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2/20/2014 1 Applying Lean Six Sigma to your Compliance Program John Kalb, JD, CHC, CCEP Operational Excellence Executive/ Compliance Officer Kootenai Health April 2, 2014 1 Content • Lean Six Sigma’s goals of reducing waste and variation can help improve organizational compliance • An overview of the application of the methodology to understand how it supports a culture of compliance • Learn specific tools that can be applied throughout your organization to increase standardization and compliance 2 Lean Six Sigma Leadership Culture • Honor and Respect People – your people have good ideas – recognize and reward them for that – allow them to contribute through collaboration and empowerment • Honor The Customer – they are the reason we exist – figure out what they want and make improvements and create standards around what they want • Honor Standards – it is the “sustain” plan to keep things in compliance ‐ document what you do, do what you document and prove it in practice • Error proof practices to ensure minimal regulatory intervention 3
Transcript of Applying Lean Six Sigma to your Compliance - hcca-info.org · PDF fileThe Lean Six Sigma...
2/20/2014
1
Applying Lean Six Sigma to your Compliance Program
John Kalb, JD, CHC, CCEPOperational Excellence Executive/ Compliance OfficerKootenai Health
April 2, 2014
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Content
• Lean Six Sigma’s goals of reducing waste and variation can help improve organizational compliance
• An overview of the application of the methodology to understand how it supports a culture of compliance
• Learn specific tools that can be applied throughout your organization to increase standardization and compliance
2
Lean Six Sigma Leadership Culture
• Honor and Respect People – your people have good ideas –recognize and reward them for that – allow them to contribute through collaboration and empowerment
• Honor The Customer – they are the reason we exist – figure out what they want and make improvements and create standards around what they want
• Honor Standards – it is the “sustain” plan to keep things in compliance ‐ document what you do, do what you document and prove it in practice
• Error proof practices to ensure minimal regulatory intervention
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The Lean Six Sigma Difference – Change in Culture
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LSS System Focus
• People are not perfect and will make mistakes
• System factors cause many negative events/ issues
• Reliable outcomes are obtainable with the right mix of people and processes
Traditional Individual Focus
• People who make mistakes are poor performers
• Systems performance will improve by removing poor performers
So, What Are Some Of The Barriers To Compliance?
• Poor Communication
• Flawed Teamwork
• No collaboration
• Rushed Procedures
• Time Pressure
• Policies that are hard to follow
• Inadequate Interfaces
• Lack of error prevention expectations or accountability
The Lean Six Sigma Difference – Change in Culture
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Lean
Eliminate Waste/ Improve Flow
Reduce cycle time
Lower complexity
Analysis of physical layout
Known Solutions
3 – 5 day deployment/
implementation
Six Sigma
Reduce defects & variability
High complexity
Unknown root causes/ solutions
Data driven control Strategy
4 – 8 month projects
Overview of Lean Six Sigma Methodology
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After
Before Work Time (value add)
Wait and ‘Other’ Time(no value)
Work Time (value add)
Wait and ‘Other’ Time(no value)
Same value,
Less time and Resource!
Six Sigma+
Eliminate waste in and around Processes Lean
Eliminate defects in Processes
=Business Improvement
Process Improvement
Benefits of Lean Six Sigma
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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%
# of process steps
3 4 5 6Lean – reduce steps & waste
Six Sigma – reduce defects & variability
Lean Processes that Operate at Six Sigma
Repeatability
Flow
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Rolled Throughput Yield
Patient A is treated in 3 Steps……
Rolled Throughput Yield is the Probability That the Process to treat the Patient Will Produce Zero Defects
Patient A
Treatment
YRT = (0.80) (0.70) (0.90) = .504 = 50.4%
Triage Diagnostic Testing
Rolled Throughput Yield = Product of the First Pass Yields
Diagnosis
YFP= 80% YFP= 70% YFP= 90%
How reducing steps reduces defects
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It started in Japan at the Toyota Motor Company
1902: Sakichi Toyoda of the Toyota group, invented an automated loom that stopped anytime a thread broke.
