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Bb training improve_print

  1. 1. The DMAIC Lean Six Sigma Projectand Team Tools ApproachImprove Phase1
  2. 2. 2Six Sigma Improve Phase“The starting point for improvement is torecognize the need.”- ImaiImprove - Introduction
  3. 3. Lean Six Sigma Black Belt Training!Improve AgendaWelcome Back and brief D M A ReviewImprove OverviewGenerate and Prioritize SolutionsRisk AssessmentsEvaluate SolutionsApproach for ImplementationTranslate Improvements for CommunicationOther Improvement Approaches and SupportDesign for Six SigmaDesigned ExperimentsApplications / Lessons Learned / ConclusionsNext Steps3
  4. 4. 4Improve Phase Review:Key StepsIn alignment with our project goal statement, andgiven what we have learned in the Define, Measure,and Analyze Phases of our project, during theImprove phase our team will complete:•Generating and prioritizing Solutions (Improvement actions)•Risk assessment•Evaluation of Solutions and Benefits•Approach for Implementation•Translating and communicating learnings to Champion andProcess Owner(s) as appropriateWe will define and implement GREAT improvement solutions!Improve – Key Deliverables
  5. 5. Lean Six SigmaDMAIC Phase Objectives• Define… what needs to be improved and why• Measure…what is the current state/performance level and potential causes• Analyze…collect data and test to determine significant contributing causes• Improve…identify and implement improvements for the significant causes• Control…hold the gains of the improved process and monitor5
  6. 6. What is Six Sigma?•A high performance measure of excellence•A metric for quality•A business philosophy to improve customer satisfaction•Focuses on processes and customers•Delivers results that matter for all key stakeholders•A tool for eliminating process variation•Structured methodology to reduce defects•Enables cultural change, it is transformational6
  7. 7. 7Six Sigma Is a Set of Powerful ToolsDefine Measure Analyze Improve ControlProblemDefinitionProcessMappingKey Factors (x) Selection Matrix OCAPProjectManagementCause & EffectMatrixBasic StatisticsPrioritizationchartStandard WorkHigh LevelMappingFishboneDiagramRegression FMEA Feedback LoopsDescriptiveStatisticsStatisticalAnalysisHypothesisTestingSimulation Transition PlansParetoValue StreamMapANOVAFuture StateProcess MapControl PlansBenchmarking MSA FMEA SPCCost/BenefitAnalysisCapability Proportions Visual Control
  8. 8. 8The Lean Six Sigma Approach• Lean Six Sigma is the combination of the Leanand Six Sigma “tool boxes” to create acustomer-centric, value-based philosophy andrapid-fire deployment of focusedmethodologies to transform our businessprocesses to be able to consistently deliverbottom line results that are sustainable andcontinuously improved.Design for Six Sigma
  9. 9. Six Sigma applied effectively…•Increases customer satisfaction•Lowers costs•Builds better leaders•Empowers an organization to be more data-driven9
  10. 10. The Basic Philosophy of Lean Six Sigma• All processes have variation and waste• All variation and waste has causes• Typically only a few causes are significant• To the degree that those causes can be understoodthey can be controlled• Designs must be robust to the effects of the remainingprocess variation• This is true for products, processes, informationtransfer, transactions, everything• Uncontrolled variation and waste is the enemy10
  11. 11. The basic focus of Six SigmaTherefore, to understand the output (results) we aregetting, we must study and understand the process andinputs that go into producing the output we are getting.Y = f(Xs)…data-driven problem solving and continuousimprovement11
  12. 12. 12Six Sigma DMAIC ProjectsAnalyze Phase–What does the process data reveal?–What are the Critical Key Xs?–How much variation in “Y” from the Key “Xs”?–What “Xs” can be and need to be improved(Root Causes)?
  13. 13. 13Y=f(x)Measure Phase15-70 xsProcess MappingParetoC&E Matrix, FishboneFMEASIPOCCapability StudyMeasurement SystemsAnalysisAnalyze Phase7-15 xsImprove Phase3-7 xsControl Phase3 or fewer xsControl Plans, SOPs,SPC, Mistake ProofingPrioritization Matrix, Improvement Ideas,C&E Matrix, Future State Map, PDSAPareto Chart, Correlation/RegressionHypothesis Tests, ANOVA, DescriptiveStatistics, t-tests, ProportionsOnly the Critical Xs need to bemonitored and controlled long term
  14. 14. 14Six Sigma Improve Phase (pg. 14 -16)The Improve Phase is a systematic approach forexamining the identified key xs, anddetermining, testing, and implementing the bestsolution(s).Improve – Introduction1. What changes can we make that will result in asustainable improvement in the process output?2. How will we know that a change has resulted inan improvement in the process output?
