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Lean Six Sigma @ Lumedx March 4 2006

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markkresse

In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement (CQI) and trained management. However, by the mid-1990s CQI was no longer the primary quality improvement approach. In the 2000s, Saint Vincent began implementing Lean Six Sigma to address the limitations of CQI and drive more significant process improvements through a customer-focused approach. The presentation outlines the key differences between CQI and Lean Six Sigma, and Saint Vincent's multi-year plan to fully deploy Lean Six Sigma across the organization.

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March 3, 2006 Lean Six Sigma Healthcare Applications Mark Kresse, MHS, PT, CHE Vice President Saint Vincent Health System
In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques.
In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S P D A S
In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement P D A S
In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement rganize a group that is familiar with the process P D A S
In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement rganize a group that is familiar with the process larify the process P D A S
In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement rganize a group that is familiar with the process larify the process ncover the root cause(s) of variation P D A S
In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement rganize a group that is familiar with the process larify the process ncover the root cause(s) of variation tart the improvement cycle Plan Do Study Act P D A S
While many of us have continued to employ the CQI philosophy and tools
While many of us have continued to employ the CQI philosophy and tools by the mid -1990s, CQI as the Saint Vincent quality improvement infrastructure was little more than a memory.
While many of us have continued to employ the CQI philosophy and tools by the mid -1990s, CQI as the Saint Vincent quality improvement infrastructure was little more than a memory. What went wrong?
While many of us have continued to employ the CQI philosophy and tools by the mid -1990s, CQI as the Saint Vincent quality improvement infrastructure was little more than a memory. What went wrong? Why are we now intent on adopting Lean Six-Sigma at Saint Vincent?
and, what have we done differently this time? Albert Einstein NY Times Insanity: doing the same thing over and over again and expecting different results.
Please raise your hand if Your organization has formally implemented Lean and/or Six-Sigma
Please raise your hand if Your organization has formally implemented Lean and/or Six-Sigma Some departments within your organization have employed Lean and/or Six-Sigma principles
Please raise your hand if Your organization has formally implemented Lean and/or Six-Sigma Some departments within your organization have employed Lean and/or Six-Sigma principles You have received some training and/or continuing education in Lean and/or Six-Sigma
Please raise your hand if Your organization has formally implemented Lean and/or Six-Sigma Some departments within your organization have employed Lean and/or Six-Sigma principles You have received some training and/or continuing education in Lean and/or Six-Sigma You have read about Lean and/or Six-Sigma
Please raise your hand if Your organization has formally implemented Lean and/or Six-Sigma Some departments within your organization have employed Lean and/or Six-Sigma principles You have received some training and/or continuing education in Lean and/or Six-Sigma You have read about Lean and/or Six-Sigma You can explain what the acronym D.M.A.I.C. means
Please raise your hand if Your organization has formally implemented Lean and/or Six-Sigma Some departments within your organization have employed Lean and/or Six-Sigma principles You have received some training and/or continuing education in Lean and/or Six-Sigma You have read about Lean and/or Six-Sigma You can explain what the acronym D.M.A.I.C. means You have serious doubts that quality improvement principles developed in the manufacturing sector can be successfully applied in healthcare
Please raise your hand if Your organization has formally implemented Lean and/or Six-Sigma Some departments within your organization have employed Lean and/or Six-Sigma principles You have received some training and/or continuing education in Lean and/or Six-Sigma You have read about Lean and/or Six-Sigma You can explain what D.M.A.I.C. means You have serious doubts that quality improvement principles developed in the manufacturing sector can be successfully applied in healthcare You understand that Lean Six-Sigma does not mean Skinny Six-Sigma
My customer focused goals for today Define audience interest, need and expectations re: Lean Six-Sigma education Provide targeted review of key Lean Six-Sigma concepts Setting realistic goals for LSS Summarize the SVHS Lean Six-Sigma efforts and outcomes Wall Street Journal
My customer focused goals for today Define audience interest, need and expectations re: Lean Six-Sigma education Provide targeted review of key Lean Six-Sigma concepts Setting realistic goals for LSS Summarize the SVHS Lean Six-Sigma efforts and outcomes Wall Street Journal Allow 10 minutes for questions, discussion and feedback End on time
SIX SIGMA: CAN IT WORK IN HEALTHCARE? MARK KRESSE November, 2005
What is everyone talking (and writing) about? Can there really be any question about the potential?