1908: Henry Ford invents the moving assembly line and raises the daily wage to $5.00 ; continuous flow as a production method is created.
“ The thing is to keep everything in motion and take the work to the man and not the man to the work. This is the real principle of our production and conveyors are only one of many means to an end.” ‐ Henry Ford : Today and Tomorrow
Several decades later Taiichi Ohno, a production engineer at the Toyota Motor Company applied the same concept as he sought to eliminate waste, or non‐value added activities, within the Toyota organization.
In addition to stopping production at every defect (Jidoka), he employed another key concept, JIT (just in time). Together, Jidoka and JIT are the pillars of the Toyota Production System, supported by a foundation of Heijunka (level loading) … the basis of Lean.
A Brief History of the Toyota Production System ‐ Lean
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Where Does Lean Come From?
• The basic philosophy of Lean is to provide the customer with…
– What they want
– When they want it
– Using the absolute minimum resources
1978
1996
1943 ‐ 1978
Value ‐ an activity that administers care or provides a service or information to meet customer/ patient needs and requirements (usually something that the customer/ patient is willing to pay for)
Value Stream Map – A graphic map of steps that occur from a request for a product or service to delivery of the product or service. Similar to a process map but with greater amount of detail – such as time taken, resources consumed, inventory etc.
Value‐added – a step, activity or a process that is perceived to add value to the customer/ patient; it transforms the product or service
Non‐value‐added– a step, activity or process that takes time, resources and/or space but does not contribute to adding value or satisfying customer/patient needs
Value Enabling or Non‐Value‐Added Essential – a step, activity or process that does not add value but must be done, usually required either because of regulations or as a pre‐requisite to completing a value‐added step
Muda = Waste – anything that takes resources but creates no value for the customer, usually an excessive or unwanted step, resource, or activity
TAKT Time – the rate at which a customer/ patient demands a product or service
TAKT Time is NOT Cycle time
Pull – used to describe the customer/ patient generating the demand for service / product as opposed to the producer ‘pushing’ to the customer/ patient
Kaizen / Kaizen‐event ‐ a Rapid Cycle Improvement ‐ 3‐5 days where actual changes are made (Action) i.e. processes are changed, equipment is moved etc.
Key Terms
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Lean Thinking Process
The continuous movement of products, services and information from end to end through the process
Define value in from the customers perspective and express value in terms of a specific product
Nothing is done by the upstream process until the downstream customer signals the need
The complete elimination of waste so all activities create value for the customer
2 Map the
Value Stream
3Establish Flow
4Implement
Pull
5Work to Perfection
1Specify Value
Map all of the steps…value added & non‐value added…that bring a product of service to the customer
The 5 steps to Lean Thinking …
Four Rules of Lean
1. Work activities are specified to:
• Content – what is being done
• Sequence – in what order
• Timing – how long should it take
• Outcome – what are the expected measurable results
2. All connections must be simple and direct
3. Pathways are simple and involve as few steps and people as necessary
4. Continuous Improvement by those doing the work and as close to the problem as possible
• Assign corrective action and improvement
• Follow up on the previous day’s action items
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TOYOTA
Just
-in-T
ime
• Single Piece Flow
• Pull Production
• TAKT Time Production
• Autonomation
• Stopping at Abnormalities
• Level Loading
• Sequencing
Jido
ka
Heijunka
ToyotaProduction System
Toyota Production System
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Toyota Production System: Jidoka
Andon Boards (Call Lights) Sounds (Machine warnings)
Reasons to Stop a Process:
• Defective Material (Rapid Response Team)
• Material Shortage (Flash Sterilization)
• Equipment Breakdown
Make everything visible to everyone:• Expose waste• Make standards clear• Improve efficiency
The Lean Toolkit – Basic Lean Tools
• Identifying and Eliminating Waste
• Value Stream Mapping (VSM)
• Root Cause Analysis Using 5 Whys
• 5S
• Spaghetti Mapping
• Takt Time
• Standard Work
• Level Loading & Sequencing
• Single Piece Flow
• Daily Action Review
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The 8 Types of Muda (DOWNTIME)
Defects
Work that contains errors, rework, mistakes or lacks
something necessary
• Medication error• Wrong patient• Wrong procedure
• Scrap• Rework• Correction
Overproduction
Producing 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
Waiting
Idle 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
Inventory
More 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 incorrect
information
• Variation in way same activities are performed
• No knowing what the next steps are• Unclear systems for reporting/
communicating
Extra Processing/
Rework
Activities/ effort that adds no value from the patient’s/
customer’s viewpoint
• Multiple bed moves• Redundant information gathering• Excessive paperwork• Unnecessary procedures• Multiple testing / Retesting
• Multiple cleaning of parts• Paperwork• Awkward tool or part design• Regulatory paperwork• Tasks that are no longer needed
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Waste examples that lead to compliance concerns:
• Data collection – process steps that do not add value for the patient. For example when in clinical trails there is the collection of extraneous data that will not be utilized in the study. This creates waste, risk and liability.