  15. 15. 15Six Sigma Improve Phase (pg. 14 -16)• Through process analysis, you will generateand test robust solutions shown to affect theproven causes (xs) that affect the criticaloutput (Y) in a positive manner.• The result will be an improved process that isstable, predictable, and one that consistentlymeets customer requirements.Improve – Introduction
  16. 16. 16Budget Lids/HiringFreezesAcross-the-boardcutsPrograms eliminatedConsolidation ofunitsDownsizing/RestructuringImprove to SixSigma performancelevelsEliminate chronicproblemsEliminate non-value-added workEliminatewaste / reworkThe (Rational) Improvement Alternativeto Downward SpirallingImprove – Introduction
  17. 17. 17New and Improved Technology and Trainingcould be the most robust solution, but alwaysremember to:“Reach for the mind before you reach for the wallet”- borrowedImprove Phase:Technology and Training - Right?Improve – Introduction
  18. 18. 18The Default Solutions…• Training & education• New technology• Working harder or faster• More inspection or auditing• New policies• More people working in a broken process…Are not always the right solutions!Improve – Introduction
  19. 19. 19Why People Don’t DoWhat They Are Expected To Do(Robert Mager)• They don’t know how to do it.• They don’t know what’s expected of them.• They don’t have the authority to do it.• They don’t get timely information about how wellthey are doing. (In other words, they don’t getfeedback.)• Their information sources (documentation) arepoorly designed, inaccessible, or nonexistent.Improve – Introduction
  20. 20. 20Why People Don’t DoWhat They Are Expected To Do (Cont’d)• They don’t have job aids to cue correct performance.• Their work stations provide obstacles to desiredperformance.• The organizational structure makes performing difficult.• They are punished or ignored for doing things right.Improve – Introduction
  21. 21. 21Why People Don’t DoWhat They Are Expected To Do (Cont’d)• They’re rewarded for doing things wrong.• Nobody ever notices whether they perform correctlyor not.Have we addressed each of these previous 11concerns as to why people don’t do what they aresupposed to do through our Improvement andControl actions?Improve – Introduction
  22. 22. 22Data-Driven Problem SolvingTo be successful with any Six Sigma project, you haveto affect at least one of the following:–Reduce Variation–Shift the Mean–Eliminate Outliers
  23. 23. Characteristic of the Performance Gap… (Problem)Accuracy and/or PrecisionLSL USL USLLSLOff-Target VariationOn-TargetCenterProcessReduceSpreadThe statistical approach toproblem solvingUSLLSLLSL = Lower spec limitUSL = Upper spec limit23
  24. 24. 24Long-termYield100%90%80%70%60%50%40%30%20%10%0%0 21 53 4 6308,537 DPMO2σ66,807 DPMO3σ 6,210 DPMO4σ233 DPMO5σ3.4 DPMO6σProcess SigmaLong-Term Yield vs Process Sigma690,000 DPMO1σ
  25. 25. Six Sigma ImproveImproving the identified Key Xs toImprove the Process (Y) and theCustomer’s Experience25
  26. 26. 26Key Deliverables for Improve• Main elements of Define, Measure, andAnalyze completed• “Obvious Xs” identified and confirmed• Potential Xs identified, data collected andconfirmed (Root Causes)• Improvement solutions generated andprioritized upon investigation of root causesand supported with dataImprove – Review & Key Deliverables
  27. 27. 27Key Deliverables for Improve• Improvement solutions tested (pilot) andbenefits estimated• Implementation plan for solution(s) draftedwith input from process owners• Champion approval of the key solution(s)implementationImprove – Review & Key Deliverables
  28. 28. 28Six Sigma Improve Phase“I know of no more encouraging factthan the unquestionable ability ofmankind to elevate his life through aconscience endeavor.”- Henry David Thoreau
  29. 29. 29Improve Phase Review:Key StepsIn alignment with our project goal statement, andgiven what we have learned in the Define, Measure,and Analyze Phases of our project, during theImprove phase our team will complete:•Generating and prioritizing Solutions (Improvement actions)•Risk assessment•Evaluation of Solutions and Benefits•Approach for Implementation•Translating and communicating learnings to Champion andProcess Owner(s) as appropriateImprove – Review & Key Deliverables
  30. 30. 30Improve Phase:Generate Solutions• The objective is to generate ideas - come up with ways toimpact our key xs in a way that will lead to an improved,consistent output. Be creative, find “out-of-the-box”solutions, invent potential fixes, and find ways to optimizeyour process.• There are many ways of generating ideas. Here are four ofthe most common and useful:– Brainstorming– Affinity Diagrams (using key xs)– Process Mapping (current v. future)– Best practices/benchmarkingImprove – Generate Solutions
  31. 31. 31Improve Phase:Generate Solutions – Brainstorming(pg 27-29)• A question or statement about an identified key x thatnegatively impacts Y is written on a board or flip chart for theentire team to see.• Creative thinking is used as team members suggest potentialimprovements for the stated x. All ideas are recorded withoutany judgment initially of their validity. “Out of the box”thinking is strongly encouraged here, and “spring-boarding”off of others ideas is powerful.• Think beyond the “status quo” or self imposed rules from theculture of the organization.Improve – Generate Solutions
  32. 32. 32Improve Phase: Generate SolutionsBrainstorming Questions to Consider• Where is the process step done? Can it be done elsewhere?• Who performs the step? Can someone else perform the step?• When is the step performed? Can the timing be changed?• Under what conditions is the step performed? Can the conditions bechanged?• What resources are required for the process step? Where else canresources be found? What else can be used?• How is the process step controlled? Is it value - adding?• What does the customer really need? How is the customer using theprocess output - product or service?Improve – Generate Solutions
  33. 33. 33Brainstorming Guidelines• Clarify the question being considered• Go around to each member asking for input, but also allowideas to be written down - as on a sticky note, etc.• Do not make any critical comments about initial ideassubmitted by team members - only ask for clarification ifneeded• Strive for a high quantity of ideas to begin with, then movetoward “quality”Improve – Generate Solutions
