Transcript An Introduction to Lean Six Sigma

An Introduction to Lean Six
Sigma
What gets measured gets done……
But not always in the way we want
Process Improvement
1. Initial Problem Perception
(large, vague, complicated)
The “Real” Problem
3. Locate the
Point of Cause
(e.g., Fishbone
diagram)
4. Root Cause
Analysis
6. Measure effectiveness
7. Standardize
o
y
ud
St
5. Develop countermeasure
D
Root Cause
an
Pl
ct
Why?
Why?
Why?
Why?
Why?
A
• Initial problem
perception
• Clarify problem
• Locate point of cause
• Root cause analysis
• Design solutions
• Test to see if worked
• Standardize
2. Clarify the Problem
(e.g. Pareto diagram)
What are Lean and Six Sigma?
•
•
•
•
•
•
A statistical measurement
A measure of quality
A goal
A methodology
A quality improvement initiative
A management philosophy focused on
customer satisfaction
• A strategy for organizational transformation
Lean Six Sigma Process Improvement
• Lean Six Sigma Seeks to improve the quality
of manufacturing and business process by:
– identifying and removing the causes of defects
(errors) and variation.
– Identifying and removing sources of waste
within the process
– Focusing on outputs that are critical to
customers
Define
Control
Improve
Measure
Analyze
Lean Six Sigma Process Improvement
• LSS is a management philosophy that seeks to drive a
quality culture change through a multi-level based
program
Level
Training
Green Belt
LSS Methodology and basic tool
set
Black Belt
Green Belt content plus
advanced data analysis
Master Black Belt
Black belt content plus program
management, leadership skills,
some advanced tools
Lean Six Sigma Timeline
Guinness
Brewery
1900
Ford
Assembly Line
Shewhart
Introduces SPC
1930
Gilbreth, Inc.
•Management
Theory
•Industrial
Engineering
Deming
•14 Points
•7 Deadly Diseases
1950
Toyota Production
System
Lean Six Sigma Timeline
SPC
TQM
1980
Just – in–Time
Motorola
Introduces Six
Sigma
1990
Lean Mfg.
AlliedSIgnal
GE Adapt LSS to
Business Processes
2000
Lean Six Sigma Timeline
2000
2013
Lean Six Sigma is … An Evolution!
Juran –
Process
Analysis
Statistical
Process Control
Scientific
Management
Assembly
Line Manufacturing
Toyota created Lean to achieve Henry
Ford’s low cost with GM’s variety of
product
•
Motorola initiated “six sigma” to meet
the challenge of Japanese chip quality
and cost
•
Deming, Baldrige and Shingo Prize’s
are Descriptive of success
•
GE Prescribed the Six Sigma
infrastructure of success connected to
business strategy
•
Lean Six Sigma integrates Lean lead
time and cost reduction with Six
Sigma quality and sustaining
infrastructure of success
Zero
Defects
Toyoda,
Ohno,
Shingo
Deming –
Systems
Thinking
TQM Total Quality
Management
Six
Sigma v1
Welch/
Bossidy –
Organizational
Infrastructure
•
Sloan –
Modern
Management
Mass
Production
Quality
Engineering
Smith
(Motorola) –
Statistical
Rigor
Continuous Improvement can be
traced to Taylor’s time studies
Ford –
Work
Analysis
Quality
Control Prof. Mayo –
“Hawthorne
Effect”
Taguchi –
Customer
Focus
•
Gilbreth
Industrial
Production
Shewhart –
Statistical
Methods
Taylor –
Time/Motion
Studies
Craft
Production
Eli Whitney Product
Standards
Harry –
DMAIC
Toyota
Production
System
Womack
& Jones
Lean
Enterprise
Six
Sigma v2
Lean Six
Sigma
George, ITT
Industries,
CAT, Xerox
Lean vs. Six Sigma
• Lean tends to be used for shorter, less complex problems.
Often time driven. Focus is on eliminating wasteful steps
and practices.
• Six Sigma is a bigger more analytical approach – often
quality driven – it tends to have a statistical approach. –
reduce defects.
• Some argue Lean moves the mean, SixSigma moves the
variance.
