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1 Nuts & Bolts of PI-II at WBH •Understanding Performance Improvement •Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black Belt Beaumont University
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Page 1: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Nuts & Bolts of PI-II at WBH

•Understanding Performance Improvement

•Overview of Deployment Model

Presented by Jayant Trewn Ph.D., Faculty and Master Black BeltBeaumont University

Page 2: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Components of a Culture Change

Culture Change WBH StatusCriteria

Empower Staff to Enable Change Top Leadership Sponsorship

Provide a support structure for projects and frontline staff

Mentors and Experts - MBB, BBs and GBs on board

Self SustainingLearn - Practice - Train environment for Ybs

Structured ApproachPI-II Structured Project Guide

Method for spreadSnowball from grassroots campaign

Provide Knowledge and training Beaumont University

Motivation driven by rewardsLinked to Pay for Performance

Page 3: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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PI-II Environment

Cost

Green Belt

Lean Expert

Facilitator – Black Belt

Process Capability Lean/Waste

removal

COST

Margins

Cycle Tim

e6Quality

Page 4: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Performance Improvement Models

Improvement Model

Primary Theory Intended Effect

PDCA - Rapid Cycle Improvement

Improve performance through incremental process changes

Achieve pre-defined measures of success

Six SigmaReduce process variation

Reduce variation in complex processes

Lean Thinking Remove wasteCreate value-added processes

Page 5: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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PDCA Overview

Page 6: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Quality : the old view

•Products and services that are exactly to specifications

•In many cases even outside the specifications

Page 7: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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The TQM view• Products and services

that totally satisfy the customer’s needs and expectations in every respect on a continuous basis. In fact they do not just satisfy but delight the customer

Page 8: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Quality is customer delight

Page 9: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Q: What delights the customer?

• product quality• cost• delivery• service

•All these constitute Q

Page 10: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Total

• T = Quality of– all products– all services– all processes

– Team work - all employees -

working together to achieve Q

Page 11: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Management

• M = Management

– integrated approach

– proper problem solving methodology

– continuous improvement

Page 12: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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The TQM Model

TEI

JIT TQC

JIT : just when customer wants it exposes problemsTQC : problem solving methods kills problemsTEI : total employee involvement people are the key

World Class

Through continuous improvement

‘If you don’t improve youdeteriorate’

Through continuous improvement

World Class

Page 13: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Total Quality Control

TQC - The heart of TQM

Page 14: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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TQM vs. Problem

Water high -problems hidden

Water lowered -problems exposed

Water reduced -problems minimised

problems

Page 15: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Quality target

• Target is 100% not even 99.9%– 2-3 rail accidents every day– 25 bombs off target in Kosovo

Page 16: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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100% inspection

• “The necessity of training farm hands for the first class farms in the fatherly handling of farm livestock is foremost in the minds of farm owners. Since the forefathers of the farm owners trained the farm hands for the first class farms in the fatherly handling of farm livestock, the farm owners feel they should carry on with the family tradition of training farm hands of first class farms in the fatherly handling of farm live stock because they believe it is the basis of good fundamental farm management.”

Page 17: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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How to kill problems - PDCA

• Problem solving – seven steps– data - in god we trust, the rest of us bring data

• fact finding• 7+ 7 QC tools

• Continuous improvement - PDCA• Maintenance of improvement - process control -

average and variability• Systems and procedures - Standard Operating

procedures• People and systems - who is the problem?

Page 18: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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7 QC tools

• stratify data

• Pareto diagram

• cause and effect diagram

• histogram

• scatter diagram

• check sheets

• control charts

Page 19: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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7 new quality management tools

• Affinity diagram

• Interrelationship digraph

• Prioritization matrices

• Matrix diagrams

• Tree diagram (systematic diagram)

• Process Decision Program Chart (PDPC)

• Activity Network Diagram

Page 20: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Page 21: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Six Sigma Problem Solving

Page 22: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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What is Six Sigma?• A business philosophy and initiative that

enables World Class quality and continuous improvement to achieve the highest level of Customer Satisfaction. 1

• Yields dramatic bottom line results by redesigning and monitoring activities to minimize cost and resources

• Drives companies to reduce variation, increase quality, and generate increased customer responsiveness.