  34. 34. 34Improve Phase:Generate Solutions - Affinity Diagrams(pg 30-31)• An Affinity Diagram is used to help a team discovermeaningful groups of ideas or relationships within araw list of ideas - as coming potentially from abrainstorming session.• Affinity diagrams are helpful when:– facts or thoughts are uncertain and need to be organized– preexisting ideas or paradigms need to be overcome– ideas need to be clarified– unity within a team needs to be strengthenedImprove – Generate Solutions
  35. 35. 35Improve Phase:Generate Solutions - Affinity Diagrams• To create an affinity diagram, the team sorts a brainstormed list,moving ideas from the raw list into affinity sets, creating groups ofrelated ideas. This can easily be done by writing on a flipchart, orusing post-it notes to “re-stick” into affinity groups.• Basic guidelines for affinity diagrams:– Rapidly group ideas together that seem to belong together– Clarify any ideas in question– Initially, it isn’t important to define why they belong together– Copy an idea into more than one affinity set if appropriate– Seek to summarize or name each set with appropriate titles and thismay lead to more robust improvement ideas / actionsImprove – Generate Solutions
  36. 36. 36Improve Phase:Process Mapping (pg. 34-41)• A process is a sequence of steps or activities usinginputs to produce an output (accomplish a giventask).• A process map is a visual tool that documents aprocess.• Several styles and varying levels of detail are used inProcess Mapping. Most common and useful stylesare SIPOC, Flow Diagrams, Box Step, and ValueStream Maps.Improve – Generate Solutions
  37. 37. 37Improve Phase: Process Mapping• The team should start with the observed, current, as-is process.• Start high-level, and work to the level of detailnecessary for your project (key inputs).• As inconsistencies are discovered, the team candevelop a future state or should-be process map toimprove the key xs and the overall output (Y) of theprocess.Improve – Generate Solutions
  38. 38. 38Analyze Roadmap:Process AnalysisTypes of Process Delays or Errors:• Gaps• Redundancies• Implicit or unclear requirements• Bottlenecks• Hand-offs• Conflicting objectives• Common problem areas
  39. 39. 39Improve Phase:Process Mapping for Process ImprovementTrue “process improvements” usually DON’T come from:- working harder using a broken or inefficient process- education or re-education- blaming / threatening / coercion / policiesConsider:- making changes that “make it easy to do it right”- hardwire in desired defaults- eliminate process steps that don’t add value- if you have too much variation or “special cause”,designing a consistent process should be your firststep to improvementLangley, et. al. “The Improvement Guide - A practical Approach to Enhancing Organizational Performance”.Improve – Generate Solutions
  40. 40. 40Improve Phase:Generate Solutions - Best Practices / Benchmarking(pg. 254-255)Benchmarking is measuring your process performance againstother “best in class” similar processes internally and / orexternally as appropriate. Adopt the process steps andparameters as appropriate to obtain the desired output resultsfrom your own process.“Best practices are a sustainable competitive advantage. It’s truethat, once a best practice is out there, everybody can imitate it,but organizations that win do two things: they imitate andimprove it.” - Jack WelchImprove – Generate Solutions
  41. 41. 41Types of Benchmarks (pg 255)Pros ConsInternal/CompanyEstablishes a baseline for externalbenchmarkingIdentifies differences within the companyProvides rapid and easy-to-adaptimprovementsOpportunities for improvement arelimited to the company’s internal bestpracticesDirectCompetitionPrioritizes areas of improvement according tocompetitionInitial area of interest to most companiesBest used for in-depth studies as supplementto competitive intelligence studiesOften a limited pool of participantsOpportunities for improvement arelimited to “known” competitivepracticesPotential antitrust issuesIndustry Provides industry trend informationProvides management with a conventionalbasis for quantitative and process-basedcomparisonOpportunities for improvement maybe limited by industry paradigmsBest-In-ClassExamines multiple industriesProvides the best opportunity for identifyingradically innovative practices and processesProvides a brand new perspectiveFree exchange of information more likely tooccurOften difficult to identify best-in-classcompaniesSometimes difficult to get best-in-class companies to participate
  42. 42. 42Improve Phase:Prioritize Solutions• Once you have a set of potential solutions, your teamwill need to narrow down your list by identifying thebest solutions to test.• You will need to consider a number of factors:impact, cost, resources, etc.– Multivoting– Prioritization matrixImprove – Prioritize Solutions
  43. 43. 43Improve Phase:Prioritize Solutions – Multivoting(pg 31-32)• Multivoting narrows a large list of possibilities to asmaller list of the top priorities or to a final selection.• Multivoting is preferable to straight up or downvoting because it allows an item that is favored by all,but not the top choice of any, to rise to the top.• Usually follows brainstorming or affinitydiagramming to prioritize the main ideas.Improve – Prioritize Solutions
  44. 44. 44Improve Phase:Prioritize Solutions - Multivoting• To conduct the multivoting process, the team works from abrainstormed list of ideas, options, etc. This can easily be done bywriting on a flipchart, marker board, or using post-it notes. Eachteam member will have a marker, or self-adhesive dots to use forvoting. The number of multiple votes each member gets dependson the size of the list, but it is usually about one third of the totalnumber of items on the list.• Basic guidelines for multivoting:– All team members get an equal number of votes– A member can distribute their votes or cast all of them for one idea– If two or three ideas are close in voting, then a multivote can occurwith those two or three ideas listedImprove – Prioritize Solutions
  45. 45. 45Multivoting ExampleBudget PrioritiesNew billing systemAdditional staffHire Six SigmaconsultantImprove officeequipmentIncrease travel budget