– Can the data collection be streamlined to remove the collection and retention of unused data?
• When communication of information and ideas is isolated or siloed within a company and/or departments.
• When the same information needs to be submitted separately to different regulatory agencies – and if they have different data definitions.
• Underutilization of staff to identify and help prevent defects
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Reevaluate
Recall
Redesign
Retest
Retype
Redo
Repeat
Reissue
Reject
Rework
Remake
Recheck
Revise
Return
Remeasure
Reship
Clues to Waste & Non‐Value Added Work
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Waste Observation ToolWaste Observation Tool
VALUE STREAM/PROCESS NAME: ____________________________
DATE: ______________________
OBSERVER: ____________________________________________
LOCATION: __________________
NO. PROCESS NAME WASTE DESCRIPTION/OBSERVATION D O W N T I M E TIME
(SEC)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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In the next 24 hours, I will remove the Waste No. _________ and communicate to the affected people.
Signature:________________________
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• Explain the 8 wastes
• Stand in the same spot every day in the center of the workplace (gemba)
• Find wastes every day
• Identify Root Causes
• Remove at least 1 waste everyday
Ohno Circle Tool
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• Preregistration process call prior to procedure
• Arriving and waiting for the nurse to call for you
• Being walked to the exam room
• Taking vital signs
• Waiting for the doctor
• Getting directions to the hospital
• Finding your way to the lab to get blood drawn
• Filling out billing information
• Correcting the bill
Which of these add value for the customer
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• Preregistration process call prior to procedure
• Arriving and waiting for the nurse to call for you
• Being walked to the exam room
• Taking vital signs
• Waiting for the doctor
• Getting directions to the hospital
• Finding your way to the lab to get blood drawn
• Filling out billing information
• Correcting the bill
Which of these are compliance concerns
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• Understand current situation ‐ Big picture
• Ratio of Non‐Value to Value Added Time
• Exposes sources of waste ‐ not just waste
• Shows linkage between the 7 types of flow
Why Value Stream?
• Start at the customer and work backwards
• Walk the actual flows
• Don’t map the organization but map the flow through it
• Identify value added and non‐value added steps (muda or waste)
• Identify where to focus analysis of activities• Don’t be too detailed this is an overview•Use pencil not power point…quick and crude
Guidelines for Mapping
TOTAL VALUE STREAM
INPUTS Your Hospital OUTPUTS
The 7 Flows
1. Patients
2. Communication
2. Supplies
4. Information (What and When)
5. People (Std. Work, Takt Time)
6. Equipment (Portable X‐Ray, EKG, etc)
7. Specimens
Value Steam Mapping
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Example: Cath Lab Value Stream Map
Reception Check‐in
0‐5 Pts.
Discharged
Admitted
Recovery
Cath Lab
Inpatient
Pre‐Cath
69 38135 233 8 300 10 133 10
122
120 96
336431
960782201
Registration
Eliminate waste in and around processes
Value Steam Mapping
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What You Think it is What it Actually is:What You WouldLike it to Be
Current State VSM is created from the patient/customer’s perspective (i.e. walk the process). The process to develop and map concepts for the Future State provides a gap analysis between where you are and where you need to go and helps to determine the improvement strategy.