1Black Belt Memory Jogger, 2002 Goal/QPC and Six Sigma Academy

Page 23: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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• A comprehensive and flexible program for achieving, sustaining and maximizing business success that:

– Is uniquely driven by a clear focus on the “Voice of the Customer”

– Is founded in a rigorous use of facts, data and statistical analysis

– Provides for diligent attention on managing, improving and reinventing business processes.

– Is a management methodology with three perspectives:• A Measure of Quality• A Process for Continuous Improvement• An Enabler for Cultural Change

What is Six Sigma?

Page 24: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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• Six Sigma is a statistical measure that expresses how close a service process comes to its quality goal

• Six Sigma refers to a process that produces only 3.4 defects per million opportunities

Sigma DPMO Yield

2 308,537 69.1463%

3 66,807 93.3193%

4 6,210 99.3790%

5 233 99.9767%

6 3.4 99.9997%

A Measure of Quality:

Page 25: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Six Sigma Problem Solving

• Variation Reduction

• Project Management Tool

– Structured Project Guide

Page 26: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Six Sigma Vision

• Every project will contribute to profitability and meeting customer needs

• Need to balance needs of customer and company so both are happy

Six Sigma Strategy

Page 27: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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What is Six Sigma?• Drives your company to work in a proactive

mode and focus on prevention• Utilizes data and statistical tools to improve

processes

Page 28: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Six Sigma Roles

• Black Belts

• Master Black Belts

• Green Belts

• Executive Sponsors

• Champions

• Process Owners

Page 29: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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What is Variation?

Page 30: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Service Process Variation

• Variations in inputs to process

• Variations in process execution

• Variation in outputs of process

Page 31: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Defining KPOV and KPIV

Page 32: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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KPOV & KPIV

Y = f (x)

KPOVKey Process Output Variable

KPIVKey Process Output Variable

Page 33: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Output Measures (KPOVs) Performance outcomes More direct and short term Easy to quantify & dashboard-

ableProcess Measures (KPIVs) How effectively the process is

working Possible to Quantify

Key Process Output Variable

Customer Needs / DataCustomer

Needs / Data

SupplierSupplier InputsInputs ProcessesProcesses OutputsOutputs CustomerCustomer

Process Data

Process Data

Page 34: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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KPOV

ExampleOutput(s) Key Process Output Variable

Coffee

Strength

Aroma

Quantity

Taste

‘Hot-ness’

Page 35: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Input(s) Key Process Input VariableIngredient list Completeness

MilkFat Content

Quantity

WaterQuantity

Type - Ordinary (or) Mineral

SugarQuantity

Type - Sacrine, Sugar grains, Sugar cubes

Coffee Powder

Quantity

Chicory %

Type - instant or filter

KPIV

Page 36: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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KPIV Classification

Input Type Description

ControllableKPIVs that can be changed to see the effect on KPOVs, also known as knob variables

CriticalInputs whose variation will impact KPOVs

Uncontrollable(difficult / unable to control)

Input variables that impact the KPOV’s but are difficult to control.Example: Environmental variables such as humidity, temperature etc…

Not controlledInputs that are uncontrollable but chosen not to be controlled

Page 37: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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The Six Sigma Model

ProcessInput 1Input 2Input 3……..Input n

Noi

se 1

Noi

se 2

……

.N

oise

m

Output 1Output 2Output 3……..Output z

Uncontrollable factors

Co

ntr

olla

ble

fac

tors

Des

ired

Ou

tco

mes

Monitor KPOVsControl KPIVs

Absorb variation

PeopleMachines

Materials

Design Process

Methods

Page 38: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Example of The Six Sigma Model KPOV/KPIV

Set Processing

Clean SetComplete Set

Missing instrument listTimely set delivery

Organized as setReplacement instruments

Set tray

Bro

ken

Inst

rum

ent

Dam

aged

in

stru

men

t

Labeled SetNo missing instNo dirty instNo broken instSterilized inst

Uncontrollable factors

Co

ntr

olla

ble

fac

tors

Monitor KPOVsControl KPIVs

Absorb variation

CPD TechsORAs

Decon m/cSterlizer

Kim guardsSet Assy Procedure

Process: Preparing Carts in CPD for OR casesSub Process: Process Sets - Assembly

Des

ired

Ou

tco

mes

Page 39: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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DMAIC Methodology:

Page 40: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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1. Define Problem2. Identify

