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Lean Six Sigma @ Lumedx March 4 2006
 

Lean Six Sigma @ Lumedx March 4 2006

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Presentation given to Lumedx annual meeting re: hospital implementation of Lean Six Sigma

Presentation given to Lumedx annual meeting re: hospital implementation of Lean Six Sigma

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Lean Six Sigma @ Lumedx March 4 2006 Lean Six Sigma @ Lumedx March 4 2006 Presentation Transcript

  • March 3, 2006 Lean Six Sigma Healthcare Applications Mark Kresse, MHS, PT, CHE Vice President Saint Vincent Health System
  • In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques.
  • In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S P D A S
  • In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement P D A S
  • In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement rganize a group that is familiar with the process P D A S
  • In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement rganize a group that is familiar with the process larify the process P D A S
  • In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement rganize a group that is familiar with the process larify the process ncover the root cause(s) of variation P D A S
  • In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement rganize a group that is familiar with the process larify the process ncover the root cause(s) of variation tart the improvement cycle
    • Plan
    • Do
    • Study
    • Act
    P D A S
  • While many of us have continued to employ the CQI philosophy and tools…
  • While many of us have continued to employ the CQI philosophy and tools… … by the mid -1990s, CQI as the Saint Vincent quality improvement infrastructure was little more than a memory.
  • While many of us have continued to employ the CQI philosophy and tools… … by the mid -1990s, CQI as the Saint Vincent quality improvement infrastructure was little more than a memory. What went wrong?
  • While many of us have continued to employ the CQI philosophy and tools… … by the mid -1990s, CQI as the Saint Vincent quality improvement infrastructure was little more than a memory. What went wrong? Why are we now intent on adopting Lean Six-Sigma at Saint Vincent?
  • … and, what have we done differently this time? Albert Einstein NY Times Insanity: doing the same thing over and over again and expecting different results.
  • Please raise your hand if …
    • Your organization has formally implemented Lean and/or Six-Sigma
  • Please raise your hand if …
    • Your organization has formally implemented Lean and/or Six-Sigma
    • Some departments within your organization have employed Lean and/or Six-Sigma principles
  • Please raise your hand if …
    • Your organization has formally implemented Lean and/or Six-Sigma
    • Some departments within your organization have employed Lean and/or Six-Sigma principles
    • You have received some training and/or continuing education in Lean and/or Six-Sigma
  • Please raise your hand if …
    • Your organization has formally implemented Lean and/or Six-Sigma
    • Some departments within your organization have employed Lean and/or Six-Sigma principles
    • You have received some training and/or continuing education in Lean and/or Six-Sigma
    • You have read about Lean and/or Six-Sigma
  • Please raise your hand if …
    • Your organization has formally implemented Lean and/or Six-Sigma
    • Some departments within your organization have employed Lean and/or Six-Sigma principles
    • You have received some training and/or continuing education in Lean and/or Six-Sigma
    • You have read about Lean and/or Six-Sigma
    • You can explain what the acronym D.M.A.I.C. means
  • Please raise your hand if …
    • Your organization has formally implemented Lean and/or Six-Sigma
    • Some departments within your organization have employed Lean and/or Six-Sigma principles
    • You have received some training and/or continuing education in Lean and/or Six-Sigma
    • You have read about Lean and/or Six-Sigma
    • You can explain what the acronym D.M.A.I.C. means
    • You have serious doubts that quality improvement principles developed in the manufacturing sector can be successfully applied in healthcare
  • Please raise your hand if …
    • Your organization has formally implemented Lean and/or Six-Sigma
    • Some departments within your organization have employed Lean and/or Six-Sigma principles
    • You have received some training and/or continuing education in Lean and/or Six-Sigma
    • You have read about Lean and/or Six-Sigma
    • You can explain what D.M.A.I.C. means
    • You have serious doubts that quality improvement principles developed in the manufacturing sector can be successfully applied in healthcare
    • You understand that Lean Six-Sigma does not mean “Skinny” Six-Sigma
  • My “customer focused” goals for today…
    • Define audience interest, need and expectations re: Lean Six-Sigma education
    • Provide targeted review of key Lean Six-Sigma concepts
    • Setting realistic goals for LSS
    • Summarize the SVHS Lean Six-Sigma efforts and outcomes
    Wall Street Journal
  • My “customer focused” goals for today…
    • Define audience interest, need and expectations re: Lean Six-Sigma education
    • Provide targeted review of key Lean Six-Sigma concepts
    • Setting realistic goals for LSS
    • Summarize the SVHS Lean Six-Sigma efforts and outcomes
    Wall Street Journal
    • Allow 10 minutes for questions, discussion and feedback
    • End on time
  • SIX SIGMA: CAN IT WORK IN HEALTHCARE? MARK KRESSE November, 2005
  • What is everyone talking (and writing) about? Can there really be any question about the potential?