What makes Lean Six-Sigma stand out vs. CQIs FOCUS-PDSA?
What makes Lean Six-Sigma stand out Voice-of-the-Customer (VOC) Critical-to-Quality (CTQ) metrics vs. CQIs FOCUS-PDSA? Wall Street Journal
What makes Lean Six-Sigma stand out Voice-of-the-Customer (VOC) Critical-to-Quality (CTQ) metrics vs. CQIs FOCUS-PDSA? Focus on the customer as the driver for quality improvement effort selections Wall Street Journal
What makes Lean Six-Sigma stand out Voice-of-the-Customer (VOC) Critical-to-Quality (CTQ) metrics vs. CQIs FOCUS-PDSA? Focus on the customer as the driver for quality improvement effort selections Emphasis on employing key operational metrics to ensure performance is designed to meet customer demands & expectations, enhance strategy & improve margins Wall Street Journal
What makes Lean Six-Sigma stand out Customer-focused guidance on project selection, vs. Find an opportunity Tied to strategic plan LSS emphasizes results in terms of profit and strategy, vs. activity completion. At SVHC CQI was too process-focused, with only incremental improvements Implementation, but no Control No accountability, no sustainability vs. CQIs FOCUS-PDSA?
What is Six Sigma? A metric A set of tools A quest to reduce variability A measure of process improvement 6-Sigma concepts combine the DMAIC Roadmap with the 6-sigma tools
What is Six Sigma? A metric A set of tools A quest to reduce variability A measure of process improvement 6-Sigma concepts combine the DMAIC Roadmap with the 6-sigma tools a systematic method with tools to measure, analyze and improve business processes identify critical areas that provide breakthrough results in market penetration organizational speed the cost of doing business
Process Capability The ratio of process variability to design specifications Upper Spec Lower Spec The natural spread of the data is 6 , Fit 6 standard deviations on both sides of the mean and spec limit = 6 Sigma capability =3.4 DPMO -1 +2 -2 +1 +3 -3 袖
Is 99% Good Enough? 99.99966% Good (6 Sigma) 20K lost articles of mail per hour Unsafe drinking water for almost 15 minutes each day 5,000 incorrect surgical operations per week Two short or long landings at most major airports each day 200,000 wrong drug prescriptions each year No electricity for almost seven hours each month Seven articles lost per hour One unsafe minute every seven months 1.7 incorrect surgical operations per week One short or long landing every five years 68 wrong prescriptions per year One hour without electricity every 34 years 99% Good (3.8 Sigma)
A New Quality Ideology Internal & External Failure Costs Prevention & Appraisal Costs Old Belief 4 Costs Internal & External Failure Costs Prevention & Appraisal Costs New Belief Costs 4 5 6 Quality Quality Old Belief High Quality = High Cost New Belief High Quality = Low Cost is a measure of how much variation exists in a process
Six-Sigma Methodology Phase 2: Measure Phase 3: Analyze Optimization Phase 4: Improve Phase 5: Control Projects worked through 5 main phases Phase 1: Define Characterization Breakthrough Strategy D M A I C
Connecting to the Voice of the Customer Quality Functional Deployment (QFD) What? method to systematically identify customer requirements and insure they are met by appropriate measurements Why? improve the communication of customer wants and more efficiently allocate resources When? any time you want to insure customer needs are translated in prioritized, measurable requirements HOUSE OF QUALITY
What is Lean? Lean thinking focuses on eliminating waste in processes (i.e. the waste of work in progress) Lean is not about eliminating people Lean is about expanding capacity by reducing costs and shortening cycle times Lean is about understanding what aspects of a product or process are important to the customer i.e. valued and reducing waste in the process to enhance that value
Before Work Time (value add) Wait and Other Time Work Time (value add) Wait and Other Time (no value) A B C E ? Making a Process Lean D 2 D 1
After Before Work Time (value add) Wait and Other Time Work Time (value add) Wait and Other Time (no value) A B C E ? Making a Process Lean D 2 D 1 A B C E
After Before Work Time (value add) Wait and Other Time Work Time (value add) Wait and Other Time (no value) + = Business Improvement A B C E ? Making a Process Lean D 2 D 1 + Same value, with less time and resources! Six Sigma Eliminate defects/variation in process Eliminate waste in & around process Lean
Eight Service Industry Wastes Errors in documents Transport of documents Doing unnecessary work not requested/required Waiting for the next process step Process of getting approvals Unnecessary motion or movement Backlog in work queues Underutilized employees
Lean Tools Value Stream Mapping 5S 5 Whys Theory of Constraints Kanban Visual Controls
Value Stream Map The simple process of directly observing the flows of information and materials as they now occur, summarizing them visually, and then envisioning a future state with much better performance (Voelkel & Chapman, 2003) Pictures are worth a thousand words!