Customer3. Identify CTQ4. Map Process5. Refine Project

Scope6. Update Project

Charter

1. Identify Metrics2. Determine Data3. Develop Data Collection

Plan4. Collect Data

1. Select Analysis Tools

2. Graphically Represent Results

3. Identify Sources of Variation

1. Generate Improvement Opportunities

2. Select Best Alternative3. Map New/Improved

Process4. Conduct FMEA5. Pilot Solution6. Validate Improvement

1. Conduct Error-Proofing

2. Develop Long Term Measurement Plan

3. Implement Control Charts

4. Develop SOP and Training Plan

PDCA – Six Sigma MAP

Page 41: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Structured Project Guide

• What is a Structured Project Guide?– Structured approach – ensures success

• Objectives of guide– Plan– Guide– Track progress– Review– Evaluate– Document

Page 42: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Structured Project Guide Framework

• Tollgate Model – 8 Tollgates

– Travel to a Tollgate

– Pay Toll

– Start journey to next Tollgate

• Structured progress

• Progress tracking

– Tollgate reviews

Page 43: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Approach Guide Tollgates

• DEFINE

• MEASURE

• ANALYZE

• IMPROVE

• CONTROL

• Tollgate 1• Tollgate 2

• Tollgate 3

• Tollgate 4• Tollgate 5

• Tollgate 6• Tollgate 7

• Tollgate 8

Page 44: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Lean in Healthcare

Page 45: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Lean Thinking

Page 46: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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A. A. MilneWinnie-the-Pooh

Here is Edward Bear,coming downstairs now,

bump bump bump

on the back of his head,behind Christopher Robin.It is, as far as he knows, the only way of coming down stairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it.

Page 47: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Significant Sustainable Competitive Advantage

Lean Behavior

LeanThoughtware

The Concept Behind Lean Thoughtware...

Page 48: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Lean Thoughtware

1. Value can only be defined from the end user customers perspective (Value)

2. To deliver customer value, the “waste” must be removed from the customer delivery process. (Value Stream)

3. Once the waste is removed, the value must be linked together in a continuous flow (Flow)

4. The flow must deliver to the exact customer requirements (pull)

5. Additional waste is eligible to be removed (continuous improvement)

Page 49: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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A Customer Perspective …is a Lean Perspective

To be customer focused..an organization must be process and lean focused

“Our processes, more than our products or services tell us where and how we are best

prepared to compete"

Page 50: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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What is Lean?

Lean is a Disciplined, Process Focused “Production” System* whose objective is to minimize the consumption of resources that add no value to a product or service…meaning: Lean is the identification and elimination of “muda” or “waste”.

Page 51: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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About Lean

• The disciplined process focused production system known a Lean production was born out of the Toyota Production System

“ The Toyota production System, however is not just a production system. I am confident it will reveal its strengths as a management system…”

Source:T.Ohno, Toyota Production System (1988)

Page 52: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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5 Critical Concepts of Lean

Lean Thoughtware and Application are based on 5 Critical Concepts:

1. Specify Value

2. Identify the Value Stream

3. Make the Value “Flow”

4. “Pull” to Customer Demand

5. Pursue Perfection

Page 53: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

Source:Blackburn, Time Based Competition. 53

Not Just a Manufacturing thingAnalysis of Cycle times and Value Adding Activities in White Collar

Processes Source: Blackburn, Time Based Competition)

Industry Process Average Cycle time

Value Adding Time

% Value Added

Life Insurance

New Policy Application

72 hours 7 min 0.16%

Consumer Packaging

New Graphic Design

18 days 2 hours 0.14%

Footwear Prototype Development

25 weeks 2 days 2.60%

Commercial Bank

Consumer Load 24 hours 34 min 2.36%

Hospital Patient Billing 10 days 3 hrs 3.75%

Motor Vehicle Equipment

Financial End-of Month Closing

11 days 5 hrs 5.60%

Airframe MFR.