– Waste elimination eliminates an opportunity to make a defect
– Less rework means faster cycle times
• Six Sigma training might be specialized to the “quality”
department, but everyone in the organization should be
trained in Lean
VOC vs. VOP
Sigma
Capability
Voice of Customer
Defects per
Million
Opportunities
% Yield
2
308,537
69.15%
3
66,807
93.32%
4
6,210
99.38%
5
233
99.98%
6
3.4
99.99966%
Voice of Process
The Voice of the Process is independent of
the Voice of the Customer
What’s good enough?
99% Good (3.8 Sigma)
99.99966% Good (6 Sigma)
20,000 lost articles of mail per hour
(based on 2,000,000/hr)
7 articles lost per hour
Unsafe drinking water for almost 15
minutes each day
1 unsafe minute every 7 months
5,000 incorrect surgical operations per
week
1.7 incorrect operations per week
2 short or long landings daily at an
airport with 200 flights/day
1 short or long landing every 5 years
2,000,000 wrong drug prescriptions
each year
680 wrong prescriptions per year
No electricity for almost 7 hours each
month
1 hour without electricity every 34
years
Goals of Lean Six Sigma
LSL
USL
Defects
LSL
Defects
Defects
Customer Target
Prevent Defects by
Reducing Variation
USL
Customer Target
LSL
USL
Customer Target
Meet Customer
Requirements
Prevent Defects by
Centering Process
Background on Lean
• Lean comes out of the industrial engineering world
• Taiichi Ohno – Toyota Production System.
– 1940s-1950s company was on verge of bankruptcy
– Dynamics of industry were changing – moving from mass
production to more flexible, shorter, varied batch runs (people
wanted more colors, different features, more models, etc).
• Ohno was inspired by 3 observations on a trip to America
– Henry Ford’s assembly line inspired the principle of flow (keep
products moving because no value is added while it is sitting
still)
– The Indy 500 – Rapid Changeover
– The American Grocery Store – led to the Pull system – material
use signals when and how stock needs to be replenished
What is Lean?
• Lean Enterprise Institute:
– “Lean is a set of concepts, principles and tools
used to create and deliver the most value from
the customers’ perspective while consuming the
fewest resources and fully utilizing the knowledge
and skills of the people performing the work”
What is Lean?
• Taiichi Ohno:
– “all we are doing is looking at the timeline from
the moment a customer gives us an order to the
point when we collect the cash. And we are
reducing that timeline by removing the non-valueadded wastes”
– It is about eliminating waste and showing respect
for people
Lean Thinking
• Lean is about making the right work easier to do
• Work is designed as a series of ongoing
experiments that immediately reveal problems
• Problems are addressed immediately through
rapid experimentation
• Solutions are disseminated adaptively through
collaborative experimentation
• People at all levels of the organization are taught
to become experimentalists
Path To Lean
Theory
Waste is Deadly
Application
1. Define Value – act on what is
important to the customer
2. Identify Value Stream – understand
what steps in the process add value
and which don’t
3. Make it flow – keep the work moving
at all times and eliminate waste that
creates delay
4. Let customer pull -- Avoid making more
or ordering more inputs for customer
demand you don’t have
5. Pursue perfection -- there is no
optimum level of performance
Focus
Flow Focused
Assumptions
Non-Value added steps exist
Results
Reduced cycle time
Waste Defined
Wastes
Transport
Inventory
Motion
Waiting
Over-Production
Over-Processing
Defects
Skills
Healthcare Examples
1.
2.
3.
1.
2.
3.
1.
2.
1.
2.
3.
1.
2.
3.
4.
1.
2.
3.
1.
2.
3.
4.
5.
6.
1.
2.
3.
4.