5S Program 5S is a Japanese methodology to clean and organize the work place 5S focuses on creating visual order, organization, cleanliness and standardization. 5 Elements Sort Straighten Shine Standardize Sustain
KANBAN Kanban: Japanese term meaning "signal". Signals a cycle of replenishment of production and materials. Maintains an orderly and efficient flow of materials throughout the entire process. Most often a printed card or visual cue that contains specific information as to what is required for the process to operate
Theory of Constraints Any system can operate only as efficiently as its critically constrained resource 60 units per day 70 units per day 40 units per day 60 units per day
Theory of Constraints Any system can operate only as efficiently as its critically constrained resource 60 units Per day 70 units Per day 40 units Per day 60 units Per day Constraint Maximum System Throughput = 40 units per day
Why Can Lean Six-Sigma Help Change Healthcare? Normally demands a CULTURAL SHIFT beginning with a CUSTOMER FOCUS Must be driven by top leadership Top-down deployment - integrated with business strategies (strategic plan) Insists on quantifiable benefits and accountability Disciplined approach (DMAIC) Defined Roles/infrastructure (Champion, MBB, BB, GB, etc) Data based decisions Continuing CUSTOMER FOCUS (internal/external)
Roadblocks to Success No fundamental acceptance of the need for genuine cultural change (realignment in thinking) Lack of leadership support and accountability Waning commitment Lack of measurable goals No clear strategies and tactics for maintaining long-term results Hesitancy to invest time and money Dr Martin Merry Mr. Jeffrey Brown
Team Roles Executive Champion - Senior leadership sponsor, acts as a LSS catalyst, breaks down barriers to success. Master Black Belt - Full-time teacher and mentor of Black Belts (may be externally contracted) Black Belt - Full-time, LSS trained change agent, works on high-level projects, mentors Project Champions Project Champion - Variable-level of management responsibilities, close to process, trained in LSS tools, drives grass-roots involvement Physician Champion Physician with vested interest in the target process and its improvement Finance/Accounting Representative Required to help define legitimate ROI
Lean Six-Sigma Planning Program 3-year Vision Timeline Phase I: June, 2005 January, 2006 Phase II: January, 2006 June, 2006 Phase III: July, 2006 December, 2006 Phase IV: January, 2007 June, 2008
Lean Six-Sigma Phase I - Goals Provide baseline training in Lean Six-Sigma principles for senior executives, vice-presidents and selected directors. Identify and prioritize possible LSS improvement projects. Bring 2-3 projects to the Improve phase of the D.M.A.I.C. process by 12/31/2005. Implement a Lean Six-Sigma internal communication plan. Identify plans for Phase II and beyond by 12/31/2005.
