Download Applying Lean Six Sigma to your Compliance Program

2/20/2014
Applying Lean Six Sigma to your Compliance Program
April 2, 2014
John Kalb, JD, CHC, CCEP
Operational Excellence Executive/ Compliance Officer
Kootenai Health
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Content
• Lean Six Sigma’s goals of reducing waste and variation can help improve organizational compliance
• An overview of the application of the methodology to understand how it supports a culture of compliance
• Learn specific tools that can be applied throughout your organization to increase standardization and compliance
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Lean Six Sigma Leadership Culture
• Honor and Respect People – your people have good ideas –
recognize and reward them for that – allow them to contribute through collaboration and empowerment
• Honor The Customer – they are the reason we exist – figure out what they want and make improvements and create standards around what they want
• Honor Standards – it is the “sustain” plan to keep things in compliance ‐ document what you do, do what you document and prove it in practice
• Error proof practices to ensure minimal regulatory intervention
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The Lean Six Sigma Difference – Change in Culture
LSS System Focus
• People are not perfect and will make mistakes
• System factors cause many negative events/ issues
• Reliable outcomes are obtainable with the right mix of people and processes
Traditional Individual Focus
• People who make mistakes are poor performers
• Systems performance will improve by removing poor performers
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The Lean Six Sigma Difference – Change in Culture
So, What Are Some Of The Barriers To Compliance?
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Poor Communication
Flawed Teamwork
No collaboration
Rushed Procedures
Time Pressure
Policies that are hard to follow
Inadequate Interfaces
Lack of error prevention expectations or accountability
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Overview of Lean Six Sigma Methodology
Lean
Eliminate Waste/ Improve Flow
Reduce cycle time
Lower complexity
Analysis of physical layout
Known Solutions
3 – 5 day deployment/
Six Sigma
Reduce defects & variability
High complexity
Unknown root causes/ solutions
Data driven control Strategy
4 – 8 month projects
implementation
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Benefits of Lean Six Sigma
Process Improvement
Before
Work Time (value add)
After
Wait and ‘Other’ Time
(no value)
Same value, Less time and Resource!
Business Improvement
=
Lean
Eliminate waste in and around Processes +
Eliminate defects in Processes Six Sigma
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Lean Processes that Operate at Six Sigma
Flow
Lean – reduce steps & waste
# of process steps
1
4
3
5
6
93.32%
99.38%
99.98%
99.999%
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61.63%
95.73%
99.97%
99.998%
10
50.08%
93.96%
99.96%
99.997%
40
25.08%
77.82%
99.00%
99.986%
100
0.10%
52.23%
97.70%
99.996%
300
0.00%
15.43%
93.26%
99.898%
700
0.00%
0.20%
84.97%
99.762%
1000
0.00%
0.00%
79.24%
99.661%
3000
0.00%
0.00%
50.15%
98.985%
Repeatability
Six Sigma – reduce defects & variability
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How reducing steps reduces defects
Rolled Throughput Yield
Patient A is treated in 3 Steps……
Triage
Diagnostic Testing
Diagnosis
YFP= 80%
YFP= 70%
YFP= 90%
Patient A
Treatment
Rolled Throughput Yield = Product of the First Pass Yields
YRT = (0.80) (0.70) (0.90) = .504 = 50.4%
Rolled Throughput Yield is the Probability That the Process to treat the Patient Will Produce Zero Defects
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A Brief History of the Toyota Production System ‐ Lean
It started in Japan at the Toyota Motor Company
1902: Sakichi Toyoda of the Toyota group, invented an automated loom that stopped anytime a thread broke.
1908: Henry Ford invents the moving assembly line and raises the daily wage to $5.00 ; continuous flow as a production method is created.
“ The thing is to keep everything in motion and take the work to the man and not the man to the work. This is the real principle of our production and conveyors are only one of many means to an end.” ‐ Henry Ford : Today and Tomorrow
Several decades later Taiichi Ohno, a production engineer at the Toyota Motor Company applied the same concept as he sought to eliminate waste, or non‐value added activities, within the Toyota organization. In addition to stopping production at every defect (Jidoka), he employed another key concept, JIT (just in time). Together, Jidoka and JIT are the pillars of the Toyota Production System, supported by a foundation of Heijunka (level loading) … the basis of Lean.