Engineering Change Orders

21 days 1.75 days 8.5o%

Page 54: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Nationally Known Healthcare Systems using Six Sigma

• BJC Healthcare• Catholic Healthcare West• Good Samaritan Health

System• Johns Hopkins• Mayo Clinic• New England Medical

Center in Boston• NewYork-Presbyterian

Hospital• North Shore Long Island

Jewish Health System

• St. John Health (SJH)• St. Jude Medical• Stanford University

Medical Center-Department of Radiology

• Trinity Health• University of Virginia

(UVA) Medical Center• M. D. Anderson Cancer

Center• Yale-New Haven Hospital

Page 55: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Organizations that admit to usingLean Techniques

• Toyota• General Motors• Dell• Oracle• Southwest Airlines• Mayo Clinic• University of Michigan Health

System

• DaimlerChrysler (LaSorda)• Ford Motor Company• Boeing• McKinsey & Company• U.S. Army• Lockheed Martin

Page 56: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Organizations that are teaching Lean Techniques

• Harvard• MIT• JCAHO• Purdue• University of Michigan• Oakland University• Oakland Community College• Institute for Healthcare

Improvement• AICPA

• GE Healthcare• Agency for Healthcare

Research and Quality• Michigan Center for Nursing• American College of

Healthcare Executives• American Society for

Healthcare Engineering

Page 57: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Page 58: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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What is Lean in Health Care?

“The endless transformation of waste into value from the customer’s perspective”.

Womack and Jones, Lean Thinking

Page 59: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Lean in Health Care?• Can healthcare use

- the Toyota Production System: - product development - production- supplier management - customer support- planning

- to transform waste into value?• Can a health system use:

- fewer inputs (time, human effort, materials) - than traditional care process - to produce a wide variety of “products” - with fewer “defects” more quickly with less stress?

• Lean is not about working harder or faster, it is about finding waste and transforming it into value our customers want.

Page 60: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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The 5 Steps of LeanCan Work in Healthcare

• Specify value from customer’s perspective• Identify the value stream for each product, and

remove the waste• Make value flow without interruptions from

beginning to end• Let the customer pull value from our process• Pursue perfection

– continuous improvement– Do this every day in all our activities

Source: Womack & Jones: Lean Thinking

Page 61: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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The clinic appointment• You call the clinic, go through 3 voice prompts, are

put on hold, and leave a message• The clerk calls you back and sets a date in 3 weeks• You arrive for the visit, check in, sit in waiting room• You are called into the exam room, wait for doctor• The doctor sees you, saying she’s been waiting for

you to arrive; diagnoses a URI, and BP is worse• The doctor prints an antibiotic prescription, goes to

the staffroom to get it. You are allergic to that drug. • You wait to pick up the prescriptions.• The doctor says she wants to see you back in a

week, no appointment is available.• The MA does an EKG.

Page 62: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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The clinic appointment• You call the clinic, go through 3 voice prompts, are

put on hold, and leave a message• The clerk calls you back and sets a date next week• You arrive for the visit, check in, sit in waiting room• You are called into the exam room, wait for doctor• The doctor sees you, saying she’s been waiting for

you to arrive; diagnoses a URI• The doctor prints an antibiotic prescription, goes to

the staffroom to get it. You are allergic to that drug. • The MA does an EKG.• At check out you ask the cost – clerk says they’ll bill

you

Page 63: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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The 5 Principles of Lean Work• Specify value from customer’s perspective

– A quick clinic visit• Identify the value stream for each product, and remove

the waste– Time on hold, callbacks, walking

• Make value flow without interruptions from beginning to end– No waiting

• Let the customer pull value from the process– Pull the appointment when you want it

• Pursue perfection– continuous improvement

– Every clerk, doctor and nurse works to redesign for better value to the customer

Page 64: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Diversity in Healthcare as a Challenge to Lean

• Large number of “product lines”– Adult vs. Peds– Specialty vs. Primary Care– Inpatient vs. Outpatient– Surgical vs. Non-surgical– Chronic vs. Acute Care

• “Each patient is unique”– More like a custom repair (job shop) than an auto manufacturer – Almost infinite variability in mix of diseases and symptoms– Variable: age, family, gender, race, social, insurances factors– Variable: health habits, tobacco/alcohol/drugs, compliance– Mental health as a primary or complicating problem– Patient preferences must be respected

Page 65: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Use Lean tools to transform waste into value from the customer’s perspective. Is There Waste (Muda) in Healthcare?

• Defects in products• Overproduction of goods• Inventories of goods

awaiting future processing or consumption

• Unnecessary movement of workers

• Overprocessing

• Unnecessary transport of goods

• Waiting(for process equipment to finish or on an upstream activity)

• Design of goods and services which do not meet users’ needs

Page 66: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Do the Eight Forms of Waste Make Sense at Beaumont?