Lean Six-Sigma Phases II-IV Goals Re-affirm and define the scope of SVHS Lean Six-Sigma philosophy Expand leadership and associate training Incorporate projects and operational metrics into leadership Quality Share for accountability Develop/hire additional internal experts
Lean Six-Sigma Phases II-IV Program Phase Characteristics Strategic Plan alignment Knowledge & Skills Transfers; Observable Behaviors Accountability Structure Team Rewards Communication Plans Support Infrastructure required Timeline Budget
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Phase I Project Status
LSS Projects Emergency Department Throughput Problem Length of stay for ED patients is too long as evidenced by the number of patients leaving w/o being seen and poor customer satisfaction ratings Critical to Quality (CTQ) Metric Length of stay (minutes), LWBS Rate Defect Admitted patient LOS > 240 minutes Goal Reduce LOS by 30 percent for admitted patients; decrease LWBS 50% Executive Champion Dr. Joseph Cacchione Benefits Improved customer satisfaction Increased ED revenue, fewer patients LWBS
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Disp to Order Families of Process Variation ED Patient (admitted) LOS Time to Time Doc to Doc Time to Time Order to Assign Assign to Room Eval to Disp Hosp to PCP Hosp to Hosp Unit to Unit Time to Time Floor to Floor Time to Time Lab Radiology Time to Time Test to Test Time to Time Test to Test Unit to Unit
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LSS Projects Problem Long lead times for delivery of nursing equipment resulting in delayed equipment, compromised patient care/safety, staff dissatisfaction and increase equipment rental cost. Critical to Quality (CTQ) Metric Delivery Lead Time (minutes) Defect Equipment delivery within 30 minutes Goal Reduce delivery time to 30 minutes or less. Champion Debbie Tamlin, VP of Patient Care Operations Benefits Improved patient care/satisfaction and throughput Decreased equipment rental cost and overtime
Equipment Availability
LSS Projects
Whats next??? What will be the next fad after LSS?
Whats next??? What will be the next fad after LSS? Systematic Innovation - a carefully managed sequence of steps, with appropriate tools and roadmaps, to improve an organizations competitive position, satisfy its customers and reduce costs
It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage, than the creation of a new system. For the initiator has the enmity of all who would profit by the preservation of the old institutions and merely lukewarm defenders in those who would gain by the new ones.
Mark Kresse Saint Vincent Heart Center 232 West 25 th Street Erie, PA 16544 814/452-7888 814/455-1675 (f) [email_address] It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage, than the creation of a new system. For the initiator has the enmity of all who would profit by the preservation of the old institutions and merely lukewarm defenders in those who would gain by the new ones. Machiavelli 1532

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Lean Six Sigma @ Lumedx March 4 2006

  • 1. March 3, 2006 Lean Six Sigma Healthcare Applications Mark Kresse, MHS, PT, CHE Vice President Saint Vincent Health System
  • 2. In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques.
  • 3. In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S P D A S
  • 4. In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement P D A S
  • 5. In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement rganize a group that is familiar with the process P D A S
  • 6. In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement rganize a group that is familiar with the process larify the process P D A S
  • 7. In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement rganize a group that is familiar with the process larify the process ncover the root cause(s) of variation P D A S
  • 8. In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement rganize a group that is familiar with the process larify the process ncover the root cause(s) of variation tart the improvement cycle Plan Do Study Act P D A S
  • 9. While many of us have continued to employ the CQI philosophy and tools
  • 10. While many of us have continued to employ the CQI philosophy and tools by the mid -1990s, CQI as the Saint Vincent quality improvement infrastructure was little more than a memory.
  • 11. While many of us have continued to employ the CQI philosophy and tools by the mid -1990s, CQI as the Saint Vincent quality improvement infrastructure was little more than a memory. What went wrong?
  • 12. While many of us have continued to employ the CQI philosophy and tools by the mid -1990s, CQI as the Saint Vincent quality improvement infrastructure was little more than a memory. What went wrong? Why are we now intent on adopting Lean Six-Sigma at Saint Vincent?
  • 13. and, what have we done differently this time? Albert Einstein NY Times Insanity: doing the same thing over and over again and expecting different results.