  • What makes Lean Six-Sigma stand out… … vs. CQI’s “FOCUS-PDSA”?
  • What makes Lean Six-Sigma stand out…
    • Voice-of-the-Customer (VOC)
    • Critical-to-Quality (CTQ) metrics
    … vs. CQI’s “FOCUS-PDSA”? Wall Street Journal
  • What makes Lean Six-Sigma stand out…
    • Voice-of-the-Customer (VOC)
    • Critical-to-Quality (CTQ) metrics
    … vs. CQI’s “FOCUS-PDSA”?
    • Focus on the customer as the driver for quality improvement effort selections
    Wall Street Journal
  • What makes Lean Six-Sigma stand out…
    • Voice-of-the-Customer (VOC)
    • Critical-to-Quality (CTQ) metrics
    … vs. CQI’s “FOCUS-PDSA”?
    • Focus on the customer as the driver for quality improvement effort selections
    • Emphasis on employing key operational metrics to ensure performance is designed to meet customer demands & expectations, enhance strategy & improve margins
    Wall Street Journal
  • What makes Lean Six-Sigma stand out
    • Customer-focused guidance on project selection, vs. “Find an opportunity”
    • Tied to strategic plan
    • LSS emphasizes results in terms of profit and strategy, vs. activity completion.
    • At SVHC…
      • CQI was too process-focused, with only incremental improvements
      • Implementation, but no Control
      • No accountability, no sustainability
    vs. CQI’s “FOCUS-PDSA”?
  • What is Six Sigma?
    • A metric
    • A set of tools
    • A quest to reduce variability
    • A measure of process improvement
    • 6-Sigma concepts combine the DMAIC Roadmap with the 6-sigma tools
  • What is Six Sigma?
    • A metric
    • A set of tools
    • A quest to reduce variability
    • A measure of process improvement
    • 6-Sigma concepts combine the DMAIC Roadmap with the 6-sigma tools
    • … a systematic method with tools to
      • measure, analyze and improve business processes
      • identify critical areas that provide breakthrough results in
        • market penetration
        • organizational speed
        • the cost of doing business
  • Process Capability
    • The ratio of process variability to design specifications
    Upper Spec Lower Spec The natural spread of the data is 6 σ , Fit 6 standard deviations on both sides of the mean and spec limit = 6 Sigma capability =3.4 DPMO -1 σ +2 σ -2 σ +1 σ +3 σ -3 σ µ
  • Is 99% Good Enough? 99.99966% Good (6 Sigma) 20K lost articles of mail per hour Unsafe drinking water for almost 15 minutes each day 5,000 incorrect surgical operations per week Two short or long landings at most major airports each day 200,000 wrong drug prescriptions each year No electricity for almost seven hours each month Seven articles lost per hour One unsafe minute every seven months 1.7 incorrect surgical operations per week One short or long landing every five years 68 wrong prescriptions per year One hour without electricity every 34 years 99% Good (3.8 Sigma)
  • A New Quality Ideology Internal & External Failure Costs Prevention & Appraisal Costs Old Belief 4  Costs Internal & External Failure Costs Prevention & Appraisal Costs New Belief Costs 4  5  6  Quality Quality Old Belief High Quality = High Cost New Belief High Quality = Low Cost  is a measure of how much variation exists in a process
  • Six-Sigma Methodology Phase 2: Measure Phase 3: Analyze Optimization Phase 4: Improve Phase 5: Control Projects worked through 5 main phases Phase 1: Define Characterization Breakthrough Strategy D M A I C
  • Connecting to the “Voice of the Customer”
    • Quality Functional Deployment (QFD)
      • What? – method to systematically identify customer requirements and insure they are met by appropriate measurements
      • Why? – improve the communication of customer wants and more efficiently allocate resources
      • When? – any time you want to insure customer needs are translated in prioritized, measurable requirements
      • “ HOUSE OF QUALITY”
  • What is Lean?
