Transcript Slide 1

Floyd Medical Center’s Lean
Six Sigma Journey
January 21, 2010
Today’s Objective
• Gain an understanding of the concepts of Lean
Six Sigma and how applying Lean Six Sigma
principles will generate improvement to any
process resulting in increased customer
satisfaction and better financial performance
2
Road Map
1. Current state of affairs
2. What is Lean Six Sigma?
3. How to jump start any improvement
process using a 100 day work out
4. Project Examples
5. What about me?
3
Current State
• Emphasis on cost containment
• Emphasis on measuring performance based on
industry benchmarks
• Reactive vs. Proactive mentality
4
Road Map
1. Current state of affairs
2. What is Lean Six Sigma?
3. How to jump start any improvement
process using a 100 day work out
4. Project Examples
5. What about me?
5
Lean and Six Sigma
• Lean is a tool used in manufacturing or
processing industry that helps eliminate waste.
Waste is defined as anything that does not add
any value to the process, also known as muda.
• Six Sigma is a quality control tool that reduces
variability in production. Six sigma does not
allow more than 3.4 defects per million
opportunities. Opportunity is defined as what
the customer wants, their expectations.
6
Lean and Six Sigma
• Lean and Six Sigma can be used together.
• Use Lean to eliminate waste and then apply six
sigma to reduce variability and sustain the
production to be near perfect.
• The goal of Six Sigma is to increase profits by
eliminating variability, defects, and waste that
undermine customer loyalty.
7
What is Waste?
Quality Waste Recovery
Goals:
• Continue the pursuit of world class quality.
• Cost recovery will result from the reduction in
waste.
“All we are doing is looking at the time line, from the moment the customer gives us an
order to the point when we collect the cash. And we are reducing the time line by
reducing the non-value adding wastes.” - Taiichi Ohno
8
What is Waste?
Definition of Quality Waste:
The intended or unintended activities consuming time
and resources which:
• Do not contribute to the quality of care
• Do not improve or cause a decrease in patient or
medical staff satisfaction
• Detract from the organization’s performance in
accomplishing its mission
• Are not a legal or regulatory requirement that must be
satisfied
• Are not mission centric to the organization
9
What is Waste?
Quality Waste Recovery
Every process has an element of inefficiency which
results in waste. This includes the Cost of Quality
(COQ) which are those activities conducted to ensure
that quality goals are met and Cost of Poor Quality
(COPQ) which are the activities that ensue when a
process fails. On average each of these steps
represent:
– 67% of resources are consumed in the Delivery of Care
– 13% of resources are consumed in the Cost of Quality
– 20% of resources are consumed in the Cost of Poor Quality
“Costs do not exist to be calculated. Costs exist to be reduced.” - Taiichi Ohno10
What is Waste?
•
•
•
•
•
•
•
7 Types of Waste
In quality staffing (over capacity)
Over correction (defects)
Over processing
Excess inventory
Waiting and delays
Motion/transport
Movement of materials/information
11
18 Change Concepts
• eliminate things that are not
used
• standardize processes where
possible
• consolidate functions and
job classifications
• eliminate multiple entries
• reduce or eliminate overkill
• recycle or reuse
• use substitution
• use constraints and forcing
functions
• use reminder systems
•
•
•
•
•
•
•
•
•
reduce classifications
apply a default mode
minimize hand-offs
adjust to peak and trough
demands
reduce setup or start up
times
move steps in the process
close together
find and remove bottlenecks
match staffing to demand
shape demand.
12
Historical Quality Initiatives
Malcolm Baldrige
Award
Total Quality
Management
Six Sigma
Lean
Manufacturing
Kaizen
ISO 9000
13
What is Six Sigma?
Six Sigma Origins:
 Phillip Cosby – zero defects and quality free approach
 Joseph Juran- trilogy quality improvement and quality control
 W.Edwards Deming – 14 points
 Taguchi- Japanese style –TQM, Quality Circles, Kaizen. Lean
 ISO 9000 Standards
 Six Sigma (MAIC) was introduced by:
 Motorola in 1987 by Dr. Mikel Harry
 Texas Instrument – 1988
 IBM – 1990
 Allied Signal and Kodak – 1994
 GE (DMAIC), Jack Welch - 1995
 Various Healthcare Entities - 1996
 Floyd Medical Center - 2006
14
What is Six Sigma ?