Overproduction/Production of Unwanted Products:

Material Movement and Worker Motion:

Waiting:

Over-processing:

Inventory:

First Time Quality Problems: Defects requiring correction:

Wasted Creativity of Employees:

Page 67: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Decon Performance Improvement Project

Project Start 6/22/05

Project End 10/30/05

Page 68: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Problem Statement

• Workflow in CPD Decon does not capture priority sets to be cleaned.

• Missing instruments from sets in Decon have never been tracked and reported back to OR Surgical Services.

• No consistent policy for how things should be done in the Decon area.

Page 69: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Project Goals

• To optimize work flow in the Decon area.• Create a system to prioritize sets for

cleaning as they enter the Decon area.• Create a system to track and report

missing instruments from sets and reduce instrument loss.

• Create a clear policy and procedure book for the Decon area to promote consistency.

Page 70: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Processes and Tools Used

• Data Collection

• Voice of Customer

• Pareto Charting

• Flowcharting

• QFD Function Matrix

• Lean/Six Sigma Tools

Page 71: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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Value Chain Concept

Instrument Flow

1. Complete Sets- Include Pans2. Send Carts ASAP3. Enzymatic Spray - Rinse

Instruments4. Organize Sets5. All Sharps Removed6. Return Paperwork7. Feedback on Priority sets8. Feedback on Missing Instruments

1. Complete Sets2. Clean Sets3. Organized Sets4. Paper pulled out of sets5. Sets received in timely manner6. Indicate missing instruments from

sets.7. Priority Set Marker8. What time set needed for next case9. Remove extra instruments

OR DECONTAMINATION PROCESSING

Supplier Customer

Supplier

Customer Supplier

Customer

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Value Added

Non Value Added

12 3 4 5 6 7 8

1. Cart arrives in Decon2. Cart & Set Scanned “Decon

Received”3. Wheel Cart to work Station4. Sets scanned “Set for Decon”5. Load Sets onto workstation6. Separate out hand wash7. Count instruments & string and

clean8. Cart goes to washer9. Waiting, Idle Time

9 9 9 9 9 9 9

Time

Wait times between Value Added StepsTotal Non Value Added 33:40 min.

Total Value Added 21:00 min.

Cycle Time AnalysisDecon Process VA/NVA

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Discussion

• Lean in your department – relate lean to one process of your department and discuss opportunities

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PI-II Implementation

Management of Change

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The path of the calf• Once upon a time there was a calf. One evening he walked home through a

thick jungle. The distance to his home was only one kilometer but he walked three kilometers since, like all calves, he wandered here and there, left and right, up and down.

• The next morning a shepherd’s dog passed that way and saw the calf’s hoof marks, and followed the path of this calf through the woods. Shortly after, the first sheep of a flock followed the path and behind him all other sheep. Thus a path was made through the wood.

• Men began to use that path, cursing its twists and turns as they did, but doing nothing about it.

• The path gradually became a lane, the lane became a road and horses and bullock carts followed it - followed the steps of the wandering calf.

• A century later the road became a street, and then a city’s crowded thoroughfare, with thousands following in the footsteps of the wobbly calf.

• Three centuries later the road became a street, and then the main street of a very large city, Buses, lorries, trams and cars followed the zigzag path of the calf.

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Integrated approach to TQM is most necessary

– Two levels of implementation• Everyone involved - continuous

improvement - small improvement/GHK programme - mass movement

• Big problems - cross functional groups– data based – seven steps– group leadership and facilitation

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PI-II Program Model• Knowledge Ref: Page 2 of PI-II concept document

– BU sponsored and managed curriculum

– Progression driven course delivery

– Management Development and Leadership Development courses to supplement PI curriculum

• Tools and Aids

– PI-II structured project guide

– Progression path YB -> GB -> BB -> MBB

– Support structure for learners

• GB supported by BB and BB supported by MBB

• People Ref: Page 3 of PI-II concept document

– Empower employees to participate in change – YBs

– Empower Supervisors to drive change linked to champion goals – GB

– Empower experts to facilitate change – BB

– Empower leaders to align goals and objectives to organization strategic plans – Champions