Moving patients from room to room
Poor workplace layouts, for patient services
Moving equipment in and out of procedure room or operating room
Overstocked medications on units/floors or in pharmacy
Physician orders building up to be entered
Unnecessary instruments contained in operating kits
Leaving patient rooms to:
•
Get supplies or record
•
Documents care provided
Large reach/walk distance to complete a process step
Idle equipment/people
Early admissions for procedures later in the day
Waiting for internal transport between departments
Multiple signature requirements
Extra copies of forms
Multiple information systems entries
Printing hard copy of report when digital is sufficient
Asking the patient the same questions multiple times
Unnecessary carbon copying
Batch printing patient labels
Hospital-acquired illness
Wrong-site surgeries
Medication errors
Dealing with service complaints
Illegible, handwritten information
Collection of incorrect patient information
Not using people’s mental, creative, and physical abilities
Staff not involved in redesigning processes in their workplace
Nurses and Doctors spending time locating equipment and supplies
Staff rework due to system failures
Applying Lean in Real Life
• Toast Kaizan
• 3:28 – Current Condition
• 20:10 – Target Condition
The Lean House
Goals: Safety, Quality, Time, Cost, Morale
Flow
•
•
•
•
Prevent
Delays
Value Stream
Focus
Pull Systems
Right care,
right place,
right time
Heijunka
(level loading
Quality
•
•
Developing
People
•
•
Standardized Work
(employee empowerment)
Identify root
Cause
Prevent errors at
the source
Involve
employees
Avoid blame
Kaizen
(Continuous Improvement)
Lean Foundations
• Standardized Work – people should analyze
their work and define the way that best meets
the needs of all stakeholders.
– “The current one best way to safely complete an
activity with the proper outcome and the highest
quality, using the fewest possible resources”
– Standardized not Identical – mindless conformity
and the thoughtful setting of standards should not
be confused
– Written by those who do the work.
Lean Foundations
• Heijunka -- Level loading – smoothing the
workflow and patient flow throughout the
hospital.
• Kaizen – continuous improvement
• Employee Empowerment
– Andon Cord
• Jidoka – problems are fixed at the source instead of
being passed along and fixed at the end
– “Suggestion Box”
Lead Time and Value Added
Types of Work
• Value Added Work
– Activities that transform materials or information into
something that the customer cares about
• Non-Valued Added Work
– Necessary
Value Added, 18
• Room changeover
• Testing
• Administration?
– Unnecessary (pure waste)
• Re-testing
• Waiting for a test
• Walking
Non-Value Added
(pure waste), 57
Non-Value Added
(required), 25
Value Stream Mapping
• A value stream map is a type of process map
– But shows how long each step takes
– As well as the wait time between each step
• Current State VSM
– Helps identify waste and opportunity for
improvement
• Future State Map
– Target for where we want to be
Insurance Claim Processing
Policy Holder’s
Family
mail
Insurance Co.
email
Process Box
Process Data
Box
Work Priority
Receiving:
Open &
Array Docs
FIFO
P/T =
L/T =
# inputs =
Reliability =
Technology
Used
FIFO
Compile
Folder
with
Docs
P/T =
L/T =
%C&A =
# ops =
Verify
Claim
finan
FIFO
P/T =
L/T =
% rejects =
Reliability =
Calculate
Amount &
Address
manual
FIFO
P/T =
L/T =
% rework =
# ops =
Print,
Stuff &
Mail
Check
P/T =
L/T =
Reliability =
% errors =
System Metric
7 Days
2 Min
7 Days
5 Min
7 Days
10 Min
7 Days
1 Min
1 Min
28 Days
19 Min
Swim Lane
• Processes and decisions are grouped visually
by placing them in lanes.
• Parallel lines divide the chart into lanes, with
one lane for each person, group or
subprocess.
• Arrows between the lanes represent how
information or material is passed between the
subprocesses.
Spaghetti Diagram
• A spaghetti diagram is a visual representation using a
continuous flow line tracing the path of an item or
activity through a process.
• Decide what you are going to observe eg product, staff
or patient flow.
• Draw the layout of the area and then draw lines on the
diagram to represent the main flows of the staff
member or patient.
• By analyzing the lines, you can identify any areas with
unnecessary movement. This helps staff decide
whether to bring two points closer together and
optimizes the flow.
Lean Methods
• Kaizen Events (or SCORE events)
– Planned and structured process that enables a small group of people
to improve some aspect of their business in a quick, focused manner.
•
•
•
•
•
Select
Clarify
Organize
Run
Evaluate
• 5S – this methodology reduces waste through improved workplace
organization and visual management
– Sort, Store, Shine, Standardize and Sustain
• Kanban – a Japanese term that can be translated as “signal,” “card,”
or “sign.”
– Most often a physical signal (paper card of plastic bin), that indicates
when it is time to order more, from whom, and in what quantity.