• “The roots of Six Sigma as a measurement standard
can be traced back to Carl Frederick Gauss (17771885) who introduced the concept of the normal
curve.
– Six Sigma as a measurement standard in product variation
can be traced back to the 1920's when Walter Shewhart
showed that three sigma from the mean is the point where
a process requires correction.” (The History of Six Sigma, 11/2002)
• Hundreds of companies around the world have
adopted Six Sigma as a way of doing business
15
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
What is Six Sigma?
•
•
•
•
•
A vision
A belief system and philosophy
A measurement system
A methodology
A strategy deployment approach
16
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
What is Six Sigma?
The “Six Sigma” term refers to a Management
Philosophy
• Executive Leadership Driven
• Strategic Alignment with Operations and
People
• Impact of the Voice of the Customer
• Established Customer/Supplier Partnerships
• Focused and Dedicated Resources
• Employee Accountability
• Competitive Business Results
• Open Communications
17
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
What is Six Sigma?
The “Six Sigma” term refers to a Metric
• Drive out waste, and improve quality, cost, time and
the performance of any business
• Sigma, , is a letter in the Greek alphabet
– Used as a symbol to denote the standard deviation of a
process (standard deviation is a measure of variation).
– A process with “six sigma” capability means having six
standard deviations between the process mean and either
specification limit.
– Process variation is reduced so that no more than 3.4 parts
per million fall outside the specification limits. The higher
the sigma value, the fewer the defects.
18
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
Measure of Quality
Process Sigma
CP
2
3
1.00
3.5
PPM/DPMO
Quality
Yield
Cost of
Quality
308,537
69.0%
Not competitive
66,807
93.3%
25% - 40% of Gross
Sales
Below Industry Avg
22,700
97.7%
4
1.33
6,210
99.4%
4.5
1.5
1,350
99.87%
5
1.67
233
99.98%
5.6
1.83
32
99.9979%
6
2
3.4
99.9997
15% - 25% of Gross
Sales
Industry Avg
5% - 15% of Gross
Sales
Best in Industry
World Class
19
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
Measure of Quality
93% Quality (2.8 )
• 5000 incorrect surgeries per
week
• 200,000 wrong prescriptions per
year
• No electricity for 7 hours per
month
• 20,000 lost articles in mail per
hour
• Two short or long landings at
Chicago O’Hare per day
• Unsafe drinking water for 15
minutes per day
99.9996% Quality (6)
• 1.7 incorrect surgeries per week
• 68 wrong prescriptions per year
• No electricity for 1 hour out of 34
years
• Seven lost articles in mail per hour
• One short or long landing in five
years
• Unsafe drinking water for one
minutes every seven months
20
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
Six Sigma Measurements
Xs
Methods
Materials
Machines
Process
WhyVariation?
Variation?
Why
“Y”
“Y”
Environment
Measurement People
Xs
21
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
Six Sigma Measurements
• Six Sigma focuses first on reducing variation and then on
improving process capability
–
–
–
–
A defect is failing to deliver what the customer wants
Process Capability is what your process can deliver
Variation is what the customer sees and feels
Stable Operations is ensuring consistent and predictable processes to
improve what the customer sees and feels
• A Six Sigma program is to minimize variation within all critical
processes
• Reducing Variation
–
–
–
–
–
Greater predictability in the process
Less waste and rework
Lower costs
High performing products and services
Delighted customers
22
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
Six Sigma Measurements
“Variation is evil
in any customertouching process.”
— Jack Welch, Chairman & CEO
Customers don’t judge us on averages or defect reduction alone.
They feel and experience the variation of each transaction and our
performance across the end-to-end customer experience.
23
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
Sigma is standard deviation..an expression of
variation
•Reducing variation is the key
What we see
Patient Wait Times (mins)
Starting Point After Project
Avg.