• Motivation

– Tied to Pay for Performance

• Rewards

– Six Sigma and Lean methodology as enablers (means to achieve) of Pay for Performance objectives

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PI-II Model launch

Time

Frame Projects PhaseYellow Belts

Green Belts

Black Belts

Existing 40-60

New 30Existing 4-

8

New 40

Existing 100

Existing 30

Existing 8-12

New 200 New 60 New 20

Existing 200

Existing 100

Existing 30

New 400 New 60 New 20

Existing 600

Existing 160

Existing 50

New 600 New 60 New 20

Current Engage

ment

GB 12BB 10

20102/quarter

/deptOn-Going

Rolling15-202008

2009 60 Snowballing

Staff Engagement

2nd Half 2007

4-6Early

Grassroots

Current PoolYB 90GB 12 BB 21

Ref: Page 3 of PI-II concept document

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Current GB Projects1  Reduction in biling concern/call routing (Service Excellence - Corporate)

Green Belts:  Marie Baloga & Julie MorseBlack Belts:  Wendy Dingwall and Kristen Cavender

 2  Reducing/eliminating duplicate chart requests (PT/OT - Troy)

Green Belts:  Elizabeth Van Hoek & Karol ClasonBlack Belts:  Jayant Trewn

 3  Reducing wasted bone products ordered for surgery from the Blood Bank (Blood

Bank - RO)Green Belts:  Randy Sprouse & Anne SepienzaBlack Belts:  Judy Easter & Brian Vargo

 4  Reducing Critical Call turn-around time for critical lab values (Lab - RO)

Green Belts:  Bob Church/Terre St. Peter/Connie DiggsBlack Belts:  Grace Bostic & Salil Balar

 5  Entering accurate and complete data into HR database (HR - Corporate)Green Belts:  Jean Ann Larson/Carol Holth/Ludmilla TscherniwetzBlack Belts:  Eric Ellerholz/Ron Grant

 6  Eliminating missed tests/orders (BRL - RO)

Green Belts:  Bonnie Fegley/Sherri D'AnnaBlack Belts:  Pam Meyer

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PI-II Delivery Structure

Champions & Sponsors

Yellow Belts

Green Belts or

Lean Expert

Black Belts

Role

Empower department leaders and frontline staff to improve department performance

Participate in PI projects

Lead PI projectsFacilitate PI projects

Motivation

Vehicle to set departmental goals and objectives tied to organization strategy

Feel empowered to make a change/improve performance

Tool to achieve pay for performance objectives

Tie practice to pay for performance objectives

RewardLink manager pay for performance objectives to champion objectives

Celebrate project success

Achieve pay for performance objectives - various

Achieve pay for performance objective - 2 successful projects per year

Ref: Page 2 of PI-II concept document

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PI-II Progression MatrixRecomme-

nded Project activity

Commit-ment per

project 1

YBPI - 100PI 200PI 300YB Cert

Participate in atleast 1 project per year

2 hours/week + assigned project work

GB orLean Expert

YB + 2 projects as team memberORSupr/Mgr/DirANDGB class + Cert

Lead 1 project per trimester

2 hours/week + assigned project work + project mgt

BBGB + 2 projects as leaderandBB class + Cert

Facilitate 1 project per trimester

2.5 hrs per week

MBB Appointed by leadership

Guide 10 projects per trimester

0.5 hour per project per week

Expert Progression Matrix Expert Expectation

Notes: 1 Expected effort for teams with novice GB and or BB, will be less for mature teams

Ref: Page 3 of PI-II concept document

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PI-II Team Composition

8-10 Yellow Belts

1 Green Belt

Six Sigma Project Team Facilitator – 1 Black Belt

Coach – Master Black Belt

Ref: Page 2 of PI-II concept document

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Typical P Project Lifecycle

• Define 2 sessions 1 Month

• Measure 1 session 2 weeks

• Analyze 2 sessions 1 Month

• Improve 2 sessions 1 Month

• Control 1 session 2 weeks

• Documentation 1 weekAnticipated timelines – some projects may take longer or shorter dependent on thematurity of the process (defined process, available data, etc.) and maturity of team members

Page 84: 1 Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black.

