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Set 1 (ppt, 3.5MB)

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  • 1. Lean Six Sigma Experiences in two Dutch hospitals Barcelona April 2007 Jaap van den Heuvel
  • 2. Quality management Quality Control Quality Planning Defect rate Quality Improvement Lessons learned Time 39
  • 3. Six Sigma is Patient
    • An integrated approach
    • Of continuous improvement
    • By reducing defect
    38 Input Care process Output
  • 4. Six Sigma Evaluation Patient The Hidden Hospital 37 Input Care process Output Rework: Logistics Complications Mistakes Handling Complaints
  • 5. Six Sigma in Industry
      • Motorola, 1987
      • IBM, Sony, Samsung, Philips
      • Boeing, Bombardier, Lockheed
      • Ford, Volvo
      • Nokia
      • Bank of America, Citibank
      • American Express
    Six Sigma at General Electric 1995: Jack Welch 1996: Investments $ 200 million; savings $ 150 million 1997: Investments $ 400 million; savings $ 600 million 1998: Investments $ 450 million; savings $ 1,2 billion 2001: Savings $ 12 billion (Turnover $ 200 billion) 36
  • 6.
    • A philosophy
    • A projectmanagement approach
    • Tools and statistical techniques
    • An organisational structure
    • An improvement culture
    Six Sigma introduces 35
  • 7. Philosophy: show us the data < 20 days: 94% Average stay: 9.9 days 34
  • 8. Six Sigma breakthrough cookbook Project mangement 33 Measure Analyze Improve Control 7. Select the important influence factors 8. Establish relationships 9. Design improvement actions 10. Improve the quality control system 11. Determine the new process capability 12. Close the project 4. Establish the process capability 5. Define the objective of the project 6. Identify potential influence factors 1. Select the internal CTQ 2. Operationalise the CTQ 3. Validate the measurement system Define
  • 9. Tools and statistical techniques Patient
    • X Y=f(X) Y
    • Control Chart
    • Pareto Chart
    • Box Plot
    • Cause and Effect Diagram
    32 Input Care process Output
  • 10. Tools and statistical techniques Patient
    • X Y=f(X) Y
    • ANOVA
    • Regression Analysis
    • Chi-square distribution
    31 Input Care process Output
  • 11. Six Sigma Organisation
    • Champions
    • Master Black Belt
    • Black Belts
    • Green Belts
    • Yellow Belts
    Directie Green Belt Green Belt Green Belt Green Belt Green Belt Black Belt Black Belt Black Belt Champions Master Black Belt Clustermanagers 30
  • 12. Implementation of Six Sigma
    • Executive training
    • Green Belt-training
    • Projects
    • Black Belt-training
    • Appointment of Master Black Belt
    29
  • 13. Six Sigma in the Red Cross Hospital
  • 14. Results In 2004 we achieved 2 million euro net earnings 27 44 19 8 Projecten 63 38 15 Green Belts 2004 2003 2002 Six Sigma
  • 15. Lean Six Sigma in the Canisius Wilhelmina Hospital
  • 16. What is Lean Manufacturing?
    • Analyses whole Processes
    • Focuses on Added Value
    • Reduces Complexity
    • Process speed is the key goal of Lean!!
    25
  • 17. Little’s Law WIP Lead Time = -------- ACR 24
  • 18. Case: The ER in the Canisius Wilhelmina Hospital
  • 19.  
  • 20.  
  • 21.  
  • 22.  
  • 23. The Emergency Room
    • Long waiting times
    • Patients stay too long in the ER
    • Not enough treatment rooms
    • Workload is too high
    18
  • 24. What do you expect the organization demands from the board??
    • Building more treatment rooms?
    • More nursing staff?
    • More physicians?
    17
  • 25. Process capability plot D M A IC 16
  • 26. Process performance D M A IC Avarage Lead Time 2,5 hour In 50% Lead Time > 2,5 hour In 25% Lead Time > 3,5 hour 15
  • 27. Average Lead Time in the ER D M A IC Announcement of the patient Arrival and registration First contact with nurse Call for physician Start examination physician Differential diagnosis known Start of treatment Patient leaves the ER 1 2 3 4 5 6 7 8 SP SP SP SP = Sub Process 9 12 83 15 20 Totaal 159 = Average Lead Time in minutes 20 14
  • 28. Potential factors of influence D M A IC 13
  • 29. Relevant factors of influence D M A I C 12
  • 30.
    • X-ray  40 min
    Relevant factors of influence Blood exam  60 min ( gem.) 11
  • 31. Relevant factors of influence Admission  25 min Second physician  50 min 10
  • 32. Most important factors of influence
    • First contact nurse ( step 2 – 3 )
    • Blood and X-ray exam ( step 3 – 4 )
    • Arrival physician ( step 4 – 5 )
    • Examination physician ( step 5 – 6 )
    • Waiting for consultant ( step 5 – 6 )
    • Examiniation second physician ( step 5 – 6)
    • Admission ( step 7 – 8 )
    9
  • 33. Define the objective 8
  • 34. Define the objective of the project Average (in min.) Max (in min.) D M A IC 7 120 335 75 120 Pediatrics 120 375 75 139 Neurology 120 365 90 145 Pulmonology 180 430 120 234 Internal Med 90 310 50 79 Small Trauma’s 150 385 100 193 Surgery target before target before
  • 35. Improvement actions
  • 36. Introducing a Dashboard
  • 37. Results in January 2007 Average Lead Time (in min.) 4 90 75 120 Pediatrics 149 75 139 Neurology 187 90 145 Pulmonology 123 120 234 Internal Med 86 50 79 Small Trauma’s 86 100 193 Surgery results target before
  • 38. Effects of a decreased Lead Time
    • Less waiting and treatment times
    • Decreased Total Treatment Time (Lead Time)
    • Less rooms needed
    • Less personnel needed
    3
  • 39. Conclusion
    • Combining Six Sigma with Lean principles is very powerful
    • Lean Six Sigma works even better in Healthcare than in Industry
    2
  • 40. Questions?