28
29
16
6
7
10
25
11
6
4
9
10
16
13
18
6
33
21
12
17
17
13
13 17
What patients feel
Mean = Big Change: 25% improvement
Variability = No Significant Change!
24
What is Six Sigma?
The “Six Sigma” term refers to Methodology
(DMAIC)
D - Define in numerical terms problems or opportunities
M - Measure the current levels of performance
A - Analyze and determine the root cause of the problem
I - Improve the situation
C - Control the new process to ensure continued better
performance
25
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
What is Six Sigma?
The “Six Sigma” term refers to a Company-wide
Deployment Strategy
•
Formulate and Deploy a Business Strategy and Initiate
Transformational Change Through a Six Sigma Initiative
–
–
–
–
–
Gain customer loyalty and bottom line profitability
Focus on critical business processes impacting customers by reducing
process defects which affects critical customer-based services
Develop a data-driven, performance-based culture by using statistical
analysis tools that capture and observe process variables (or at least
stop reporting averages by themselves)
Respond to the need for dramatically shorter cycle times, reduction in
costs, first-pass yields, increases in productivity and higher
performance levels
Develop human capabilities
26
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
What is Six Sigma?
• A Six Sigma Program first and foremost…
– Intensively assigns and trains improvement experts to
support and accelerate progress in every project
– Tackles only those projects that have a significant impact
on the financials of the organization
– Selects projects based upon their direct connection and
contribution to the strategic plan of the organization
27
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
What is Six Sigma?
• Six Sigma is proven, prescriptive and powerful
– Six Sigma seems to work best when it’s mandated
from the senior-leadership team and implemented
aggressively
28
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
Six Sigma Roles
•
•
•
•
•
•
Executive Management
Sponsor/Champion
Master Black Belt
Black Belt
Green Belt/Team Member
Process Owner
29
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
Themes of Six Sigma
• Proactive Management
• Boundary less (no borders) Collaboration
• Strive for Perfection, Tolerate Failure
•
Focus on the Customer – first and foremost
•
Fact-Driven Management, not estimating
•
Focus on Process
30
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
Financial Benefits
Financial Impact on a Six Sigma Organization
– During 1996 and 1997 Allied Signal recorded savings of $3.2
billion through their Premier Performance initiative.
– In 1999, Honeywell realized more than $600 million in Six
Sigma Plus-related savings.
– J&J reported that Six Sigma saved $200 million in 1999, $350
million in 2000 and $500 million in 2001
– Ford Motor Corporation reported $52 million in 2000, $200
million in 2002
– Honeywell states $500 million in 1998, $500 in 1999 and $700
million in 2000
– A financial services company saved the addition of 24 full time
positions in one call center alone
31
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
O.K. but what about Floyd…?
Past Floyd Projects
Decrease ECC Door to Provider Time
Goal: decrease < 30 minutes
Business Case: all ECC throughput net revenue loss (LWBS) $247,226, gross $1,052,513
ECC Last test to MD Disposition Decision
Goal: < 15 minutes
Business Case: all ECC throughput net revenue loss (LWBS) $247,226, gross $1,052,513
ECC MD Disposition Decision to Floor
Goal: < 30 minutes
Business Case: all ECC throughput net revenue loss (LWBS) $247,226, gross $1,052,513
CAU Utilization
Goal: Convert CAU to roving unit when not operating as overflow, decrease utilization to < 20%
Business Case: $757,205
Increase % Discharges before 2 PM
Goal: 80% of discharges before 2PM
Business Case: $318,106
Decrease % Incomplete ECC Registrations
Goal: 0% of patients leave without a completed registration
Business Case: $440,000
32
O.K. but what about Floyd…?
Past Department Level Floyd Projects
Floyd Healthcare Management Postage Standardization Project
Goal: Maximize use of discounted rates
Business Case:$30,000
Decreasing defects in collections of patient financial responsibilities
Goal: Decrease defect rate by 1%
Business Case: $77,000 annualized
Floyd Respiratory Therapy Cost Reduction Strategy
Goal: Decrease allowable time for aerosol treatment
Business Case: $44,713
33
Road Map
1. Current state of affairs
2. What is Lean Six Sigma?
3. How to jump start any improvement
process using a 100 day work out
4. Project Examples
5. What about me?
34
Getting Started
• Our initiative began in the summer of 2006
with a management retreat with Chip Caldwell
and Associates, who were engaged to assist the
initiative and remain for a year of training.