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Where Does Lean Come From?
1943 ‐ 1978
1978
1996
• The basic philosophy of Lean is to provide the customer with…
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What they want –
When they want it
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Using the absolute minimum resources
Key Terms
 Value ‐ an activity that administers care or provides a service or information to meet customer/ patient needs and requirements (usually something that the customer/ patient is willing to pay for)
 Value Stream Map – A graphic map of steps that occur from a request for a product or service to delivery of the product or service. Similar to a process map but with greater amount of detail – such as time taken, resources consumed, inventory etc.
 Value‐added – a step, activity or a process that is perceived to add value to the customer/ patient; it transforms the product or service
 Non‐value‐added– a step, activity or process that takes time, resources and/or space but does not contribute to adding value or satisfying customer/patient needs
 Value Enabling or Non‐Value‐Added Essential – a step, activity or process that does not add value but must be done, usually required either because of regulations or as a pre‐requisite to completing a value‐added step  Muda = Waste – anything that takes resources but creates no value for the customer, usually an excessive or unwanted step, resource, or activity
 TAKT Time – the rate at which a customer/ patient demands a product or service  TAKT Time is NOT Cycle time
 Pull – used to describe the customer/ patient generating the demand for service / product as opposed to the producer ‘pushing’ to the customer/ patient
 Kaizen / Kaizen‐event ‐ a Rapid Cycle Improvement ‐ 3‐5 days where actual changes are made (Action) i.e. processes are changed, equipment is moved etc.
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Lean Thinking Process
The 5 steps to Lean Thinking …
2 Map the Value Stream
Define value in from the customers perspective and express value in terms of a specific product
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Specify Value
Map all of the steps…value added & non‐value added…that bring a product of service to the customer
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Establish Flow
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Work to Perfection
The complete elimination of waste so all activities create value for the customer
The continuous movement of products, services and information from end to end through the process
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Implement
Pull
Nothing is done by the upstream process until the downstream customer signals the need
Four Rules of Lean
1. Work activities are specified to:
• Content – what is being done
• Sequence – in what order
• Timing – how long should it take
• Outcome – what are the expected measurable results
2. All connections must be simple and direct 3. Pathways are simple and involve as few steps and people as necessary
4. Continuous Improvement by those doing the work and as close to the problem as possible
• Assign corrective action and improvement
• Follow up on the previous day’s action items
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Toyota Production System
TOYOTA
• Pull Production
• TAKT Time Production
Jidoka
• Single Piece Flow
Just-in-Time
Toyota
Production System
• Autonomation
• Stopping at
Abnormalities
Heijunka
• Level Loading
• Sequencing
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Toyota Production System: Jidoka
Reasons to Stop a Process:
• Defective Material (Rapid Response Team)
• Material Shortage (Flash Sterilization)
• Equipment Breakdown
Andon Boards (Call Lights)
Sounds (Machine warnings)
Make everything visible to everyone:
• Expose waste
• Make standards clear
• Improve efficiency
The Lean Toolkit – Basic Lean Tools
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Identifying and Eliminating Waste
Value Stream Mapping (VSM)
Root Cause Analysis Using 5 Whys
5S
Spaghetti Mapping
Takt Time
Standard Work
Level Loading & Sequencing
Single Piece Flow
Daily Action Review
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The 8 Types of Muda (DOWNTIME) Defects
Work that contains errors,
rework, mistakes or lacks
something necessary
• Medication error
• Wrong patient
• Wrong procedure
• Scrap
• Rework
• Correction
Overproduction
Producing more than the
customer/ patient needs
right now
• Medications given early or testing ahead
of time to suit schedule
• Treatments done to balance hospital staff
or equipment workload
• Writing or entering the same information
many times
• Making copies of chart notes that are
not used
• Producing more to avoid set-ups
• Batch process resulting in extra output
• Copies of reports that are sent
automatically
Idle time created when
material, information,
people, or equipment is not
ready
Waiting for…
• Bed assignments
• Testing & Treatment, Discharge
• Patient lab test results
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Non-Utilized
Resources
Resources that either not
be used at all or not being
utilized to their full potential
• Staff not be utilized at their skill level
• Empty Beds due to no staff
• Excess Inventory on shelves
Transportation/