Three Versions of Value Stream Map Processes
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Root Cause Analysis (RCA)
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Root Cause Analysis (RCA)
A process for identifying the basic or causal factors that underlie variation in performance, including the occurrence or possible occurrence of a defect
Why Conduct an RCA:
• To identify the processes and systems related to the occurrence as well as the proximate cause of the event
• Leads to an improvement in processes or systems
• Decreases the likelihood of similar events in the future
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• A simple and widely used tool
• Team asks/ considers “why” at least five times
• Agree on root cause
• Develop action plan for improvement
Root Cause Analysis (RCA) – 5 Whys Tool
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Department/Area: Initiator: Date:
Issue/General Information : Occurrences:
Why #1: Why #2:
Why #3: Why #4:
Why #5: Temporary Countermeasure:
1.
Final Countermeasure:
Ask WHY a final time:
Read backwards after completion. Does the analysis make sense?
Circle One: Yes No
Root Cause Analysis (RCA) – 5 Whys Tool
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What is 5S?
Sort
Simplify
Shine
Standardize
Sustain
Arrange & Prioritize ‐ Distinguish needed and unneeded items
Prevent Problems from occurring ‐arrange and identify needed item for ease of use
Inspect and Clean up area daily
Establish Orderliness/ Standards/ clearly define tasks
Discipline to maintain established procedures – audit area
• Get everyone involved.
• Integrate 5S Principles into daily work.
• Communicate need for 5S, roles of all
participants.
• Be consistent in following 5S in all areas
• Leadership involvement at all levels
• Follow through ‐ 5S takes effort &
persistence.
• Link 5S activity with all other initiatives.
Keys to Success
5S
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• 5 cowboys to drive 1000 cattle
• Should take one look and understand the situation
• Clearly differentiate between what is “Normal” and “Abnormal”
• Detect what is “Abnormal”
Create Standards … Detect Abnormalities
Look Here …
Not Here …
5S
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5SClassifying Supply Locations By Frequency of UseTag based on Frequency
Priority Frequency of use How to Store
Low Less than once a week Throw away !!Store in distant place
Medium Once a week Store together or somewhere in department
High Once a day Carry or keep atonce per takt time individual work place
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5S ToolItem Score( 0 ‐ 5 )
What is the team doing toimprove to the next level?
Bulletin Boards
Emergency Access
Items on Floor
Aisle‐waysMarking
Aisle‐ waysMaintenance
Floor Cleaning
Storage of CleaningEquipment
Removing unnecessary items
Item # andDescription
Storage andArrangement
Equipment Painting
Five S Evaluation Form
All paperwork, supplies, tools, equipment, cabinets, stands etc not required for performing operations are removed from the area. Only tools and product are at work stations.
All cleaning equipment is stored in a neat, orderly manner,handy and readily available when needed.
All bulletin boards are arranged in a neat and orderlymanner. No outdated, torn or soiled announcementsare displayed.
All floors are clean and free of debris, oil and dirt.Cleaning of floors is done routinely ‐ daily at a minimum ‐a posted schedule or checklist is present.
Fire hoses and emergency equipment are unobstructedand stored in a prominent easy to locate area. Switches and breakers are marked or color coded for visibility.
Supplies and any other materials are not left to sit directly on the floor. Large items such as boxes are placed on the floor in clearly identified and marked areas.
Aisles and walkways are clearly marked and can beidentified at a glance, lines are straight and at rightangles with no chipped or worn paint.
Aisles are always free of materials and obstructions, nothing is placed on the lines, and objects are alwaysplaces at right angles to the aisles.
Storage of boxes, containers and material is always neatand at right angles. When items are stacked, they arenever crooked or in danger of toppling over.
All machines and equipment are neatly painted,there are no places in the area less than six feet high that are unpainted.
SubtotalFor Page 1Score 0 to 5 with 5 being the highest.
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2
3
4
5
6
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8
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10
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5S ToolItem Score( 0 ‐ 5 )
What is the team doing toimprove to the next level?