5S and the Visual Healthcare
Workplace
• Sort
– Get rid of unneeded items
• Straighten
– Organize and label the location for items that are needed in the
area
• Shine
– Clean the workspace
– Equipment clean and prepped for use
• Standardize
– Develop cleaning methods and cleanliness standards to
maintain the first 3 S’s
• Sustain
– Review the workplace regularly. Make it a habit
Lean Daily Management
• The LDM process promotes employee
ownership of their operational performance
• Creates a no-fault culture
• Reinforces continual improvement efforts.
• Physicians often respond well to its
transparent, data-oriented nature.
Lean Daily Management
• Each day, a team (composed of all operational
stakeholders) gathers for a 5-minute
discussion to review a dashboard
• four categories: safety, quality, cost, and
efficiency.
• To help focus and prioritize its improvement
efforts, the team should place only one metric
in each category.
The Glass Wall
The Glass Wall
The Glass Wall
Departmental Boards
Departmental Boards
Departmental Boards
Departmental Boards
Departmental Boards
London 2015???
Errors per Worked Hour by Month
0.003
0.0025
0.002
0.0015
Errors per hour
Ubar
0.001
UCL
LCL
0.0005
2011
December
November
October
September
August
July
June
May
April
March
February
January
December
November
October
September
August
July
May
June
April
March
February
January
0
2012
• Special Causes in March 2012, and July-Sept 2012
January
February
March
April
May
June
July
August
September
October
November
December
January
February
March
April
May
June
July
August
September
October
November
December
Correcting the “Bad Apples”
0.0025
0.002
0.0015
Errors per hour
0.001
Ubar
UCL
0.0005
LCL
0
2011
2012
• Error rate falls from .00090 to .00082
January
February
March
April
May
June
July
August
September
October
November
December
January
February
March
April
May
June
July
August
September
October
November
December
January
February
March
April
May
June
July
August
September
October
November
December
When we “changed the process”
0.0025
0.002
0.0015
Errors per hour
0.001
Ubar
UCL
LCL
0.0005
0
2011
2012
2013
• When we changed the process, rate fell to .0049
Sample Sizes
Six Sigma Overview
• Diligent attention to managing, improving, and
reinventing business processes
• Disciplined use of facts, data, and statistical
analysis
• A close understanding of both internal and
external customer needs
• Standard deviation (σ) is used to measure the
amount of process variation
• As sigma gets larger, process variation increases
• Variation is the enemy
Six Sigma is a Quality Measure and
a Goal
Six Sigma as a Methodology
• Underlying methodology called DMAIC
• Empowerment of trained professionals
• Formal project charters set the scope and
objectives
• Various basic quality tools and statistical
tools applied during project
• Project champion/sponsor both approve
project tollgates
Lean & Six Sigma are Synergistic
Lean Focus on Waste Elimination supports Six Sigma Quality
(waste elimination eliminates an opportunity to make a defect)
Lean
Six Sigma
Goal: Improve process performance in
Goal: Improve process performance
relation to what is critical to the
through waste elimination & cycle
customer
time reduction
Focus: Bias for action
Focus: Bias for analysis
Method: Implement Lean tools such as
Method: Uses the DMAIC method and
Kaizen events, Value Stream
quality tools
Mapping, 5S, TPM etc.
Deployment: Implicit infrastructure
Deployment: Explicit Infrastructure
Speed, Flow, Cost
Customer Satisfaction
Six Sigma Quality supports Lean Speed
(less rework means faster cycle times)
What Tool do I use?
C
o
m
p
l
e
x
i
t
y
o
f
t
o
o
l
6
σ
L
e
a
n
Variation
Reductio
n
Waste and
Flow Issues
Simple Problems
C
o
m
p
l
e
x
i
t
y
o
f
I
s
s
u
e
What Makes a Good Six Sigma Project?
• There is no known solution
• The root cause is not known
• The problem is complex and needs statistical
analysis
• The problem is part of a process
• The process is repeatable
• A defect can be defined
• Project will take 3-6 months
• There are data available
The DMAIC Methodology
• Define – describe the problem quantifiably and the
underlying process to determine how performance will
be measured.
• Measure – use measures or metrics to understand
performance and the improvement opportunity.
• Analyze – identify the true root cause(s) of the
underlying problem.
• Improve – identify and test the best improvements that
address the root causes.