  46. 46. 46Improve Phase:Prioritize Solutions - Prioritization Matrix• A prioritization matrix is used to comparechoices (options, improve approaches, etc.)relative to criteria such as cost, ease ofimplementation, resources, effort, etc.• This tool forces a team to focus on the bestthings to do, not everything they could do,dramatically increasing the chances forimplementation success.Improve – Prioritize Solutions
  47. 47. 47Improve Phase:Prioritize Solutions - Prioritization MatrixBasic guidelines for a prioritization matrix:– Virtually any criteria or factor can be used forranking the options– Effort (resources, costs) vs. Impact is a commonmatrix format for ranking potential improvementactivities– A cause and effect matrix is a form of aprioritization matrix– All team members should come to consensus onthe ranking of each optionImprove – Prioritize Solutions
  48. 48. 48Sample Prioritization Matrix:Lean PharmacyImprove – Prioritize SolutionsLow Impact Medium Impact High ImpactLowComplexity-Omnicell restockprocess-Workstation design:Repackaging area-Kanban inventory; FrozenstockMediumComplexity-Crashcartdesign/quantity;standard work forrestock-Workstation/room layout;IV room-Workstation design; Orderentry area-Kanban inventory: IVfluid boxes-Metrics developmentand trackingHighComplexity-Delivery cart setupand delivery process-Order clarification process-Workstation design: Medpick area-Standard work system; jobguidance sheets: all areasImpact for PharmacyComplexity/AmountofWorkRequired
  49. 49. 49Generate and Prioritize Solutions-Summary–Brainstorming–Affinity Diagrams (using key xs)–Process Mapping (current v. future)–Best practices/benchmarking–Prioritization
  50. 50. 50Improve Phase:Risk Assessment• Even your solutions may have potential flaws or gapsat which they could break down.• You will need multiple participants with differentperspectives in this process to identify the potentialproblems and possible modifications to create themost robust improvement solution with minimizedrisk.• The two techniques for assessing risk that we willfocus on are:– Force Field Analysis (FFA)– Failure Mode and Effect Analysis (FMEA)Improve – Assess Risks
  51. 51. 51Improve PhaseAssess Risks - Force Field Analysis (FFA)• FFA is a method borrowed from a Mechanical Engineeringtechnique known as Free-Body Diagramming, and from socialpsychology studies in human behavior.• FFA is used to identify all the forces surrounding and acting on abody (plan, improvement implementation, etc.)• The objective is to ascertain the forces leading to an equilibriumstate (determine the resources and costs)• Generates a chart or table for further analysis or presentation• With FFA, “EQUILIBRIUM” can be:– a desired goal– the status-quoImprove – Assess Risks
  52. 52. 52FFA - Barriers & EnablersDriving Forces Restraining ForcesBARRIERSENABLERSImprove – Assess Risks
  53. 53. 53FFA - Barriers & EnablersImprove – Assess Risks
  54. 54. 54Improve PhaseAssess Risks - FMEAFailure Mode and EffectsAnalysisImprove – Assess Risks - FMEA
  55. 55. 55FMEA(Failure Mode and Effects Analysis)(pg 270-273)• A documented methodology for evaluating, prioritizing, andanalyzing risks with the objective of eliminating or minimizingthese risks through a team effort.• A systematized group of structured activities to:1. recognize and evaluate the potential failure of a product or process and itseffect,2. identify actions which could eliminate or reduce the chance of the potentialfailure occurring, and3. document the process.• An FMEA is very complementary to defining what a product /process must do to consistently meet the needs of the customer.Improve – Assess Risks - FMEA
  56. 56. 56Using FMEA in DMAIC• During MEASURE to:– Assess the current process failures and risk– Identify potential Xs to be tested• During IMPROVE to:– To evaluate potential risk for improvement ideas– Prioritize improvements with high risk– To generate additional improvement ideasImprove – Assess Risks - FMEA
  57. 57. 57FMEAs Basically Answer:• What process step or product function could fail?• What would be the effect of that failure occurringand how severe would that effect be (severity)?• What are the potential root causes of the failure andwhat is the likelihood or frequency of those rootcauses causing the failure (occurrence)?• What current controls are in place to stop orimmediately detect the potential root causes andhow effective are those controls (detection)?• What recommended actions should be taken tominimize or reduce the likelihood of the greatestrisks identified?Improve – Assess Risks - FMEA
  58. 58. 58FMEAs Risk Prioritization• A ranking system, usually on a scale of 1 to 10, isused by the team for each of these categories:SeverityOccurrenceDetection• A Risk Priority Number (RPN) is calculated foreach single potential cause and associated failuremode by multiplying the three ranked values.These relative ranked values are used to identifythe greatest risks and prioritize actions.Improve – Assess Risks - FMEA
  59. 59. ProcessStep/Input Potential Failure Mode Potential Failure EffectsSEV Potential CausesOCC Current ControlsDETRPNActionsRecommended0 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 0FMEA Format and StructureWhatis theInputWhatcan gowrongwith theInput?What isthe Effecton theOutputs?HowBad?What aretheCauses?HowOften?How arethesefound orprevented?Howwell?What canbe done?StepsImprove – Assess Risks - FMEA59
  60. 60. 60FMEA - Step by Step (pg. 270)1. For each Process Input, determine ways the Input can go wrong(Failure Modes)2. For each Failure Mode associated with Inputs, determineEffects of Failures on customers3. Identify potential Cause(s) of each Failure Mode4. List Current Controls for each Cause or Failure Mode5. Use standard, or create, Severity, Occurrence, and Detectionrating scales6. Assign Severity, Occurrence, and Detection ratings to eachCause7. Calculate RPNs for each Cause8. Determine Recommended Actions to reduce high RPNs9. Complete Recommended Actions and recalculate RPNsImprove – Assess Risks - FMEA
  61. 61. 61Example FMEAImprove – Assess Risks - FMEA
  62. 62. 62FMEA Hints• Keep it simple; not complex• Must involve a team, usually 3 to 6 members, no“lone ranger” development• Update it as you move through the process andknowledge increases• Make sure the FMEA is an action tool, not just adocument; use the right half of the toolImprove – Assess Risks - FMEA
