2. “We don’t know what we don’t know.
We can’t act on what we don’t know.
We won’t know until we search.
We won’t search for what we don’t question.
We don’t question what we don’t measure.
Hence, we just don’t know.”
Dr. Mikel Harry
3. Quality
“An essential requirement of… products is that they meet
the needs of those members of society who will actually
use them. This concept of fitness for use is
universal…The popular term for fitness for use is quality,
and our basic definition becomes quality means fitness
for use.”
- J. M. Juran
6. THE EVOLUTION OF
AWARENESS
• IOM - resulted in the report To Err Is Human:
Building a Safer Health System.
• Quality of Health Care in America Project
7. • 44,000 to 98,000 Americans die each year as a result
of medical errors in hospitals.- 1998
• A second major report by the IOM’s Committee on the
Quality of Health Care in America—Crossing the
Quality Chasm
8.
9. Quality in Healthcare
“Degree to which health services for individuals
and populations increase the likelihood of
desired health outcomes and are consistent with
current professional knowledge”.
- IOM
10. SIX SIGMA
• Six sigma is a business statistical Strategy identifying
defects and removing them from the process of
products to improve quality using Statistical measures.
• A defect is defined as any process output that does not
meet customer specifications.
11.
12. History
• Carl Fredrick Gauss (1777-1855), who introduced the
concept of the normal curve or distribution.
• Walter Shewhart introduced three sigma as a
measurement of output variation in 1922
13. HISTORY
• The Six sigma was founded by Motorola in the 1980s.
• They founded a connection between increases in
quality and decreases in costs of production.
• Bill Smith, “Father of six sigma” introduce this quality
improvement Methodology to Motorola.
• Malcom Baldrige National Quality Award (MBNQA)-
1988
14. • Quality management program developed by Motorola
in the 1980s.
• Management philosophy focused on business process
improvements to:
• Eliminate waste, rework, and mistakes
• Increase customer satisfaction
• Increase profitability and competitiveness
15. Sigma (S.D)
• Standard Deviation shows the variation in
data. If the data is close together, the standard
deviation will be small. If the data is spread out,
the standard deviation will be large.
• Standard Deviation is often denoted
by the lowercase Greek letter sigma
16. Standard Deviation Formula
The standard deviation formula can be
represented using Sigma Notation:
2
( )x
n
Notice the standard deviation formula is
the square root of the variance.
17.
18. 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
21. Define
• Identify the customer and which type of a product and
hope from it. These are analyze by using flow
cause/effect diagrams, check sheets, pareto analysis.
22. 2. Measure
• Collect the baseline data to determine where the
process stands as compare to where it needs to be
• Quality characteristics an estimate current process
capability.
• Then find out the current sigma level according to
those identified characteristic that are mostly important
to the customer
23. Analyze
• This shows the amount of improvement necessary to
make the Critical to quality characteristics the best in
the industry.
• For this phase -descriptive statistical methods like
mean, mode, median…etc.
24. Improve
• Implement the suggested improvements in this phase
and also test possible solutions to the process
problem.
• Collect data from the all possible solutions and test
them on a small scale
• Then choose the best solution
25. Control
• Measures are implemented to ensure improvements
are maintained.
• To monitor the process improvements, basically use
tools like statistically process control charts.
• Monitor the process to ensure that the process is in the
control limits.
26. what is LEAN ?
• The term “Lean Thinking” was coined by James P.
Womack and Daniel T. Jones in their book, Lean
Thinking
• The goal is to minimize work and all non- value adding
activities to increase value and reduce opportunities
for defects and errors
• Customer satisfaction increases and production costs
decreases
27.
28. Goals of LEAN
• Eliminate waste ( or in Japanese “muda”)
• Improve Quality
• Reduce operating cost
• Manage Inventory control
• Toyota Management System ( TMS)-1960s
29. What Is Typically Found
Lean Value Stream Management starts with defining
value in terms of products and process capabilities to
provide the customer with what they need at the
right time and at an appropriate price.
Value
added
Non-value
added/waste
30. 8 wastes - Lean
1. Overproduction—making or doing more than is
required or earlier than needed.
2. Waiting—for information, materials, people,
maintenance, etc.
3. Transport—moving people or goods around or
between sites.
4. Poor process design—too many/too few steps, non-
standardization, inspection rather than prevention,
etc.
31. 1. Inventory—raw materials, work-in-progress, finished
goods, papers, electronic files, etc.
2. Motion—inefficient layouts or poor ergonomics at
work-stations or in offices.
3. Defects—errors, scrap, rework, non-conformance.
4. Underutilized personnel resources and
creativity—ideas that are not listened to, skills that
are not utilized.
32. Lean Six Sigma
• Lean Six Sigma is an approach to integrating the
power of Six Sigma Tools and Lean Enterprise Tools
which can be applied within an organization to create
the fastest rate of improvement, maximize shareholder
value, and increase customer delight.
36. • Dissatisfaction with
being “average”
• Physicians not
engaged with prior
approaches
• Insufficient tools to
execute vision
• Need for structure
and discipline in
decision-making
processes
Driving force in healthcare
• Need for higher
level analysis
• Need to “shine a
light” on processes
• Need for a new
platform/bar for
leadership skills
• Market positioning
• Current quality
programs need
resuscitation
37. 44,000 to 98,000 Preventable Hospital
Deaths
(IOM study, 1998)
In-Hospital Deaths from Medical
Errors at 195,000 per Year. Patient
Safety Incidents In Hospitals Account
for $6 Billion per Year in Extra Costs
(HealthGrades - July, 2004)
How Safe is Healthcare?
Defects in healthcare are costly -- unlike manufacturing, you can’t
simply shut down the line until you find and fix the problem.
38. Reduction in Blood Stream Infections in ICU
Stroke Patient Length of Stay
Reduced Number of Inpatient Transfers
Emergency Department Patient Wait Time
Improved Patient Throughput in Radiology
Reduction in Lost Films
MR Exam Scheduling Improvement
Staff Recruitment and Retention
Operating Room Case Cart Accuracy
Quality of Care and Satisfaction of Families in Newborn ICU
Examples of Projects Across a Health System
39. Key Success Factors
• Top man leadership with clear vision for the initiative
• Invest in resources and make a long term commitment
• Dedicate “best and brightest”
• Change the systems and structures to support the effort
• Select and scope projects carefully: Focus on critical
issues tied to business priorities, with measurable and
manageable parameters
• Use change management tools to identify cultural
barriers, gain acceptance and build momentum
• Establish shared need, values and vision
40. o Customer Service/Satisfaction
o Reduced Wait Times
o Consistent Service
o Delivered Quality of Care
o Reduced Medical Errors
o Use of Appropriate Technology
o Cost Management
o Increased Productivity and
Throughput
o Decreased Cost through Reduced
Variation
o Compliance requirements
Align opportunities with organizational objectives
key issues in healthcare:
41. This is a journey – not a destination
Lean Six Sigma is a solid approach, but not a “magic bullet” --
Transforming healthcare will also likely require changes in
technology, legislation/regulation, transparency and culture.
Over 60% of quality efforts fail. To be among the successful
40%, pay attention to the people side of change.
The Effectiveness (E) of the
result is equal to the Quality (Q)
of the solution times the
Acceptance (A) of the idea.
42. Conclusion
• Six Sigma is a toolset, not a management system and
is best used in conjunction with other more
comprehensive quality standards such as Lean for
Performance Excellence and customer satisfaction
which can also be applied in a Healthcare settings.