• Control – identify sustainment strategies that ensure
process performance maintains the improved state.
Define
• Define Scope of the Problem
– Document the Process
– Collect and Translate the Voice of the Customer
• Determine Project Objective and Benefits
– Define Metrics and Defects
– Establish Preliminary Baseline
– Develop Problem & Objective Statements
– Estimate Financial Benefit
Define (continued)
• Create Project Charter
– Confirm Improvement Methodology
– Define Project Roles and Responsibilities
– Identify Risks
– Establish Timeline
– Managerial Buy-in
• Focus here is on the problem
Measure
Measure what is measurable, and make measurable what is not so” – Galileo
• Define “As Is” process
– Value stream map/process flow diagram
• Validate Measurement System for Outputs
– Don’t assume your measurements are accurate –
measuring system must accurately tell what is
happening
• Quantify Process Performance
– Collect data (Y’s)
– Examine process stability/capability analysis
“Before”
“Before”
Analyze
• Identify Potential Causes (X’s)
• Investigate Significance of X’s
– Collect data on x’s
– Graphical/Quantitative analysis
•
•
•
•
•
Pareto Chart
Fishbone Diagram (cause and effect)
Chi Square Test
Regression Analysis
Failure Mode Effects Analysis
• Identify Significant Causes to focus on (y=f(X))
– Evaluate the impact of x’s on y
• Here you identify the critical factors of a “good” output and
the root causes of defects or “bad” output.
Fishbone (Cause and Effect) Diagram
Requesting MD
Bed Assignment
Bed Flow not contacted
Know criteria
Appropriate admit
No appropriate workup
Know Criteria
documentation
alternatives
Ability to follow
recommendations
Use of IQ tool
workup
LOC available
documentation
Know criteria
Outpatient option
alternatives
Medical necesity
Know criteria
Patient
Facility
Orders written
Admitting MD
Admission
NOT
meeting IQ
criteria
Cause and Effect Matrix (Root Cause Analysis)
Process Step
order-exam
order-exam
order-exam
order-exam
order-exam
order-exam
order-exam
order-exam
order-exam
order-exam
order-exam
order-exam
order-exam
order-exam
order-exam
order-exam
order-exam
exam
exam
exam
exam
exam
exam-complete
exam-complete
exam-complete
exam-complete
exam-complete
exam-complete
Process Input
allergy assess
Cr assessed
order print
order approval
appropriate order
communication to RN
RN availability
Pt availability
Pt acuity
IV access
Oral contrast ordered
contrast available
supervision
transport
wc stretcher avail
check in
ordering resident education
IV contrast infusion
transfer to CT scanner
release of images
CT tech avail
Ct scan availability
radiology resident availability
queue of exams
PACS availability
radiology attending availability
radiology resident education
radiology attending education
CT order
to exam
time
Exam to
Complete
time
Accuracy
of CT
order
Accuracy
of CT
Report
<-- Process Outputs
10
8
6
9
<-- Importance
Correlation of Input to Output
3
3
7
9
4
10
10
8
9
6
4
3
8
8
8
2
6
2
1
0
9
9
4
0
0
3
0
0
Total
0
0
0
0
0
0
0
0
5
7
2
9
9
0
0
0
0
0
0
0
7
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
8
7
7
9
2
0
0
0
0
0
0
0
0
7
0
0
0
0
0
3
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
6
9
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
60
72
82
144
157
100
100
80
90
60
40
30
80
80
80
20
102
20
10
25
90
90
122
56
56
102
76
81
Improve
• Generate Potential Solutions
• Select & Test Solution
• Develop Implementation Plan
Control
• Create Control & Monitoring Plan
– Mistake proof the process
– Determine the x’s to control and methods
– Determine Y’s to monitor
• Implement Full Scale Solution
– Revise/develop process
– Implement and evaluate solution
• Finalize Transition
– Develop transition plan
– Handoff process to owner
“After”
P Chart of Combined Number Meeting Criteria by phase
baseline PFC
0.9
Handoff
Control
UCL=0.8589
_
P=0.8012
0.8
Proportion
1
LCL=0.7435
0.7
0.6
0.5
1
3
5
7
9
11
Sample
Tests performed with unequal sample sizes
13
15
17
19