    • Lean thinking focuses on eliminating waste in processes (i.e. the waste of work in progress)
    • Lean is not about eliminating people
    • Lean is about expanding capacity by reducing costs and shortening cycle times
    • Lean is about understanding what aspects of a product or process are important to the customer – i.e. valued – and reducing waste in the process to enhance that value
  • Before Work Time (value add) Wait and ‘ Other’ Time Work Time (value add) Wait and ‘ Other’ Time (no value) A B C E ? Making a Process Lean D 2 D 1
  • After Before Work Time (value add) Wait and ‘ Other’ Time Work Time (value add) Wait and ‘ Other’ Time (no value) A B C E ? Making a Process Lean D 2 D 1 A B C E
  • After Before Work Time (value add) Wait and ‘ Other’ Time Work Time (value add) Wait and ‘ Other’ Time (no value) + = Business Improvement A B C E ? Making a Process Lean D 2 D 1 + Same value, with less time and resources! Six Sigma Eliminate defects/variation in process Eliminate waste in & around process Lean
  • Eight Service Industry Wastes
    • Errors in documents
    • Transport of documents
    • Doing unnecessary work not requested/required
    • Waiting for the next process step
    • Process of getting approvals
    • Unnecessary motion or movement
    • Backlog in work queues
    • Underutilized employees
  • Lean Tools
    • Value Stream Mapping
    • 5S
    • 5 Why’s
    • Theory of Constraints
    • Kanban – Visual Controls
  • Value Stream Map
    • The simple process of directly observing the flows of information and materials as they now occur, summarizing them visually, and then envisioning a future state with much better performance (Voelkel & Chapman, 2003)
    • Pictures are worth a thousand words!
  • 5S Program
    • 5S is a Japanese methodology to clean and organize the work place
    • 5S focuses on creating visual order, organization, cleanliness and standardization.
    • 5 Elements
    • Sort
    • Straighten
    • Shine
    • Standardize
    • Sustain
  • KANBAN
    • Kanban: Japanese term meaning "signal".
    • Signals a cycle of replenishment of production and materials.
    • Maintains an orderly and efficient flow of materials throughout the entire process.
    • Most often a printed card or visual cue that contains specific information as to what is required for the process to operate
  • Theory of Constraints
    • Any system can operate only as efficiently as its critically constrained resource
    60 units per day 70 units per day 40 units per day 60 units per day
  • Theory of Constraints
    • Any system can operate only as efficiently as its critically constrained resource
    60 units Per day 70 units Per day 40 units Per day 60 units Per day Constraint Maximum System Throughput = 40 units per day
  • Why Can Lean Six-Sigma Help Change Healthcare?
    • Normally demands a CULTURAL SHIFT beginning with a CUSTOMER FOCUS
    • Must be driven by top leadership
    • Top-down deployment - integrated with business strategies (strategic plan)
    • Insists on quantifiable benefits and accountability
    • Disciplined approach (DMAIC)
    • Defined Roles/infrastructure (Champion, MBB, BB, GB, etc)
    • Data based decisions
    • Continuing CUSTOMER FOCUS (internal/external)
  • Roadblocks to Success
    • No fundamental acceptance of the need for genuine cultural change (realignment in thinking)
    • Lack of leadership support and accountability
    • Waning commitment
    • Lack of measurable goals
    • No clear strategies and tactics for maintaining long-term results
    • Hesitancy to invest time and money
    Dr Martin Merry Mr. Jeffrey Brown
  • Team Roles
    • Executive Champion - Senior leadership sponsor, acts as a LSS catalyst, breaks down barriers to success.