  63. 63. 63Improve Phase:Evaluation of Solutions (Pilot)(pg 273-276)• You will want to run trials of your selectedimprovement solutions in a real environment.• A test of all or part of a proposed solution on a smallscale in order to better understand its effects and tolearn how to make the full-scale implementationmore effective.• It is sometimes called a pilot test, a trial, or a smalltest of changeImprove – Test Solutions
  64. 64. 64PDSA: Plan Do Study Act• The Deming cycle, or PDSA cycle, is an improvementmodel consisting of a logical sequence of fourrepetitive steps for continuous improvement andlearning. It may also be called the Deming wheel ofcontinuous improvement.• Its origin can be traced back to the 1920’s whenWalter Shewart, statistics expert at Bell Laboratories,introduced the improvement concept of Plan, Do,and then See.Improve – PDSA
  65. 65. 65Act PlanStudy DoBasic PDSA StepsPLAN1. Identify the problem and desired outcome2. Identify the most likely causes/factorsusing data3. Identify potential solutions and thedata needed for evaluation (planthe details of the change: the who,what, when, and where)DO4. Implement solutions and collectdata needed for evaluation. Makesure the data collected allows youto assess progress toward thedesired outcome or target.STUDY5. Analyze data and develop conclusionsACT6. Recommend further study and/or action
  66. 66. 66Improvement Implementation PlanA PS DPrioritized Solutions and IdeasChanges thatresult inimprovementSeries of small testsLearn as you goData driven test cycles“Truth is found more often from mistakesthan from confusion.”- Francis Bacon, 1561 - 1626
  67. 67. 67Appropriate Scope for a Pilot TestImplementLarge ScaleTestSmall ScaleTestCost offailuresmallLarge ScaleTestSmall ScaleTestVery SmallScale TestCost offailurelargeHighConfidencethat changeidea will lead toImprovementSmall ScaleTestVery SmallScale TestVery SmallScale TestCost offailuresmallVery SmallScale TestVery SmallScale TestVery SmallScale TestCost offailurelargeLowConfidencethat changeidea will lead toImprovementReadyIndifferentResistantCurrent SituationReadiness for ChangeProvost, Lloyd. CHAI Fall Conference. Nashville, TN. Sep 2004Improve – Test Solutions
  68. 68. 68Improve Phase:Benefits EstimationHow much positive change in “Y” will occur as a resultof this improvement, and how much is this positivechange worth to our organization?― Unit cost― Total Resource― Benchmark (Gold standard)― Process FlowImprove – Benefits Estimation
  69. 69. 69Improve Phase: Benefits Estimation• Unit cost– Cost of each defect x number of occurrences• Total Resource– Total resources used to do an activity– % of time on non-value add activity = total opportunity• Benchmark (Gold standard)– Compare our performance to a gold standard; what is thequantifiable gap• Process Flow– From our process map, what are the NVA steps/activities– Design new process to eliminate NVA stepsImprove – Benefits Estimation
  70. 70. 70Improve Phase:Approach for Implementation of Improvements• Clearly identify who the process owner is and all associatesinvolved in the process• Identify all documentation related to the process being improvedand determine what modifications / updates need to be made(Policies, Procedures, Work Instructions, etc.)• Develop a communication plan– Who will be impacted by the change?– Communicate before the change goes into effect• Create a simple responsibility matrix to identify who will be doingwhat when, and ensure Champion is in agreement• Monitor and Adjust if needed as the improvement is incorporatedinto the processImprove – Implementation Approach and Plan
  71. 71. 71Improve Phase:Translating and Communicating Learnings forChampion Approval• For all significant improvement changes, the project’sExecutive Champion must be informed and must formallyapprove the implementation.• Before discussing improvement implementation with yourchampion, you must have “done your homework” andhave data to support your plan including risk assessment,pilot testing results, resources needed, and potentialbenefits.Improve – Champion Approval
  72. 72. Lean Six SigmaImprovement Approachesand Support Tools72
  73. 73. 73Resource Guide to Change ConceptsThe Improvement Guide (pg. 293-299)• Consider potential consequences of applying change concepts• The concepts are guidelines and general in nature• Every change concept does not apply to every problem• What change can we make that will result in improvement?• “While all changes do not lead to improvement, allimprovement requires change.”Improve – Change Concepts
  74. 74. 74Value Added vs. Non-Value Added• Value Adding Process– A process step that transforms or shapes a productor service towards that which is sold to acustomer. Changes “form, fit, or function” in away that customers are willing to pay for• Non-Value Adding Process– Those process steps that take time, resources, orspace, but do not add to the value of the productor service itself (These activities should beeliminated, simplified, reduced or integrated)Improve – Eliminate Waste
  75. 75. WaitingzzzzzOver-Production &Over- ProcessingSign-offsTransportation12 1 109 86 4132311 5 7Waste of People:Underutilized orUnused CreativityNoway!Motion: Walkingor ReachingInventory Rework / QualityDefectsWrong infoInfo missingKeypunch errorMedical ErrorEight WastesInspection75
  76. 76. 76Why Lean Tools?• Six Sigma and Lean are very complimentaryapproaches to improvement• Often creates rapid improvement and elimination of theeight wastes• Creates a stable process which can be furtherimproved• When deployed correctly, embeds a rapid continuousimprovement mindset in the culture• Drives shorter lead-times, reduced inventory, lowerscostsImprove – Eliminate Waste
  77. 77. 77Does a distance of 45 feet Matter?Example: LeBonheur Lab Renovation Initial Design -Tube System Location45 feet each way = 90 feet walked per specimen250,000 core lab specimens per year= 22,500,000 feet per year walked= 4,260 miles per year walked (the distance from New York to Rome)At two miles per hour, = 2130 hours per year= 1.02 FTEs per year moving the sample from tube station toreceiving areaImprove – Improve Work Flow
  78. 78. Red = Zone 1 OperatorBlue = ProcessorMove Steps in the ProcessCloser Together & SynchronizeAfter78