• Managers were given a copy of What is Lean
Six Sigma by Mike George, Dave Rowlands,
and Bill Kastle
• 100-day Work out (check ins at 30, 60, 90, and
100 days)
35
Deliverable
• Staff were assigned to come up with two
changes every 30 days.
• We had a check in at 30, 60 and 90 days for
leaders to report on their changes.
• Changes and financial impacts were entered
into an access data base provided by Chip
Caldwell and Associates.
36
First Work Out Results
270 validated changes & savings of $2,458,208
Highlights and awards:
• “The Most Creative” award – Materials Management
for a new process designed to eliminate storage of
unneeded item. Yielded a savings of $63, 522 in
storage.
• “The Greatest Financial Impact” - Pharmacy for
switch Zofran to a generic drug yielded a savings of
$223, 802.
• “Greatest Laugh Factor” – Dietary phone extension
change from 7063.
37
Second Work Out
• Focus was on In Quality staffing
• Deliverable was four changes
• Rapid Cycle Test concept was introduced
– A test of new assumptions in a short time period.
– By testing assumptions first, changes can be tried before
full-scale implementation, and if successful, change is
then accelerated because there is a greater trust and
confidence.
38
Second Work Out
Highlights:
• GI staff cross train to fill needed position in
another department yielded as savings of
$22,000
Results – reduction in overtime, decreased
utilization of agency staff, and decrease in
number of positions through attrition.
– 131 validated changes for a savings of $1,543,581
39
Results
Workout
Start Date
Deliverable
Activity
9/1/2006
1/15/2007
4/25/2007
8/31/2007
12/19/2007
4/23/2008
8 changes
4 changes (2 Inquality)
4 changes (2 SIPOC)
2 waste
1 SIPOC, 1 Inquality staffing
4 waste changes
270
131
55
55
40
107
658
Validated
Planned
Savings
$2,458,208
$1,543,581
$635,895
$1,030,581
$329,005
$1,602,238
$7,599,508
Savings are removed from department’s operating budget
40
41
Fall 2008 Results:
• Teams:
–
–
–
–
–
–
–
–
–
Ortho/Neuro Services Line
ECC Throughput
2 PM Discharge
Patient Satisfaction – Informed about delays, Responsiveness
HRS Solutions Survey
Discharge Not Final Billed/ Discharged Not Final Coded
Antibiotic Stewardship
SCIP
Time Management
• Savings and Revenue enhancement = $668,222
42
Spring 08-09 Results:
• Teams:
–
–
–
–
–
–
–
–
–
–
Ortho/Neuro Services Line
ECC Throughput
2 PM Discharge
Patient Satisfaction – Staff cared about me as a person, ECC return rate
Discharge Not Final Billed/ Discharged Not Final Coded
Self Pay Collections
Antibiotic Stewardship
HRS result action plan
Red Rules – Isolation/transmission based precautions
SCIP
• Savings and Revenue enhancement = $1,721,046
43
Summer 2009 Results:
• Teams:
–
–
–
–
–
–
–
–
Cerner
RAC Preparedness
ECC Operational Performance
2 PM Discharge
Pneumonia Antibiotic Selection
Red Rules – Barrier Precautions, Time Out
Patient Satisfaction – Noise level, Informed about delays
Best Places to Work
• Savings and Revenue enhancement =
$77,000
44
New for Fall 2009
• Quality Waste Workout:
–
–
–
–
The “Biggest Loser” theme
Teams are aligned by VP
Competitive spirit
% “waste” lose/total operating budget
• Bottom Line Impact
– Not purist
– Quantifiable revenue counts equally with cost
savings
45
Kurt Stuenkel
Previous Weight
$3,461,352
Current Weight
$3,234,852
$3,140,702
$3,201,963
$3,120,963
9.264%
Difference
($320,650)
Fall 2009 Results:
• Teams:
–
–
–
–
–
–
–
Cerner
RAC Preparedness
ECC Operational Performance
2 PM Discharge
Corporate Culture
Patient Satisfaction
Quality Waste
• Annualized Savings and Revenue enhancement
to date = $3,500,000
47
Road Map
1. Current state of affairs
2. What is Lean Six Sigma?
3. How to jump start any improvement
process using a 100 day work out
4. Project Examples
5. What about me?
48
C
D MD AM AI I C
Lab Test to Disposition
Overall Data Comparison for Last Test - Disposition Decision
600
Baseline
1
1
60 Day
30 Day
90 Day
Summation
1
500
Length in Minutes
400
WOW!