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PI-II Project Implementation Tool

Structured Project Guide (SPG)

• What– Structured project PLAN– Embedded TEMPLATES/TOOLS

• MethodWhen What

– TIMELINE driven TASKLIST How Who– TEMPLATES and RESPONSIBLE Person

• Use– Champion and MBB Project Tracker

– BB Project Facilitation tool

– GB Project guide and documentation tool

– YB Tools and templates

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PI-II Project Support Structure

Support list with contact info on BU• Master Black Belt support

– E-Mail/phone/consult support for Black Belts– Guides – weekly ½ hr project reviews with Black Belts/GBs– Monthly 2 hour open house – Q&A for Black Belts

• Black Belt Support for Green Belts– E-Mail/phone/consult support for Green Belts– Project facilitation – facilitate 6 projects – 2 hrs per week

• Green Belt Collaboration– HPIC/HCBC monthly lunch & learn meetings – share

experiences– Quarterly GB colloquiums – Q&A with BBs and MBB– Annual 6s symposium – hear and learn

Ref: Page 5 of PI-II concept document

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PI-II CurriculumBU Course #

Course NamePI II

TrackCourse Length

Pre-requisite

Nursing Contact Hrs

OfferingClass size

Comments Course Status

Yellow Belt Curriculum

PI 100 Performance Improvement 100 Yellow 3.5 hours None Yes3 each

trimester, 9/yr35 Implemented

PI 200 Performance Improvement 200 Yellow 4 hours PI 100 Yes3 each

trimester, 9/yr35 Implemented

PI 300 Statistics and Control Charts Yellow 3 hoursExcel course

or quizYes

3 each trimester, 9/yr

15 Revised May 07

PI 5000 Root cause Analysis Elective 2.5 hours None1 each

trimester, 3/yr20 Implemented

Leader Curriculum

PI 350Intro to Six Sigma for Project Sponsors and Champions

Sponsor 4 hours None1 each

trimester, 1/yr35

To be developed/ Target rollout Sept 07

Lean Curriculum

PI 400 Lean Tool Kit Lean 16 hours PI 100 -3001 each

trimester, 1/yr35

Pilot in progress/ Target rollout Oct 07

PI 500 Voice of Customer / Quality Function Deployment

Elective 4 hours PI 100 - 3001 each

trimester, 1/yr35

Pilot revision/ Target rollout Oct 07

Green Belt Curriculum

PI 600 Green Belt Green6 weeks/24

hoursPI 100 - 300

1 each trimester, 1/yr

25Pilot revision/ Target rollout Oct 07

PI 650 Internal SSGB Exam Green 4 hours1 each

trimester, 1/yr25

May be substituted with ASQ SSGB Certification

To be developed/ Rollout Oct 07

Black Belt Curriculum

PI 700 FMEA Elective 2 hours None Yes1 each

trimester, 1/yr35 Implemented

PI 800 Black Belt Black8 weeks/32

hoursPI 100 – 300,

600, 6502/yr 20

To be developed/ Rollout Jan 08

PI 900 SSBB Project Completion Black2 completed

projects as GBSPG Pilot

PI 1000 Internal SSBB Exam Black 4 hours 2/yr 20May be substituted with ASQ SSBB Certification

To be developed/ Rollout Jan 08

Master Black Belt Curriculum

PI 1100 Six Sigma Project Completion Master TBD TBDTo be developed/ Rollout Sept 08

PI 1200 Six Sigma Project Completion Master TBD TBDTo be developed/ Rollout Sept 08

PI 1300 Mentor Black Belt Project Master TBD TBDTo be developed/ Rollout Sept 08

Investigate internal vs external curriculum

Course available Pilot course available Course needs to be rebuilt No course material available

Ref: Page 4 of PI-II concept document

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Certification Proposal

• YB – Certified on completion of PI 100 + 200 + 300 & on-line test

• GB (Progression certification)

– Class + on-line test - multiple choice (certificate applicant)

– Lead 1 successful Project (certificate candidate)/mentored

– Internal Test (Certified – problem solving scenario test for GB)

• BB (Progression certification)

– Class (certificate applicant)

– Facilitate 1 Project (certificate candidate)/mentor

– Internal Test – written 4 hour with problems (Certified)

• Lean (Application certification)

– Class (certificate applicant)

– Lead 1 successful Project (certificate candidate)

– Internal Test – written 4 hour with a practical test/lean case (Certified)