  79. 79. 79Do Tasks in Parallel /Eliminate BatchingSmaller centrifugeallows forindividualsingle piecetesting, instead ofwaiting for a largecentrifuge to fillwith specimensbeforespinning (batch)Improve – Improve Work Flow
  80. 80. 80Take Care of Basics: 5S1) SortClear out rarely useditems by red tagging4) StandardizeCreate rules to sustainthe first 3S’s2) StraightenOrganize and label aplace for everything3) ShineClean it5) SustainUse regularmanagement audits tostay disciplinedImprove – Change Work Environment
  81. 81. Did somebody order some 5S?81
  82. 82. 82Post 5S Improvement ResultsImprove – Change Work Environment
  83. 83. Sustain5S within OR Rooms OR #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8Stock Turnover: Are bins being completely emptied prior torefill to ensure turn-over of stock? (Yes or No)Restock Carts: Are empty bins being placed into the restockcarts as they are emptied?Stock Amounts: Are bins being properly filled and notoverstocked?Visual Control: If the associates are too busy to restock arethey placing the restock carts in the hallway (with empty bins)Visual Control: Are all necessary items labeled for properlocation and shadowed appropriately?Sort, Shine, Stabilize: Are rooms clean and organized? Allitems in the proper place, excess items removed, etc?Standardization: Are items in the rooms properly placed intotheir designated locations?OR Storeroom:Kanban Cards: Are Kanban cards properly located accordingto minimum stock amount listed on card? (Verify5 cards on 5 separate carts, list SAP# checked)Inventory: Are supplies properly organized so longeroutdates and last used? Longer outdates onright/bottom/back and shorter outdates on left/top/front?(Verify 5 cards on 5 separate carts, list SAP# checked)Process: Are Kanban card properly located in the "To BeOrdered" location when appropriate and moved to "Ordered"when order is placed?Orderliness: Is the storeroom clean and organized, itemsremoved from walkways? All carts properly located?Timeliness: Are supplies being ordered in a timely manner sothat out-of stock does not occur?(Look for empty supply locations)CSR: Are CSR stocked items (red stripe on Kanban cards)properly filled and organized?Other:Hallway: Are items in hallways properly labeled andshadowed for position and all items accounted for? Arehallways free of debris, etc?Scrubs: Are Kanban cards properly located and is processbeing followed? (Empty bins cards at front desk, Full 2nd binhas card located on it)Small Equipment Room: Are equipment and suppliesproperly located, organized, labeled and shadowed within thisarea?Auditor: Date:Standardized Process Audit - Supply ManagementAdditional Comments or Suggestions:83
  84. 84. # Work Elements / Important Steps Est. Time Reasons for Key Points1Clinician will send patient back to triage, if lobbyis backed up call patient back to triage42Using FIFO helps patientsatisfaction and does not use theED as a fast track system2 Get patient weight prior to entering triage room. 60 weight is critical for the providers3Obtain brief chief complaint while getting vitalsigns120Saves cycle time when donetogether4 Put complaint and vital signs in computer 167necessary information for theprovider5 Complete full triage in computer 60 key for provider to have upfront6 Determine ACUITY level of patient. 26Diagnosis, not acuity level drivesthe LCT7Escort patient to lobby if LCT exam rooms arefull5891011 Total Estimated Time 480We are using a FIFO (first-in-first-out) system,unless high acuity dictates differentlyDocument wt on Registration formDo vitals and chief complaint in parrallelDocument vital signs on registration form, do notwrite down the patients information, enter it directlyinto the computerPast medical history and home medicationsAlthough assigning acuity level we are assigningpatients to the LCT by diagnosis, (refer todiagnosis sheet for lean track patientsWORK STANDARD & JOBBREAKDOWN SHEETJob Function: Triage NurseKey Points Sketch/Drawing/PictureSheet No. 1 Of 1Area: Front of EDOperation Name: TriageDate: 9-18-07Prepared By BeLinda ContiApproved ByUpdate NameDept. Emergency DepartmentTriage1&2 Greeter&ClinicianStandard Work84
  85. 85. Ten Types of Human Errors(and how to protect against them)1. Forgetfulness - Protection: alerting operators in advance, regularchecking, automated reminders2. Misunderstanding - Protection: std work, training, checking in advance3. Identification – Protection: training, attentiveness, vigilance4. Lack of experience – Protection: Skill building, work standardization5. Ignoring rules – Protection: Basic education, experience, audits,discipline6. Inadvertent – Protection: Attentiveness, discipline, std work7. Slowness, delays in judgment – Protection: Skill building, std work8. No standards – Protection: work instructions, std work9. Surprise – Protection: Preventative maintenance, std work10.Intentional – Protection: Education, discipline85
  86. 86. Defect Sources• Omitted processing• Processing errors• Setting up work pieces• Missing parts• Wrong parts• Processing wrong work piece• Misoperation• Adjustment error• Improper setup• Tools, fixtures, jigs improperly preparedImprove – Design Systems to Avoid Mistakes86
  87. 87. Design for Six SigmaDFSS87
  88. 88. 88Improvement from the Start• DFSS (Design for Six Sigma) builds a process that isdesigned to operate at a Six Sigma level ofperformance from the very launch of the newprocess. It focuses on the customer (needs), reviewscurrent related processes, and benchmarks internallyand externallyDesign for Six Sigma
  89. 89. 89Design for Six Sigma• DMAIC is structured to improve an existingprocess - reduce variation, eliminate defects.• Design for Six Sigma (DFSS) uses DMADV (DefineMeasure, Analyze, Design, Validate); or IDOV(Identify, Design, Optimize, Verify) to create anew process that produces minimal defects fromthe start• We usually focus on DMAICDesign for Six Sigma
  90. 90. 90Design for Six Sigma• The intent of DFSS is to bring a new product orservice to “market” with a process performancenear a six sigma level for each key customerrequirement of the product / service.• DFSS is essentially an attitude and approach towardnew or re-designed products and services, and nota methodology. The DFSS concept utilizesmethodologies such as DMADV or IDOV.Design for Six Sigma
