

4

5

6

Box Plot Box Plot Chart & Chart & FMEA FMEA

Analyze Phase: Analyze Phase: Note: Measure Note: Measure

Phase used C&E Matrix – similar to RadiologyPhase used C&E Matrix – similar to Radiology

Week

Day

Wait Time

Fri

Thur

Wed

Tues

Mon

1:30:001:00:000:30:000:00:00 1:30:001:00:000:30:000:00:00

Fri

Thur

Wed

Tues

Mon

Fri

Thur

Wed

Tues

Mon

1:30:001:00:000:30:000:00:00 1:30:001:00:000:30:000:00:00

7:00 8:00 9:00 10:00

11:00 12:00 13:00 14:00

15:00 16:00 17:00

Panel variable: Hour

Sept 2006 Wait Time vs Week Day

Analyze: Wait Time vs. Week Day Analyze: Wait Time vs. Week Day

CHCS-Volume Summary Report

Mon Mon

Tue

Tue

Wed

Wed

ThurThurFri

Fri

0500

100015002000250030003500

Jul Aug

Main

To

tal # R

x

Wait Time

Fre

qu

en

cy

120100806040200

35

30

25

20

15

10

5

0120100806040200

Morning Afternoon

Pharmacy Wait Time by Time of Day

Q-Matic Daily Category

August 2006

Wait Time

Fre

qu

en

cy

120100806040200

50

40

30

20

10

0

Pharmacy Wait TimeAugust 2006

Q-Matic Daily Category

Area to improveLongest wait time

Failure Mode & Effects Analysis

Key Key Points Points

Improve Phase: Improve Phase:

Processes Under Improvement:

CommunicationOrganizationStaff involvement/awarenessOverall wait times

Example 4Example 4VSM SimulationVSM Simulation

QUESTIONS….QUESTIONS….

References:References:

George, M., Rowlands, D., Kastle B. What George, M., Rowlands, D., Kastle B. What is Lean Six Sigma? 2004 George Groupis Lean Six Sigma? 2004 George Group

Phillips Corporation presentationPhillips Corporation presentation