Motion
Movement of people that
does not add value
• Searching for patients
• Searching for meds and/or charts
• Gathering tools / supplies
• Handling paperwork
• Searching for equipment
• Sorting through materials
• Reaching for tools
• Waling to fax or copier machine many
times a day
More materials, parts, or
products on hand than the
customer/ patient needs
right now
• Bed assignments
• Pharmacy overstock / Lab oversupplies
• Specimens waiting analysis
• Patients in beds past discharge time
• Raw materials
• Work in process
• Finished goods
• Paperwork in process
People are not sure about
the best way to perform
work tasks
• Variation in practice patterns
• Unclear orders
• Unclear systems for reporting/
communicating
• Patients scheduled with incorrect
information
• Variation in way same activities are
performed
• No knowing what the next steps are
• Unclear systems for reporting/
communicating
Activities/ effort that adds
no value from the patient’s/
customer’s viewpoint
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Waiting
Inventory
Missing
Information /
Confusion
Extra
Processing/
Rework
Multiple bed moves
Redundant information gathering
Excessive paperwork
Unnecessary procedures
Multiple testing / Retesting
Waiting for parts
Waiting for inspection
Waiting for information
Waiting for others at meetings
Multiple cleaning of parts
Paperwork
Awkward tool or part design
Regulatory paperwork
Tasks that are no longer needed
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Waste examples that lead to compliance concerns:
• Data collection – process steps that do not add value for the patient. For example when in clinical trails there is the collection of extraneous data that will not be utilized in the study. This creates waste, risk and liability.
– Can the data collection be streamlined to remove the collection and retention of unused data?
• When communication of information and ideas is isolated or siloed within a company and/or departments.
• When the same information needs to be submitted separately to different regulatory agencies – and if they have different data definitions.
• Underutilization of staff to identify and help prevent defects
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Clues to Waste & Non‐Value Added Work
Remeasure
Remake
Recheck
Reevaluate
Recall
Redo
Repeat
Rework
Reissue
Return
Reship
Retest
Reject
Revise
Redesign
Retype
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Waste Observation Tool
Waste Observation Tool
VALUE STREAM/PROCESS NAME:
____________________________
DATE:
______________________
OBSERVER:
____________________________________________
LOCATION:
__________________
NO.
PROCESS
NAME
WASTE DESCRIPTION/OBSERVATION
D
O W N T
I
M E
TIME
(SEC)
1
2
3
4
5
6
7
8
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10
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12
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16
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In the next 24 hours, I will remove the Waste No. _________ and communicate to the affected people.
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Signature:________________________
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Ohno Circle Tool
• Explain the 8 wastes
• Stand in the same spot every day in the center of the workplace (gemba)
• Find wastes every day
• Identify Root Causes
• Remove at least 1 waste everyday
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Which of these add value for the customer
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Preregistration process call prior to procedure
Arriving and waiting for the nurse to call for you
Being walked to the exam room
Taking vital signs
Waiting for the doctor
Getting directions to the hospital
Finding your way to the lab to get blood drawn
Filling out billing information
Correcting the bill
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Which of these are compliance concerns
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Preregistration process call prior to procedure
Arriving and waiting for the nurse to call for you
Being walked to the exam room
Taking vital signs
Waiting for the doctor
Getting directions to the hospital
Finding your way to the lab to get blood drawn
Filling out billing information
Correcting the bill
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Value Steam Mapping
Why Value Stream?
INPUTS
The 7 Flows
1.
2.
2.
4.
5.
6.
7.
OUTPUTS
Your Hospital
TOTAL VALUE STREAM
• Understand current situation ‐ Big picture
• Ratio of Non‐Value to Value Added Time
• Exposes sources of waste ‐ not just waste
• Shows linkage between the 7 types of flow
Patients
Communication
Supplies
Information (What and When)
People (Std. Work, Takt Time)
Equipment (Portable X‐Ray, EKG, etc)
Specimens
Guidelines for Mapping
• Start at the customer and work backwards
• Walk the actual flows
• Don’t map the organization but map the flow through it
• Identify value added and non‐value added steps (muda or waste)
• Identify where to focus analysis of activities
• Don’t be too detailed this is an overview
•Use pencil not power point…quick and crude
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Value Steam Mapping
Example: Cath Lab Value Stream Map
Inpatient
Reception
Registration
Check‐in
0‐5 Pts.