  91. 91. 91Design for Six Sigma• DMADV and IDOV are very similar and basicallyprovide a structured roadmap to create a newproduct or design a new process that has minimalvariation and defects• The key initial focus areas of DFSS includecollecting, analyzing, and clearly understanding theVOC and CTQs - “What would a Six Sigma levelperforming product or process need to look like, orconsistently produce?”Design for Six Sigma
  92. 92. 92Design for Six Sigma - IDOV• Identify - Quantified customer information alongwith technical requirements, specifications, andperformance targets are identified anddocumented.• Design - The CTQs are emphasized, and all keyinputs considered as conceptual designs areevaluated to create a new process that producesminimal defectsDesign for Six Sigma
  93. 93. 93Design for Six Sigma - IDOV• Optimize - The capability of the new process tomeet all critical requirements is evaluated, andthe design is optimized through simulation,small scale tests, benchmarked data, etc.• Verify - The optimized process design is formallytested and validated to consistently meet criticalrequirements. Longer term monitoring andfeedback may be necessary.Design for Six Sigma
  94. 94. 94Design for Six Sigma - DMADV• Define - Define the project goals and customerdeliverables• Measure - Determine customer needs andspecifications• Analyze - Study process options to meet the customer’sneeds• Design - Develop process details to meet the criticalrequirements• Validate - Verify the design performance and ability toconsistently meet customer’s needsDesign for Six Sigma
  95. 95. 95Design for Six SigmaCommon Tools• SIPOC (VOC and CTQ emphasized)• Detailed Process Maps• QFD - Quality Function Deployment• FMEA• Simulation and Small Scale Testing• Poka-Yoke (Mistake Proofing)Design for Six Sigma
  96. 96. 96IDOV DMADV Deliverable ToolIdentify Define Intiate, scope, and planthe projectCharterBenchmarkingFMEA on current processMeasure Understand customerneeds and specify CTQsVOCQuantify specifications, technical requirementsDefine key inputsHigh-level map of current process or SIPOCAnalyze Develop design conceptsand high-level designHigh-level design of new processQuality Function Deployment (QFD)Process Capability analysisOptimize Design Develop detailed designand control/test planDetailed process mapSimulationFMEAPoka-yokeFFAVerify Verify Test, design, andimplement full-scaleprocessesControl plan and feedback loopData collection and analysisSPCCapability AnalysisStandard Operating ProceduresDesignIDOV and DMADV
  97. 97. Designed ExperimentsorDesign of Experiments(DOE)97
  98. 98. Design of Experiment• DOE identifies how factors (Xs) alone and incombination affect a process and its outputs(Ys).• DOE is a systematic approach• Provides a mathematical model• Identifies the best combinations of Xs98
  99. 99. Why is DOE needed?• A man decided to investigate the causes of intoxication.• On his first trial, he drank whiskey and water and becameintoxicated.• On his second trial, he held all variables constant except one…he replaced the whiskey with vodka… and became intoxicated• On the third trial, he used bourbon instead of whiskey andvodka… and became intoxicated.• After recovering, he concluded that water causes intoxication,because it was the only constant variable!99
  100. 100. 100Designed Experiments orDesign of Experiments (DOE)pg 184 - 194• DOE is a structured approach to improve anexisting process by testing multiple factors at atime thus reducing the number of experimentalruns and time needed for testing• The most important factors affecting a givenoutput of a process, and the controlled testedfactor’s best settings are identified.Six Sigma DOE
  101. 101. 101Alternatives• One Factor at a Time (OFAT) – A given factor tested atmultiple levels while holding everything else constant.This approach may work OK in a high school chemistry lab,but it can be very time consuming and inefficient whenapplied to a complex process in a “working” environment.• Many Things at Once – it becomes difficult to determinewhich changes contributed to the effects and to whatdegree, might keep doing something that is harmful toresults, impossible to assess cost/benefit for each changeSix Sigma DOE
  102. 102. 102Alternatives• Not every project has to include a designedexperiment. Many will use pilots of controlledsmall tests of change or work-out sessions toachieve improvements… but considering DOE asappropriate doesn’t hurt, either!Six Sigma DOE
  103. 103. 103Designed Experiments orDesign of Experiments (DOE)• Results from DOEs identify main effects from thetested controlled factors as to the extent the factorsinfluence chosen response variables.• The factors would be considered the inputs, and theresponse variables would be the outputs.• Results from DOEs also look at how the interactions ofthe factors influence the response variables.Six Sigma DOE
  104. 104. One Factor at a TimeGas Type Timing Set up MPGG1 T1 30G2 T1 20Which gas type and engine timing setting willproduce the best gas mileage?Since G1 produced the best mileage, test it againstboth timing settings…Gas Type Timing Set up MPGG1 T1 30G1 T2 25Best Value!But… what did we miss?104
  105. 105. DOE shows the effects of interactionsGas Type Timing Set up MPGG1 T1 30G1 T2 25G2 T1 20G2 T2 4520504030T2T1G1G2This interactionwas missed usingone factor at atime!105
  106. 106. Terminology• Factors – the variables you are testing• Levels – the settings you are checking for eachfactor• Factorial – describes the basic design– 2 x 3 x 3 design describes 3 factors– one at 2 levelsand two at 3 levels… 18 trials or “runs” in all– 2k describes an experiment with k factors, each at2 levels. A 23 design means 3 factors with 2 levelseach, or 8 runs in all106
  107. 107. Terminology• Main Effects – the differences between eachfactor level• Interactions – differences between two ormore factor level combinations107
  108. 108. Main Effects and Interactions Plots20504030T2T120504030T2T12530T2T1G1G2G2G1Main Effects Interactions108
  109. 109. Terminology• Run – Each trial with a combination of factorsyielding a result• Replicates – The number of times you repeatthe full set of runs• Full Factorial – A design that tests each factorat every level• Fractional Factorial – A design that tests onlyselected combinations of factors109