300
200
100
UCL=58.0
GOAL=15
_
X=5.1
LCL=-47.9
0
-100
Mean = 131
Mean = 29.3
Mean = 24.2
Mean = 23.7
Mean = 5.1
P-Value <0.014
-200
1
22
43
64
85
106
127
148
169
190
211
Observation January - April 2007
After all changes we had a decrease in variation and reduced the mean from 131 minutes to 5.1 minutes not only meeting
our goal but exceeding it. The process went from being out of statistical control to being in statistical control throughout
the 90 day process. We feel that our project showed tremendous success!
© 2006 Chip Caldwell & Associates, LLC. All Rights Reserved.
FLOYD_ECC_042607
D M
D A
M AI I C
C
Changes Implemented
30 Day Changes: Mean 29.3
• ECC Charge Nurse to standardized process of getting completed test results to MD.
• MDs asked not to batch.
60 Day Changes: Mean 24.2
• Activated a “Chart Complete” column on the tracking board that flashes green.
• Charge Nurse will utilize this column and have Clinician watch so they know when test are complete and chart
is ready.
• Radiology results will be sent to one fax machine instead of two different ones.
90 Day Changes: Mean 23.7
• Mental Health Assessment will be computerized and sent to facility via Right Fax in order to free up ECC fax
machine to allow for Radiology use. Update: Computerized forms are complete and the laptops were ordered
(takes 3 weeks for delivery). They should be ready to utilize by late April.
• In order to improve communication between the Lab and the ECC when instruments are down the Lab staff are
now completing an instrument downtime form for tracking purposes. They have also been reminded to notify
the ECC immediately when instruments are down.
Summation:
Mean 5.1
• Automatic Radiology “Complete Message” has been implemented. (When x-ray is complete the interface
sends an automatic message to the tracking board that it is complete.)
© 2006 Chip Caldwell & Associates, LLC. All Rights Reserved.
FLOYD_ECC_042607
D M A I C
EVS to Clean Time
EVS Request to Clean Time
250
baseline
P-value = 0.000
post work out
200
time in minutes
150
100
UCL=96.3
_
Mean = 46.2
50
Goal < 45
0
LCL=-3.9
-50
Mean was 74.4
-100
1
19
37
55
73
91
109
127
145
163
discharges
© 2007 Chip Caldwell & Associates, LLC. All Rights Reserved.
51Floyd ECC 042607
D M A I C
Changes Hardwired
Unit secretary or nurse will enter discharge into
STAR at the time the patient leaves the room
Transporter will enter discharge into HRS from
patient’s room
Shifting of EVS staff to meet demand
Set cleaning goal of 25 minutes
© 2007 Chip Caldwell & Associates, LLC. All Rights Reserved.
52Floyd ECC 042607
Nebulizer Changes
Treatment Time Progression
Baseline Time
1100
Flow
Supplies
BAN Trial
Gas Source
1
Patient became
Patientillissue
1000
1
Individual Value
900
1
1
800
UCL=743.7
700
600
Goal < 540
_
X=506.7
500
1
400
300
1
LCL=269.8
200
1
47
93
Mean = 703
139
185 231 277
323 369 415
461
Mean = 658
Mean = 503 Mean = 506
Mean = 533
P = 0.001
P = 0.040
P = 0.142
P = 0.000
53
Process Change
• We tried to increase the flow and thereby decrease the
time to complete the treatment.
• Then changed brand of nebulizer that is designed for
more efficiency and better particle deposition. Less
time more drug!