Admitted
Pre‐Cath
Recovery
Cath Lab
122
69
135
233
8 300 10
133
38
10
431
120
96
Discharged
336
78
960
2201
Eliminate waste in and around processes 26
Three Versions of Value Stream Map Processes
What You Think it is
What it Actually is:
What You Would
Like it to Be Current State VSM is created from the patient/customer’s perspective (i.e. walk the process). The process to develop and map concepts for the Future State provides a gap analysis between where you are and where you need to go and helps to determine the improvement strategy.
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Root Cause Analysis (RCA)
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Root Cause Analysis (RCA)
A process for identifying the basic or causal factors that underlie variation in performance, including the occurrence or possible occurrence of a defect
Why Conduct an RCA:
• To identify the processes and systems related to the occurrence as well as the proximate cause of the event
• Leads to an improvement in processes or systems
• Decreases the likelihood of similar events in the future
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Root Cause Analysis (RCA) – 5 Whys Tool
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A simple and widely used tool
Team asks/ considers “why” at least five times
Agree on root cause
Develop action plan for improvement
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Root Cause Analysis (RCA) – 5 Whys Tool
Department/Area:
Initiator: Date: Issue/General Information : Occurrences: Why #1: Why #2: Why #3: Why #4: Why #5: Temporary Countermeasure:
1.
Final Countermeasure: Ask WHY a final time: Read backwards after completion. Does the analysis make sense?
Circle One: Yes No
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5S
What is 5S?
Sort
Simplify
Shine
Arrange & Prioritize ‐ Distinguish needed and unneeded items
• Integrate 5S Principles into daily work.
Prevent Problems from occurring ‐
• Communicate need for 5S, roles of all arrange and identify needed item for participants.
ease of use
• Be consistent in following 5S in all areas Inspect and Clean up area daily
• Leadership involvement at all levels
Standardize Establish Orderliness/ Standards/ clearly define tasks
Sustain
Keys to Success
• Get everyone involved.
Discipline to maintain established procedures – audit area
• Follow through ‐ 5S takes effort & persistence.
• Link 5S activity with all other initiatives. 32
5S
Create Standards … Detect Abnormalities
Look Here …
• 5 cowboys to drive 1000 cattle
• Should take one look and understand the situation
• Clearly differentiate between what is “Normal” and “Abnormal”
• Detect what is “Abnormal”
Not Here …
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5S
Classifying Supply Locations By Frequency of Use
Tag based on Frequency
Priority Frequency of use
How to Store
Low
Less than once a week
Throw away !!
Store in distant place
Medium
Once a week Store together or somewhere in department
High
Once a day
once per takt time
Carry or keep at
individual work place
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5S Tool
Item # and
Description
Item Score
( 0 ‐ 5 )
Five S Evaluation Form
1
Removing unnecessary items
2Storage of What is the team doing to
improve to the next level?
All paperwork, supplies, tools, equipment, cabinets, stands etc not required for performing operations are removed from the area. Only tools and product are at work stations.
All cleaning equipment is stored in a neat, orderly manner,
handy and readily available when needed.
Cleaning
Equipment
3
All floors are clean and free of debris, oil and dirt.
Cleaning of floors is done routinely ‐ daily at a minimum ‐
a posted schedule or checklist is present.
Floor Cleaning
4
All bulletin boards are arranged in a neat and orderly
manner. No outdated, torn or soiled announcements
are displayed.
Bulletin Boards
5
Emergency Access
6
Fire hoses and emergency equipment are unobstructed
and stored in a prominent easy to locate area. Switches and breakers are marked or color coded for visibility.
Supplies and any other materials are not left to sit directly on the floor. Large items such as boxes are placed on the floor in clearly identified and marked areas.
Items on Floor
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Aisles and walkways are clearly marked and can be
identified at a glance, lines are straight and at right
angles with no chipped or worn paint.
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Aisles are always free of materials and obstructions, nothing is placed on the lines, and objects are always
places at right angles to the aisles.
9
Storage of boxes, containers and material is always neat
and at right angles. When items are stacked, they are
never crooked or in danger of toppling over.
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All machines and equipment are neatly painted,
there are no places in the area less than six feet high that are unpainted.