  • 14. Please raise your hand if Your organization has formally implemented Lean and/or Six-Sigma
  • 15. Please raise your hand if Your organization has formally implemented Lean and/or Six-Sigma Some departments within your organization have employed Lean and/or Six-Sigma principles
  • 16. Please raise your hand if Your organization has formally implemented Lean and/or Six-Sigma Some departments within your organization have employed Lean and/or Six-Sigma principles You have received some training and/or continuing education in Lean and/or Six-Sigma
  • 17. Please raise your hand if Your organization has formally implemented Lean and/or Six-Sigma Some departments within your organization have employed Lean and/or Six-Sigma principles You have received some training and/or continuing education in Lean and/or Six-Sigma You have read about Lean and/or Six-Sigma
  • 18. Please raise your hand if Your organization has formally implemented Lean and/or Six-Sigma Some departments within your organization have employed Lean and/or Six-Sigma principles You have received some training and/or continuing education in Lean and/or Six-Sigma You have read about Lean and/or Six-Sigma You can explain what the acronym D.M.A.I.C. means
  • 19. Please raise your hand if Your organization has formally implemented Lean and/or Six-Sigma Some departments within your organization have employed Lean and/or Six-Sigma principles You have received some training and/or continuing education in Lean and/or Six-Sigma You have read about Lean and/or Six-Sigma You can explain what the acronym D.M.A.I.C. means You have serious doubts that quality improvement principles developed in the manufacturing sector can be successfully applied in healthcare
  • 20. Please raise your hand if Your organization has formally implemented Lean and/or Six-Sigma Some departments within your organization have employed Lean and/or Six-Sigma principles You have received some training and/or continuing education in Lean and/or Six-Sigma You have read about Lean and/or Six-Sigma You can explain what D.M.A.I.C. means You have serious doubts that quality improvement principles developed in the manufacturing sector can be successfully applied in healthcare You understand that Lean Six-Sigma does not mean Skinny Six-Sigma
  • 21. My customer focused goals for today Define audience interest, need and expectations re: Lean Six-Sigma education Provide targeted review of key Lean Six-Sigma concepts Setting realistic goals for LSS Summarize the SVHS Lean Six-Sigma efforts and outcomes Wall Street Journal
  • 22. My customer focused goals for today Define audience interest, need and expectations re: Lean Six-Sigma education Provide targeted review of key Lean Six-Sigma concepts Setting realistic goals for LSS Summarize the SVHS Lean Six-Sigma efforts and outcomes Wall Street Journal Allow 10 minutes for questions, discussion and feedback End on time
  • 23. SIX SIGMA: CAN IT WORK IN HEALTHCARE? MARK KRESSE November, 2005
  • 24. What is everyone talking (and writing) about? Can there really be any question about the potential?
  • 25. What makes Lean Six-Sigma stand out vs. CQIs FOCUS-PDSA?
  • 26. What makes Lean Six-Sigma stand out Voice-of-the-Customer (VOC) Critical-to-Quality (CTQ) metrics vs. CQIs FOCUS-PDSA? Wall Street Journal
  • 27. What makes Lean Six-Sigma stand out Voice-of-the-Customer (VOC) Critical-to-Quality (CTQ) metrics vs. CQIs FOCUS-PDSA? Focus on the customer as the driver for quality improvement effort selections Wall Street Journal
  • 28. What makes Lean Six-Sigma stand out Voice-of-the-Customer (VOC) Critical-to-Quality (CTQ) metrics vs. CQIs FOCUS-PDSA? Focus on the customer as the driver for quality improvement effort selections Emphasis on employing key operational metrics to ensure performance is designed to meet customer demands & expectations, enhance strategy & improve margins Wall Street Journal
  • 29. What makes Lean Six-Sigma stand out Customer-focused guidance on project selection, vs. Find an opportunity Tied to strategic plan LSS emphasizes results in terms of profit and strategy, vs. activity completion. At SVHC CQI was too process-focused, with only incremental improvements Implementation, but no Control No accountability, no sustainability vs. CQIs FOCUS-PDSA?