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BU Course # Course Name Plan Faculty Date Time Max Location Classroom Backup Faculty

PI 100 Performance Improvement 100 Sep-07 Grace Bostic 9/21/07 AM 35 Royal Oak ro_abwest_ll_Clsrm3_Seats35 Lynn Farr

PI 100 Performance Improvement 100 Sep-07 Kristen Cavender 9/10/07 AM 25 Troy Troy_Hosp_LL_Clrm3_Seats25 Kim Lemieux

PI 100 Performance Improvement 100 Oct-07 Grace Bostic 10/29/07 AM 35 Royal Oak ro_abwest_ll_Clsrm3_Seats35 Kristen Cavender

PI 100 Performance Improvement 100 Nov-07 Grace Bostic 11/13/07 AM 35 Barnum BARNUM_Mezz2_ClsrmCD_Seats35 Lynn Farr

PI 100 Performance Improvement 100 Nov-07 Kim Lemieux 11/9/07 AM 25 Troy Troy_Hosp_LL_Clrm1_Seats25 Kristen Cavender

PI 200 Performance Improvement 200 Sep-07 Randy Sprouse 9/21/07 PM 35 Royal Oak ro_abwest_ll_Clsrm3_Seats35 Lynn Farr

PI 200 Performance Improvement 200 Sep-07 Kristen Cavender 9/10/07 PM 25 Troy Troy_Hosp_LL_Clrm3_Seats25 Kim Lemieux

PI 200 Performance Improvement 200 Oct-07 Kristen Cavender 10/29/07 PM 35 Royal Oak ro_abwest_ll_Clsrm3_Seats35 Kim Lemieux

PI 200 Performance Improvement 200 Nov-07 Randy Sprouse 11/13/07 PM 35 Barnum BARNUM_Mezz2_ClsrmCD_Seats35 Jayant Trewn

PI 200 Performance Improvement 200 Nov-07 Kim Lemieux 11/9/07 PM 25 Troy Troy_Hosp_LL_Clrm1_Seats25 Kristen Cavender

PI 300 Statistics and Control Charts Jul-07 Charles Phillips 7/10/07 AM 16 Troy Troy Computer Classroom

PI 300 Statistics and Control Charts Jul-07 Jayant Trewn 7/17/07 AM 16 Barnum Computer Trg Room #2

PI 300 Statistics and Control Charts Jul-07 Jayant Trewn 7/24/07 AM 16 Barnum Computer Trg Room #2

PI 300 Statistics and Control Charts Sep-07 Wendy Dingwall 9/27/07 AM 25 Barnum Computer Trg Room #2 Jayant Trewn

PI 300 Statistics and Control Charts Nov-07 Mike Meitzner 11/2/07 AM 16 Troy Troy Computer Classroom Jayant Trewn

PI 300 Statistics and Control Charts Nov-07 Wendy Dingwall 11/14/07 AM 25 Barnum Barnum Computer Classroom 2 Jayant Trewn

PI 310 Basic SPSS Jul-08 Jayant Trewn 7/19/08 AM 10 Barnum Computer Trg Room #2

PI 5000 Root Cause Analysis Sep-07 Lisa Wiethorn 9/19/07 9-11:30 am 25 Troy Troy_Hosp_LL_Clrm2_Seats25

PI 5000 Root Cause Analysis Nov-07 Lisa Wiethorn 11/16/07 1-3:30 pm 25 Troy Troy_Hosp_LL_Clrm1_Seats25

PI700 FMEA Jun-07 M. Getzinger/L.Wiethorn 6/22/07 AM 25 Troy Troy_Hosp_LL_Clrm2_Seats25 Jayant Trewn

PI 700 FMEA Sep-07 M. Getzinger/L.Wiethorn 9/7/07 9-11:00 am 25 Troy Troy_Hosp_LL_Clrm2_Seats25 Jayant Trewn

PI 700 FMEA Nov-07 Randy Sprouse/Jayant Trewn 11/30/07 9-11:00 am 25 Royal Oak RO_ABWest_LL_Clsrm3_Seats35 Monique Getzinger

PI600 Six Sigma Green Belt Sep-07 Jayant Trewn 9/10/07 AM 25 Barnum Barnum_Classroom_C/D_Seats25

PI-II Course Work Scheduling 2007-2008

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Q & A


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