Aisle‐ways
Marking
Aisle‐ ways
Maintenance
Storage and
Arrangement
Equipment Painting
Subtotal
For Page 1
Score 0 to 5 with 5 being the highest.
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5S Tool
Item # and
Description
Item Score
( 0 ‐ 5 )
Five S Evaluation Form
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Equipment Cleanliness
All machines and equipment are kept clean
by routine daily care.
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Controls of machines are properly labeled and critical
points for daily maintenance checks are clearly marked.
Equipment check‐sheets are neatly displayed and clean. 13
Nothing is placed on top of machines, cabinets or equipment. Nothing leans against walls or columns.
Equipment Maintenance
Equipment Storage
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Documents
Storage
Only documents necessary to the operation are stored at the work stations and are neat and orderly.
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All documents are labeled clearly as to content and
responsibility for control and revision. Obsolete or unused
documents are routinely removed.
Documents
Control
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Tools and Gages
Arrangement
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Tools, gages and fixtures are arranged neatly and
stored, kept clean and free of any risk of damage.
Tools and Gages
Convenience
Tools, gages and fixtures are arranged so they can be
easily accessed when changeovers or setups are made.
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Shelves are arranged, divided and clearly
labeled. It is obvious where things are stored, status
and condition is recorded.
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Work areas and desks are kept free of objects including
records and documents. Equipment is clean and
placed in their proper location.
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There is a disciplined system of control and maintained
at the highest possible level. It is the responsibility of
everyone to maintain this system and environment.
Shelves
Arrangement
Work area and Desk Control
5S Control and
Maintenance
What is the team doing to
improve to the next level?
Score 0 to 5 with 5 being the highest.
Subtotal
For Page 2
+ Subtotal
Page 1

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Spaghetti Mapping
• A diagram that shows the motion of the patient / family / care‐giver throughout the care experience
Not to exact scale
Guidelines for Mapping
•Obtain / draw a layout of the care area
•Observe first the patient as he/she goes from one station to another and draw on the layout
•Do not lift your pencil from the paper –
continuous flow
•Repeat for care‐giver & family
•Measure the total distance traveled and note
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Spaghetti Mapping
Shopper
Non‐shopper
Shopper
Non‐shopper
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Takt Time
Takt = Rate at which the Patient/Customer PULLS from you (the heartbeat of the org).
Takt = Total Available Time (in seconds) Total Patients seen in that time frame (Demand)
Ex. If there are 60 patients that come into an ED during a given shift, Takt time can be calculated as:
60 sec. x 60 mins. x 8 hrs. 60 patients
= 480 Secs.
In order to ‘keep up’ at the rate at which a patient walks into the ED, you would need to complete a patient treatment every 480 seconds
OR
Every 480 seconds there is a patient walking into the ED, so every 480 seconds, there should be one being discharged – or else there will be a wait
NOTE: This does not mean it only takes 480 seconds to treat a patient! It means that the slowest step in the process should not exceed 480 seconds, and if it does, there will be waits and bottlenecks.
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Standard Work
• Standardizes the way everyone does specific tasks
• Best process for quality, safety, compliance and efficiency
• Helps maintain control
• Makes it easier to expose and solve problems
“Everything should be made as simple as possible, but not one bit simpler”
‐Albert Einstein
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Standard Work Sequence
Standard Work Sheet
Standard Work / Combination Sheet
Standardized Work Job Instructions (SWJI)
easy to follow displays, placed where the work gets done, to ensure consistency
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Level Loading & Sequencing
Process Step
Ensures that all steps in a Value Stream operate at or below Takt
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Level Loading & Sequencing
Time
Takt Time
60”
By redistributing some of the tasks in Step D to A, B, and C …
A
(50”)
. .we can easily identify our target for improvement. If we reduce the cumulative Cycle Times for all the steps by 12 seconds, we can potentially reduce from four steps to three.
B
C
D
Step
(44”) (56”) (42”)
Time
Takt Time
60”
A
(60”)
B
C
D
Step
(60”) (60”) (12”)
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Single Piece Flow
Batch Production
Single Piece Flow
From: The Toyota Production System
Catches Defects too Late
• How many more do you have?
• Where are they in the process?
• What is the root cause?