  • 30. What is Six Sigma? A metric A set of tools A quest to reduce variability A measure of process improvement 6-Sigma concepts combine the DMAIC Roadmap with the 6-sigma tools
  • 31. What is Six Sigma? A metric A set of tools A quest to reduce variability A measure of process improvement 6-Sigma concepts combine the DMAIC Roadmap with the 6-sigma tools a systematic method with tools to measure, analyze and improve business processes identify critical areas that provide breakthrough results in market penetration organizational speed the cost of doing business
  • 32. Process Capability The ratio of process variability to design specifications Upper Spec Lower Spec The natural spread of the data is 6 , Fit 6 standard deviations on both sides of the mean and spec limit = 6 Sigma capability =3.4 DPMO -1 +2 -2 +1 +3 -3 袖
  • 33. Is 99% Good Enough? 99.99966% Good (6 Sigma) 20K lost articles of mail per hour Unsafe drinking water for almost 15 minutes each day 5,000 incorrect surgical operations per week Two short or long landings at most major airports each day 200,000 wrong drug prescriptions each year No electricity for almost seven hours each month Seven articles lost per hour One unsafe minute every seven months 1.7 incorrect surgical operations per week One short or long landing every five years 68 wrong prescriptions per year One hour without electricity every 34 years 99% Good (3.8 Sigma)
  • 34. A New Quality Ideology Internal & External Failure Costs Prevention & Appraisal Costs Old Belief 4 Costs Internal & External Failure Costs Prevention & Appraisal Costs New Belief Costs 4 5 6 Quality Quality Old Belief High Quality = High Cost New Belief High Quality = Low Cost is a measure of how much variation exists in a process
  • 35. Six-Sigma Methodology Phase 2: Measure Phase 3: Analyze Optimization Phase 4: Improve Phase 5: Control Projects worked through 5 main phases Phase 1: Define Characterization Breakthrough Strategy D M A I C
  • 36. Connecting to the Voice of the Customer Quality Functional Deployment (QFD) What? method to systematically identify customer requirements and insure they are met by appropriate measurements Why? improve the communication of customer wants and more efficiently allocate resources When? any time you want to insure customer needs are translated in prioritized, measurable requirements HOUSE OF QUALITY
  • 37. What is Lean? Lean thinking focuses on eliminating waste in processes (i.e. the waste of work in progress) Lean is not about eliminating people Lean is about expanding capacity by reducing costs and shortening cycle times Lean is about understanding what aspects of a product or process are important to the customer i.e. valued and reducing waste in the process to enhance that value
  • 38. Before Work Time (value add) Wait and Other Time Work Time (value add) Wait and Other Time (no value) A B C E ? Making a Process Lean D 2 D 1
  • 39. After Before Work Time (value add) Wait and Other Time Work Time (value add) Wait and Other Time (no value) A B C E ? Making a Process Lean D 2 D 1 A B C E
  • 40. After Before Work Time (value add) Wait and Other Time Work Time (value add) Wait and Other Time (no value) + = Business Improvement A B C E ? Making a Process Lean D 2 D 1 + Same value, with less time and resources! Six Sigma Eliminate defects/variation in process Eliminate waste in & around process Lean
  • 41. Eight Service Industry Wastes Errors in documents Transport of documents Doing unnecessary work not requested/required Waiting for the next process step Process of getting approvals Unnecessary motion or movement Backlog in work queues Underutilized employees
  • 42. Lean Tools Value Stream Mapping 5S 5 Whys Theory of Constraints Kanban Visual Controls
  • 43. Value Stream Map The simple process of directly observing the flows of information and materials as they now occur, summarizing them visually, and then envisioning a future state with much better performance (Voelkel & Chapman, 2003) Pictures are worth a thousand words!
  • 44. 5S Program 5S is a Japanese methodology to clean and organize the work place 5S focuses on creating visual order, organization, cleanliness and standardization. 5 Elements Sort Straighten Shine Standardize Sustain
  • 45. KANBAN Kanban: Japanese term meaning "signal". Signals a cycle of replenishment of production and materials. Maintains an orderly and efficient flow of materials throughout the entire process. Most often a printed card or visual cue that contains specific information as to what is required for the process to operate
  • 46. Theory of Constraints Any system can operate only as efficiently as its critically constrained resource 60 units per day 70 units per day 40 units per day 60 units per day
  • 47. Theory of Constraints Any system can operate only as efficiently as its critically constrained resource 60 units Per day 70 units Per day 40 units Per day 60 units Per day Constraint Maximum System Throughput = 40 units per day