DocumentsStorage
DocumentsControl
Tools and GagesArrangement
Tools and GagesConvenience
ShelvesArrangement
Equipment Storage
Equipment Maintenance
Equipment Cleanliness
Item # andDescription
Work area and Desk Control
5S Control andMaintenance
Five S Evaluation Form
All machines and equipment are kept cleanby routine daily care.
Controls of machines are properly labeled and criticalpoints for daily maintenance checks are clearly marked.Equipment check‐sheets are neatly displayed and clean.
Only documents necessary to the operation are stored at the work stations and are neat and orderly.
Nothing is placed on top of machines, cabinets or equipment. Nothing leans against walls or columns.
All documents are labeled clearly as to content andresponsibility for control and revision. Obsolete or unuseddocuments are routinely removed.
Tools, gages and fixtures are arranged so they can beeasily accessed when changeovers or setups are made.
Tools, gages and fixtures are arranged neatly andstored, kept clean and free of any risk of damage.
Shelves are arranged, divided and clearlylabeled. It is obvious where things are stored, statusand condition is recorded.
Work areas and desks are kept free of objects includingrecords and documents. Equipment is clean andplaced in their proper location.
There is a disciplined system of control and maintainedat the highest possible level. It is the responsibility ofeveryone to maintain this system and environment.
SubtotalFor Page 2
+ SubtotalPage 1
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• A diagram that shows the motion of the
patient / family / care‐giver throughout
the care experience
•Obtain / draw a layout of the care area
•Observe first the patient as he/she goes from
one station to another and draw on the layout
•Do not lift your pencil from the paper –
continuous flow
•Repeat for care‐giver & family
•Measure the total distance traveled and note
Guidelines for Mapping
Spaghetti Mapping
Not to exact scale
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Spaghetti Mapping
Shopper
Shopper
Non‐shopper
Non‐shopper
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Takt Time
Takt = Rate at which the Patient/Customer PULLS from you (the heartbeat of the org).
Takt = Total Available Time (in seconds)
Total Patients seen in that time frame (Demand)
Ex. If there are 60 patients that come into an ED during a given shift, Takt time can be calculated as:
60 sec. x 60 mins. x 8 hrs.
60 patients
In order to ‘keep up’ at the rate at which a patient walks into the ED, you would need to complete a patient treatment every 480 seconds
OR
Every 480 seconds there is a patient walking into the ED, so every 480 seconds, there should be one being discharged – or else there will be a wait
NOTE: This does not mean it only takes 480 seconds to treat a patient! It means that the slowest step in the process should not exceed 480 seconds, and if it does, there will be waits and bottlenecks.
= 480 Secs.
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Standard Work
• Standardizes the way everyone does specific tasks
• Best process for quality, safety, compliance and efficiency
• Helps maintain control
• Makes it easier to expose and solve problems
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“Everything should be made as simple as possible, but not one bit simpler”
‐Albert Einstein
Standard Work Sequence
Standard Work Sheet
Standard Work / Combination Sheet
Standardized Work Job Instructions (SWJI)
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easy to follow displays, placed where the work gets done, to ensure consistency
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Level Loading & Sequencing
Process Step
Ensures that all steps in a Value Stream operate at or below Takt
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By redistributing some of the tasks in Step D to A, B, and C …
. .we can easily identify our target for improvement. If we reduce the cumulative Cycle Times for all the steps by 12 seconds, we can potentially reduce from four steps to three.
Time
Step
Takt Time
A B C D
60”
(50”) (44”) (56”) (42”)
Time
Step
Takt Time
A B D
60”
(60”) (60”) (60”) (12”)C
Level Loading & Sequencing
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Catches Defects too Late
• How many more do you have?• Where are they in the process?• What is the root cause?
Catches Defects Immediately
• You only have one• You know where it occurred• Resolve the root cause immediately
Batch Production Single Piece Flow
From: The Toyota Production System
Single Piece Flow
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Daily Action Review
• Series of interconnected, brief and structured daily meetings that:
• Compare actual to expected performance
• Assign corrective action and improvement
• Follow up on the previous day’s action items
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• Measure of Quality
• Process For Continuous Improvement
What is Six Sigma
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Business Strategy An overall strategy that encompasses an organization’s quality philosophy. It sets the vision for achieving Six Sigma levels of quality in key processes and services.