Catches Defects Immediately
• You only have one
• You know where it occurred
• Resolve the root cause immediately
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Daily Action Review
• Series of interconnected, brief and structured daily meetings that:
• Compare actual to expected performance
• Assign corrective action and improvement
• Follow up on the previous day’s action items
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What is Six Sigma
• Measure of Quality
• Process For Continuous Improvement 47
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Understanding of Six Sigma
Sigma DPMO
Statistically
2
3
4
5
6
Six Sigma refers to a process that produces only 3.4 defects per million opportunities
308,537
66,807
6,210
233
3.4
Most U.S. Businesses Goal
Business Strategy An overall strategy that encompasses an organization’s quality philosophy. It sets the vision for achieving Six Sigma levels of quality in key processes and services.
Tools and Tactics
A set of statistical tools and a disciplined methodology used by specially trained individuals to improve processes by reducing variation and defects. 49
Measure of Quality
Every Human Activity Has Variability...
Mean
Lower
Customer Specification
Upper
Customer Specification
1
p(defect)
Target
Reducing variability is the essence of six sigma
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Measure of Quality
What is Sigma? Mean
Customer
Specification
BEFORE
6.6% Defects
3
w i d e
3
v a r i a n c e
Mean
Customer
Specification
6
AFTER
No Defects
6
slim variance
Patients don’t feel the averages, they feel the variation
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Six Sigma Quality
• 68% of data falls within 1 standard deviation of the mean
• 95% of data falls within 2 standard deviations of the mean
• 99.7% of data falls within 3 standard deviations of the mean
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Six Sigma Quality
Lets look at our “average” LOS for a procedure. Looking at
the last 30 patients we had an average LOS of 5 days.
What is the problem?
5 days
Is this what our patients are feeling? Is everyone getting out
in 5 days?
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Six Sigma Quality
No!
Lets look at a distribution of the actual data.
Frequency
2 days
5 days
8 days
It probably looks more like this with the
average being 5 days.
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Six Sigma Quality
We can see that there are a significant number of patients
getting out later and earlier. Either way this can be a
source of customer dissatisfaction & regulatory inquiry
LSL is 4 days
USL is 6 days
Frequency
2 days
5 days
8 days
Lets say that our patients & regulators are OK if they are out
between 1 day early and 1 day late. These are our spec
limits.
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Six Sigma Quality
Where are our defects, or, where are our dissatisfied patients?
LSL is 4 days
USL is 6 days
Frequency
2 days
5 days
8 days
If our standard deviation was 1day, then we would have 68% of
our patients getting out between 4 and 6 days AND 32% not.
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Six Sigma Quality
If we can reduce variation, we can reduce dissatisfied patients &
regulators
LSL is 4 days
USL is 6 days
Frequency
2 days
5 days
8 days
If our standard deviation was reduced to .5 day, then we
would have 95% of our patients getting out between 4 and
6 days
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Six Sigma Quality
Patient Wait Times (mins)
Starting Point
After Project
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18
6
23
5
8
16
19
33
11
29
6
10
12
4
10
13
10
20
13
17
13
Average
What We See
13 17
What Patients Feel
Mean
Variability
Big Change
25% improvement
… No Significant Change!
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Process for Continuous Improvement
Six Sigma provides a process based approach to continuous
improvement. It can be used to improve any process…
business, transactional or healthcare. 59
Process for Continuous Improvement
Six Sigma Methodologies
DMAIC: To improve any existing product or process Define
Measure
Who are the customers and what are their priorities? Analyze
What are the most important causes of the defects?
How is the process performing and how is it measured?
Improve
Control
How can we maintain the improvements?
How do we remove the causes of the defects?
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Process for Continuous Improvement
Formulating the Practical Problem
DMAIC
Steps A,B,C : CTQ’s, Charter, Process Map
“How do my customers look at me?”
DMAIC
DMAIC
Step 1 : Select the CTQ characteristic
Step 2 : Define Performance Standards
“What do I want to Improve?”
“What’s the best way to measure?”
DMAIC
Step 3 : Validate the Measurement System
“Can I trust the output data?”
Changing to a Statistical Problem
DMAIC
Step 4 : Establish Process Capability
“How good am I today?”
DMAIC
Step 5 : Define Performance Objectives
“How good do I need to be?”