  • 48. Why Can Lean Six-Sigma Help Change Healthcare? Normally demands a CULTURAL SHIFT beginning with a CUSTOMER FOCUS Must be driven by top leadership Top-down deployment - integrated with business strategies (strategic plan) Insists on quantifiable benefits and accountability Disciplined approach (DMAIC) Defined Roles/infrastructure (Champion, MBB, BB, GB, etc) Data based decisions Continuing CUSTOMER FOCUS (internal/external)
  • 49. Roadblocks to Success No fundamental acceptance of the need for genuine cultural change (realignment in thinking) Lack of leadership support and accountability Waning commitment Lack of measurable goals No clear strategies and tactics for maintaining long-term results Hesitancy to invest time and money Dr Martin Merry Mr. Jeffrey Brown
  • 50. Team Roles Executive Champion - Senior leadership sponsor, acts as a LSS catalyst, breaks down barriers to success. Master Black Belt - Full-time teacher and mentor of Black Belts (may be externally contracted) Black Belt - Full-time, LSS trained change agent, works on high-level projects, mentors Project Champions Project Champion - Variable-level of management responsibilities, close to process, trained in LSS tools, drives grass-roots involvement Physician Champion Physician with vested interest in the target process and its improvement Finance/Accounting Representative Required to help define legitimate ROI
  • 51. Lean Six-Sigma Planning Program 3-year Vision Timeline Phase I: June, 2005 January, 2006 Phase II: January, 2006 June, 2006 Phase III: July, 2006 December, 2006 Phase IV: January, 2007 June, 2008
  • 52. Lean Six-Sigma Phase I - Goals Provide baseline training in Lean Six-Sigma principles for senior executives, vice-presidents and selected directors. Identify and prioritize possible LSS improvement projects. Bring 2-3 projects to the Improve phase of the D.M.A.I.C. process by 12/31/2005. Implement a Lean Six-Sigma internal communication plan. Identify plans for Phase II and beyond by 12/31/2005.
  • 53. Lean Six-Sigma Phases II-IV Goals Re-affirm and define the scope of SVHS Lean Six-Sigma philosophy Expand leadership and associate training Incorporate projects and operational metrics into leadership Quality Share for accountability Develop/hire additional internal experts
  • 54. Lean Six-Sigma Phases II-IV Program Phase Characteristics Strategic Plan alignment Knowledge & Skills Transfers; Observable Behaviors Accountability Structure Team Rewards Communication Plans Support Infrastructure required Timeline Budget
  • 55. 油
  • 56. Phase I Project Status
  • 57. LSS Projects Emergency Department Throughput Problem Length of stay for ED patients is too long as evidenced by the number of patients leaving w/o being seen and poor customer satisfaction ratings Critical to Quality (CTQ) Metric Length of stay (minutes), LWBS Rate Defect Admitted patient LOS > 240 minutes Goal Reduce LOS by 30 percent for admitted patients; decrease LWBS 50% Executive Champion Dr. Joseph Cacchione Benefits Improved customer satisfaction Increased ED revenue, fewer patients LWBS
  • 58. 油
  • 59. Disp to Order Families of Process Variation ED Patient (admitted) LOS Time to Time Doc to Doc Time to Time Order to Assign Assign to Room Eval to Disp Hosp to PCP Hosp to Hosp Unit to Unit Time to Time Floor to Floor Time to Time Lab Radiology Time to Time Test to Test Time to Time Test to Test Unit to Unit
  • 60. 油 油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油 油 油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油 油 油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油 油 油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油 油 油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油 油 油 油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油油
  • 61. LSS Projects Problem Long lead times for delivery of nursing equipment resulting in delayed equipment, compromised patient care/safety, staff dissatisfaction and increase equipment rental cost. Critical to Quality (CTQ) Metric Delivery Lead Time (minutes) Defect Equipment delivery within 30 minutes Goal Reduce delivery time to 30 minutes or less. Champion Debbie Tamlin, VP of Patient Care Operations Benefits Improved patient care/satisfaction and throughput Decreased equipment rental cost and overtime
  • 64. Whats next??? What will be the next fad after LSS?
  • 65. Whats next??? What will be the next fad after LSS? Systematic Innovation - a carefully managed sequence of steps, with appropriate tools and roadmaps, to improve an organizations competitive position, satisfy its customers and reduce costs
  • 66. It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage, than the creation of a new system. For the initiator has the enmity of all who would profit by the preservation of the old institutions and merely lukewarm defenders in those who would gain by the new ones.
  • 67. Mark Kresse Saint Vincent Heart Center 232 West 25 th Street Erie, PA 16544 814/452-7888 814/455-1675 (f) [email_address] It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage, than the creation of a new system. For the initiator has the enmity of all who would profit by the preservation of the old institutions and merely lukewarm defenders in those who would gain by the new ones. Machiavelli 1532