• Stocked portable cart with needed Respiratory
supplies to ensure anything that may be needed when
arriving to the patients room was available.
• Make available compressed gas source so Therapist
do not have to spend time manipulating patients
oxygen set up.
54
Decreasing defects in collections of
patient financial responsibilities
Chris Butler GBT
P-Chart
Baseline vs. Current State
1.0
Baseline (Random Sample of C Y 2008)
1 1111 1 1
1
1 111
1 1 1
1 1 111 11
1
11
1 11
1
0.8
% of Defects
1
P=.95
1
C urrent State (A pril-May 2009)
1
111 1 1 1 1 1111
1
11 1
1
11 1
1
1
1
1
1
1
0.6
1
1
1
11
1
1
0.4
1
11
UCL=0.938
_
P=0.912
LCL=0.886
P-value=.0000
1
Goal was .94 1
1
0.2
0.0
11
1
1 1 1 11111 11 1 1 11
10
19
28
37
46
days
Tests performed with unequal sample sizes
55
64
73
82
91
56
Hardwired
• Point of Service collection was hardwired
on April 10, 2009
• Blue Card and asking for lower amount if
patient can not afford the deposit amount
on April 23,2009
• Job-Matching the registration staff was
hardwired June 10,2009
57
Newborn Denial Reduction
Control Chart of NBI Denied Accounts
2008
0.8
2009
0.7
% Defective
0.6
1
0.5
1
0.4
0.3
0.2
1
0.1
UCL=0.0480
_
P=0.0021
0
0.0
1
17
33
49
65
81
97
113 129 145
Days: May - July 2008 vs. May 20 - July, 2009
Tests performed with unequal sample sizes
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
161
LCL=0
58
Benefits of our Lean Six Sigma Journey
–
–
–
–
–
–
–
–
–
Customer Focused (What customers expect)
Process Focused (Our capability to deliver)
Causal Thinking (What makes this happen)
Accountability Driven (Ownership)
Fact-Based Statistical Thinking (Data Driven)
Stretch Goals (More than continuous improvement)
Standardized Approach to Improvement
Partnership (Employees working together)
Open Communications
59
© Chip Caldwell & Assoc., LLC. 2007. All Rights Reserved
Road Map
1. Current state of affairs
2. What is Lean Six Sigma?
3. How to jump start any improvement
process using a 100 day work out
4. Project Examples
5. What about me?
60
What about me?
• Focus on waste elimination - most important
single concept of Lean
– “When you buy bananas all you want is the fruit not the skin, but you have to
pay for the skin also. It is a waste. And you the customer should not have to
pay for the waste.” - Shigeo Shingo
• Learn to identify waste through the eyes of the
customer
– Ask “Would the patient want to pay for this”?
– “Does it change the form, fit, or function of the
process”?
– Review 7 categories of waste & 18 change
concepts
61
What about me?
• Emphasize “Mistake Proofing”
– Mistake-proofing your processes
• Improves quality and productivity
• Eliminates re-work
– Performing significant root cause analysis is
vital
– Prevent the customer from finding a defect
62
What about me?
• Encourage staff buy-in
– 100,000 ideas annually at Toyota
• “Why not make the work easier and more interesting so that people do not
have to sweat? The Toyota style is not to create results by working hard. It
is a system that says there is no limit to people’s creativity. People don’t
go to Toyota to ‘work’ they go there to ‘think’” - Taiichi Ohno
– Take notes of opportunities for improvement
– Don’t just report to management – work to find a
solution and fix it
63
What about me?
• Measure before implementing changes
• Utilize the “Rapid Cycle Test”
• Don’t be satisfied with reporting averages –
always include the standard deviation as a
measurement of variation in a process
• Focus on improving your process capability
over the long term – not simply hitting a target
as a result of one time focused efforts
• Make performance results visible
64
Resources
• Chip Caldwell and Associate
• Six Sigma Green Belt Training – Overview
slides, Lynne Sisak, Chip Caldwell and
Associates
• Process Improvement: “Structured Problem
Solving” for Centura Health Leaders – 2008,
Deborah Smith
• The Six Sigma Memory Jogger II
65
Questions?
66