Tools and Tactics A set of statistical tools and a disciplined methodology used by specially trained individuals to improve processes by reducing variation and defects.
Goal
Six Sigma refers to a process that produces only 3.4 defects per million opportunities
2 308,5373 66,8074 6,2105 2336 3.4
Sigma DPMOStatistically
Most U.S. Businesses
Understanding of Six Sigma
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Reducing variability is the essence of six sigma
Every Human Activity Has Variability...
Mean
1
Target
p(defect)
UpperCustomer Specification
LowerCustomer Specification
Measure of Quality
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Mean CustomerSpecification
3 3BEFORE
w i d e v a r i a n c e
6AFTER
slim variance
Mean CustomerSpecification
6
Patients don’t feel the averages, they feel the variation
No Defects
6.6% Defects
What is Sigma?
Measure of Quality
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• 68% of data falls within 1 standard deviation of the mean• 95% of data falls within 2 standard deviations of the mean• 99.7% of data falls within 3 standard deviations of the mean
Six Sigma Quality
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Lets look at our “average” LOS for a procedure. Looking atthe last 30 patients we had an average LOS of 5 days. What is the problem?
5 days
Is this what our patients are feeling? Is everyone getting out in 5 days?
Six Sigma Quality
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No!
Lets look at a distribution of the actual data.
5 days
It probably looks more like this with the average being 5 days.
8 days2 days
Frequency
Six Sigma Quality
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We can see that there are a significant number of patients getting out later and earlier. Either way this can be a source of customer dissatisfaction & regulatory inquiry
5 days
Lets say that our patients & regulators are OK if they are out between 1 day early and 1 day late. These are our spec limits.
8 days2 days
USL is 6 daysLSL is 4 days
Frequency
Six Sigma Quality
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Where are our defects, or, where are our dissatisfied patients?
5 days 8 days2 days
USL is 6 daysLSL is 4 days
If our standard deviation was 1day, then we would have 68% of our patients getting out between 4 and 6 days AND 32% not.
Frequency
Six Sigma Quality
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If our standard deviation was reduced to .5 day, then we would have 95% of our patients getting out between 4 and 6 days
If we can reduce variation, we can reduce dissatisfied patients & regulators
Six Sigma Quality
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5 days 8 days2 days
USL is 6 daysLSL is 4 days
Frequency
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Starting Point
After Project
Patient Wait Times (mins)
28186
2358
16193311
17
296
10124
1013102013
13Average
MeanBig Change25% improvement
What We See
What Patients Feel
13 17
Variability… No Significant Change!
Six Sigma Quality
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Six Sigma provides a process based approach to continuousimprovement. It can be used to improve any process…business, transactional or healthcare.
Process for Continuous Improvement
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DMAIC: To improve any existing product or process
Six Sigma Methodologies
DefineDefine MeasureMeasure AnalyzeAnalyze ImproveImprove ControlControl
Who are the customers and what are their priorities?
How is the process performing and how is it measured?
What are the most important causes of the defects?
How do we remove the causes of the defects?
How can we maintain the improvements?
Process for Continuous Improvement
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DMAIC
Changing to a Statistical Problem
“How good do I need to be?”Step 5 : Define Performance Objectives
Step 6 : Identify Variation Sources “What factors make a difference?”
“How good am I today?”Step 4 : Establish Process CapabilityDMAIC
DMAIC
DMAIC
Developing a Statistical Solution
“What’s at the Root of the Problem?”
“How can I predict the Output?”
Step 7 : Screen Potential Causes
Step 8 : Discover Variable Relationships
Step 9 : Establishing Operating Tolerances “How tight does the control have to be?”
DMAIC
DMAIC
DMAIC
Implementing the Practical Solution
“Can I trust the in-process data?”
“Have I reached my goal?”
Step 10 : Validate X Measurement Systems
Step 11 : Determine Process Capability
Step 12 : Implement Process Control “How can I sustain the improvement?”