DMAIC
Step 6 : Identify Variation Sources
“What factors make a difference?”
Developing a Statistical Solution
DMAIC
Step 7 : Screen Potential Causes
“What’s at the Root of the Problem?”
DMAIC
Step 8 : Discover Variable Relationships
“How can I predict the Output?”
DMAIC
Step 9 : Establishing Operating Tolerances
“How tight does the control have to be?”
Implementing the Practical Solution
DMAIC
DMAIC
DMAIC
Step 10 : Validate X Measurement Systems
Step 11 : Determine Process Capability
“Can I trust the in-process data?”
Step 12 : Implement Process Control
“How can I sustain the improvement?”
“Have I reached my goal?”
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Case Study – Surgical Services Equipment Availability
Pictures of Before State:
Blocked doorways/ clutter
Equipment in non‐sterile hallway
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Case Study – Surgical Services Equipment Availability
Pictures of Before State:
Expensive equipment in
vulnerable location
Egress blocked by equipment
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2/20/2014
Case Study – Surgical Services Equipment Availability
Improvements:
• Equipment moved to storage room on first floor – Relocated 2 pharmacy employee offices
– Removed expired equipment & supplies
– Moved vendor items to one location, initiating consignment process which vendors had been resistant to
– Added wall boards for more efficient storage
– Taped floor for access to door and where equipment goes
– Put pictures of items on wall to indicate where it goes in room; also put picture in old location with note indicating where it is now located
• Created equipment transport process
– Tagging process so equipment is no longer just left in elevator due to not knowing the clean or dirty status of equipment
– Now know what equipment is going up (clean) and going down (dirty)
– Included involvement of Patent & Equipment Transport Team and Central Sterile team, in addition to Surgical Services Staff
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Case Study – Surgical Services Equipment Availability
Improvements:
• Renovated Darkroom located in Surgical Services
– Was rarely used, and had become unnecessary due to new technology
– Replaced water damaged wall and flooring that had created a great environment for growth – Fixed water drained that leaked into Unit on floor below
– Reconfigured open space with wall mount system which allowed relocation of supplies
• Renovated and reconfigured an exiting “work” (storage) room:
– Large 248 sq foot space with a lot of extra room that was underutilized
– Dropped par levels on supplies by over $3,000
– Removed cabinets and sinks, and expanded the doorway
– New open space allowed storing $3M of equipment that was formally stored old hallway – expensive, easily damaged equipment now in a protected area
– Able to outline floor to ensure storage locations are maintained
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Case Study – Surgical Services Equipment Availability
Pictures of After State:
Cleared Egress
Hallway cleared of clutter
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Tenants of Successful Lean Six Sigma Management
• The basis of management decisions should be long‐term vision and strategy, even if that is at the expense of short term gains
• Create a process to continuously bring problems to the surface
• Level out the work (The tortoise and the hare)
• Build a culture of stopping to fix problems and getting things right the first time
• Standardize processes and tasks to get to and maintain continuous improvement and front line empowerment
• Implement visual controls so problems will not be concealed
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Tenants of Successful Lean Six Sigma Management
• Use technology that serves your people and processes – do not become subservient to technology
• Develop leaders who understand the work, live the vision, strategy and values and teach it to others
• Develop excellence in your people an dteams
• Respect your extended network of partners and help them improve
• Go to the work (gemba) and understand the problem
• Make decisions slowly, considering all your options, but implement decisions rapidly
• Become a learning organization
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Ending Thoughts
• Tracking and trending data and issues will highlight issues that need to be brought better into compliance
• Standardized work and documentation will improve by involving the stakeholders
• Bringing a cross functional team together to resolve issues ensures a common approach and culture throughout the organization
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Self Assessment
What is your experience?
Lessons Learned
Successes
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Good judgment comes from experience, and a lot of that comes from bad judgment
– Will Rogers
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Application of Learnings
One Thing Learned………..
……….One Thing to Apply
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Ending Thought
It’s easier to behave ourselves
into a new way of thinking
than to think ourselves
into a new way of behaving.
Managing on the Edge, R. Pascale
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Questions
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Contact Information:
John Kalb, JD, CHC, CCEP
Operational Excellence Executive/ Compliance Officer
Kootenai Health
Phone: 208‐659‐5505
[email protected]
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