    • Master Black Belt - Full-time teacher and mentor of Black Belts (may be externally contracted)
    • Black Belt - Full-time, LSS trained change agent, works on high-level projects, mentors Project Champions
    • Project Champion - Variable-level of management responsibilities, close to process, trained in LSS tools, drives grass-roots involvement
    • Physician Champion – Physician with vested interest in the target process and its improvement
    • Finance/Accounting Representative – Required to help define “legitimate” ROI
  • Lean Six-Sigma Planning
    • Program 3-year Vision
    • Timeline
      • Phase I: June, 2005 – January, 2006
      • Phase II: January, 2006 – June, 2006
      • Phase III: July, 2006 – December, 2006
      • Phase IV: January, 2007 – June, 2008
  • Lean Six-Sigma Phase I - Goals
    • Provide baseline training in Lean Six-Sigma principles for senior executives, vice-presidents and selected directors.
    • Identify and prioritize possible LSS improvement projects.
    • Bring 2-3 projects to the “Improve” phase of the D.M.A.I.C. process by 12/31/2005.
    • Implement a Lean Six-Sigma internal communication plan.
    • Identify plans for Phase II and beyond by 12/31/2005.
  • Lean Six-Sigma Phases II-IV Goals
    • Re-affirm and define the scope of SVHS Lean Six-Sigma philosophy
    • Expand leadership and associate training
    • Incorporate projects and operational metrics into leadership “Quality Share” for accountability
    • Develop/hire additional internal experts
  • Lean Six-Sigma Phases II-IV
    • Program Phase Characteristics
      • Strategic Plan alignment
      • Knowledge & Skills Transfers; Observable Behaviors
      • Accountability Structure
      • Team Rewards
      • Communication Plans
      • Support Infrastructure required
      • Timeline
      • Budget
  •  
  • Phase I Project Status
  • LSS Projects
    • Emergency Department Throughput
    • Problem
    • Length of stay for ED patients is too long as evidenced by the number of patients leaving w/o being seen and poor customer satisfaction ratings
    • Critical to Quality (CTQ) Metric
    • Length of stay (minutes), LWBS Rate
    • Defect
    • Admitted patient LOS > 240 minutes
    • Goal
    • Reduce LOS by 30 percent for admitted patients; decrease LWBS 50%
    • Executive Champion
    • Dr. Joseph Cacchione
    • Benefits
    • Improved customer satisfaction
    • Increased ED revenue, fewer patients LWBS
  •  
  • Disp to Order Families of Process Variation ED Patient (admitted) LOS Time to Time Doc to Doc Time to Time Order to Assign Assign to Room Eval to Disp Hosp to PCP Hosp to Hosp Unit to Unit Time to Time Floor to Floor Time to Time Lab Radiology Time to Time Test to Test Time to Time Test to Test Unit to Unit
  •                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
  • LSS Projects
    • Problem
    • Long lead times for delivery of nursing equipment resulting in delayed equipment, compromised patient care/safety, staff dissatisfaction and increase equipment rental cost.
    • Critical to Quality (CTQ) Metric
    • Delivery Lead Time (minutes)
    • Defect
    • Equipment delivery within 30 minutes
    • Goal
    • Reduce delivery time to 30 minutes or less.
    • Champion
    • Debbie Tamlin, VP of Patient Care Operations
    • Benefits
    • Improved patient care/satisfaction and throughput
    • Decreased equipment rental cost and overtime
  • Equipment Availability
  • LSS Projects
  • What’s next???
    • What will be the next “fad” after LSS?
  • What’s next???
    • What will be the next “fad” after LSS?
    • Systematic Innovation - a carefully managed sequence of steps, with appropriate tools and roadmaps, to improve an organization’s competitive position, satisfy its customers and reduce costs
  • It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage, than the creation of a new system. For the initiator has the enmity of all who would profit by the preservation of the old institutions and merely lukewarm defenders in those who would gain by the new ones.
  • Mark Kresse Saint Vincent Heart Center 232 West 25 th Street Erie, PA 16544 814/452-7888 814/455-1675 (f) [email_address] It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage, than the creation of a new system. For the initiator has the enmity of all who would profit by the preservation of the old institutions and merely lukewarm defenders in those who would gain by the new ones. Machiavelli 1532