DMAIC
DMAIC
Formulating the Practical Problem
DMAIC Steps A,B,C : CTQ’s, Charter, Process Map “How do my customers look at me?”
“What do I want to Improve?”DMAIC
“What’s the best way to measure?”DMAICStep 1 : Select the CTQ characteristic
Step 2 : Define Performance Standards
Step 3 : Validate the Measurement System “Can I trust the output data?”DMAIC
Process for Continuous Improvement
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Pictures of Before State:
Blocked doorways/ clutter Equipment in non‐sterile hallway
Case Study – Surgical Services Equipment Availability
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Pictures of Before State:
Expensive equipment in
vulnerable location Egress blocked by equipment
Case Study – Surgical Services Equipment Availability
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Improvements:
• Equipment moved to storage room on first floor
– Relocated 2 pharmacy employee offices
– Removed expired equipment & supplies
– Moved vendor items to one location, initiating consignment process which vendors had been resistant to
– Added wall boards for more efficient storage
– Taped floor for access to door and where equipment goes
– Put pictures of items on wall to indicate where it goes in room; also put picture in old location with note indicating where it is now located
• Created equipment transport process
– Tagging process so equipment is no longer just left in elevator due to not knowing the clean or dirty status of equipment
– Now know what equipment is going up (clean) and going down (dirty)
– Included involvement of Patent & Equipment Transport Team and Central Sterile team, in addition to Surgical Services Staff
Case Study – Surgical Services Equipment Availability
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Improvements:
• Renovated Darkroom located in Surgical Services
– Was rarely used, and had become unnecessary due to new technology
– Replaced water damaged wall and flooring that had created a great environment for growth
– Fixed water drained that leaked into Unit on floor below
– Reconfigured open space with wall mount system which allowed relocation of supplies
• Renovated and reconfigured an exiting “work” (storage) room:
– Large 248 sq foot space with a lot of extra room that was underutilized
– Dropped par levels on supplies by over $3,000
– Removed cabinets and sinks, and expanded the doorway
– New open space allowed storing $3M of equipment that was formally stored old hallway – expensive, easily damaged equipment now in a protected area
– Able to outline floor to ensure storage locations are maintained
Case Study – Surgical Services Equipment Availability
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Pictures of After State:
Cleared Egress Hallway cleared of clutter
Case Study – Surgical Services Equipment Availability
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Tenants of Successful Lean Six Sigma Management
• The basis of management decisions should be long‐term vision and strategy, even if that is at the expense of short term gains
• Create a process to continuously bring problems to the surface
• Level out the work (The tortoise and the hare)
• Build a culture of stopping to fix problems and getting things right the first time
• Standardize processes and tasks to get to and maintain continuous improvement and front line empowerment
• Implement visual controls so problems will not be concealed
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Tenants of Successful Lean Six Sigma Management
• Use technology that serves your people and processes – do not become subservient to technology
• Develop leaders who understand the work, live the vision, strategy and values and teach it to others
• Develop excellence in your people an dteams
• Respect your extended network of partners and help them improve
• Go to the work (gemba) and understand the problem
• Make decisions slowly, considering all your options, but implement decisions rapidly
• Become a learning organization
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Ending Thoughts
• Tracking and trending data and issues will highlight issues that need to be brought better into compliance
• Standardized work and documentation will improve by involving the stakeholders
• Bringing a cross functional team together to resolve issues ensures a common approach and culture throughout the organization
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Lessons Learned
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Successes
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Self AssessmentWhat is your experience?
Good judgment comes from experience, and a lot of that comes from bad judgment
– Will Rogers
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One Thing Learned………..
……….One Thing to Apply
Application of Learnings
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It’s easier to behave ourselves
into a new way of thinking
than to think ourselves
into a new way of behaving.
Managing on the Edge, R. Pascale
Ending Thought
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Questions
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Contact Information:
John Kalb, JD, CHC, CCEP
Operational Excellence Executive/ Compliance Officer
Kootenai Health
Phone: 208‐659‐5505