  110. 110. Set up a 22 Full Factorial Experiment• Stat>DOE>Factorial>Create Factorial DesignSelect the number ofreplicates110
  111. 111. Set up a 22 Full Factorial Experiment• Stat>DOE>Factorial>Create Factorial DesignName the factorSelect the data typeSet the levels111
  112. 112. Set up a 22 Full Factorial ExperimentFull Factorial DesignFactors: 2 Base Design: 2, 4Runs: 8 Replicates: 2Blocks: 1 Center pts (total): 0All terms are free from aliasing.Add column for results.Run the experiment andrecord responses.Standard sequenceRandomized “run” sequence112
  113. 113. Analyze Factorial Design• Stat>DOE>Factorial>Analyze Factorial Design113
  114. 114. Analyze Factorial Design• Stat>DOE>Factorial>Analyze Factorial Design114
  115. 115. Analyze Factorial DesignFactorial Fit: Mileage versus Gas, TimingEstimated Effects and Coefficients for Mileage (coded units)Term Effect Coef SE Coef T PConstant 29.500 0.7289 40.47 0.000Gas 4.000 2.000 0.7289 2.74 0.052Timing 7.500 3.750 0.7289 5.14 0.007Gas*Timing 14.500 7.250 0.7289 9.95 0.001S = 2.06155 PRESS = 68R-Sq = 97.08% R-Sq(pred) = 88.32% R-Sq(adj) = 94.89%Analysis of Variance for Mileage (coded units)Source DF Seq SS Adj SS Adj MS F PMain Effects 2 144.500 144.500 72.250 17.00 0.011Gas 1 32.000 32.000 32.000 7.53 0.052Timing 1 112.500 112.500 112.500 26.47 0.0072-Way Interactions 1 420.500 420.500 420.500 98.94 0.001Gas*Timing 1 420.500 420.500 420.500 98.94 0.001Residual Error 4 17.000 17.000 4.250Pure Error 4 17.000 17.000 4.250Total 7 582.000Estimated Coefficients for Mileage using data in uncoded unitsTerm CoefConstant 29.5000Gas 2.00000Timing 3.75000Gas*Timing 7.25000Timing settings and the combination of timingsettings and gas type are statisticallysignificantThe factors we tested account for 95% of thevariation in the result115
  116. 116. Analyze Factorial DesignGraphical Illustrationof the significance ofthe factors tested116
  117. 117. Analyze Factorial DesignResidual Plots• Normality plot is tight• Versus Fits is evenlydistributed about 0• Histogram looks non-normal, but not enormouslyskewed• Versus order doesn’tmatter since sequencewasn’t important in theexperiment117
  118. 118. Main Effects and Interactions Plots• Stat>DOE>Factorial>Factorial Plots118
  119. 119. Main Effects and Interactions Plots119
  120. 120. Designed ExperimentsStatapult Example120
  121. 121. Set up a 2 x 2 x 3 Full FactorialDesigned ExperimentFactors• Rubber Band Tension– Level 1 setting: 1– Level 2 setting: 4• Pull-Back Angle– Level 1 setting: 160o– Level 2 setting: 180o• Stop Angle– Level 1 setting: 1– Level 2 setting: 3– Level 3 setting: 6121
  122. 122. Set up a 2 x 2 x 3 Full FactorialDesigned ExperimentResults• Distance – measured from front edge ofstatapult to impact point• Skew – measured from right edges of foil toimpact point (a measure of how far off-centerthe ball landed)122
  123. 123. Set up a 2 x 2 x 3 Full FactorialDesigned Experiment• Stat>DOE>Factorial>Create Factorial Design123
  124. 124. Analyze a 2 x 2 x 3 Full FactorialDesigned Experiment• Stat>DOE>Factorial>Analyze Factorial DesignGeneral Linear Model: Distance versus Rubber Band, Stop Angle, ...Factor Type Levels ValuesRubber Band fixed 2 1, 4Stop Angle fixed 3 1, 3, 6Pull Back Angle fixed 2 160, 180Analysis of Variance for Distance, using Adjusted SS for TestsSource DF Seq SS Adj SS Adj MS F PRubber Band 1 33063 33063 33063 493.79 0.000Stop Angle 2 43258 43258 21629 323.02 0.000Pull Back Angle 1 30392 30392 30392 453.90 0.000Rubber Band*Stop Angle 2 3295 3295 1648 24.61 0.000Rubber Band*Pull Back Angle 1 3173 3173 3173 47.39 0.000Stop Angle*Pull Back Angle 2 919 919 460 6.87 0.004Rubber Band*Stop Angle* 2 155 155 78 1.16 0.331Pull Back AngleError 24 1607 1607 67Total 35 115863S = 8.18281 R-Sq = 98.61% R-Sq(adj) = 97.98%124
  125. 125. Analyze a 2 x 2 x 3 Full FactorialDesigned Experiment• Stat>DOE>Factorial>Analyze Factorial Design125
  126. 126. Analyze a 2 x 2 x 3 Full FactorialDesigned Experiment• Stat>DOE>Factorial>Effects PlotsNotice the curvedeffect on Stop AngleResultsscaleInteraction Effects Plots can bedifficult to read, so pay closeattention to what they aretelling you! 126
  127. 127. Results• Practically, the DOE has given us someinformation about the optimal settings tomaximize the distance of the ping-pong ball– Stop Angle at 6– Rubber Band tension at 1– Pull back to 180o (less significant factor)127
  128. 128. Summary• DOE can provide you with vital informationabout your critical Xs and their interactions• DOE takes time and thought to set up andtime and discipline to conduct• DOE results also take time and thought tounderstand, interpret, and apply• DOE improves your process by getting thefactors set at the optimum levels128
  129. 129. 129Review of Improve PhaseImprove – Review & Key Deliverables
  130. 130. 130Key Deliverables for Improve• Main elements of Define, Measure, andAnalyze completed• “Obvious Xs” identified and confirmed• Potential Xs identified, data collected andconfirmed (Root Causes)• Improvement solutions generated andprioritized upon investigation of root causesand supported with dataImprove – Review & Key Deliverables
  131. 131. 131Key Deliverables for Improve• Improvement solutions tested (pilot) andbenefits estimated• Implementation plan for solution(s) draftedwith input from process owners• Champion approval of the key solution(s)implementationImprove – Review & Key Deliverables
  132. 132. 132Improve Phase Review:Key StepsIn alignment with our project goal statement, andgiven what we have learned in the Define, Measure,and Analyze Phases of our project, during theImprove phase our team will complete:•Generating and prioritizing Solutions (Improvement actions)•Risk assessment•Evaluation of Solutions and Benefits•Approach for Implementation•Translating and communicating learnings to Champion andProcess Owner(s) as appropriateWe will define and implement GREAT improvement solutions!Improve – Review & Key Deliverables
  133. 133. 133Start Date: Enter DateEnd Date: Enter Date Benchmark Analysis Project Charter Formal ChampionApproval of Charter(signed) SIPOC - High LevelProcess Map Customer CTQs Initial Team meeting(kickoff)Start Date: Enter DateEnd Date: Enter Date Identify Project Y(s) Identify Possible Xs(possible cause andeffect relationships) Develop & ExecuteData Collection Plan MeasurementSystem Analysis Establish BaselinePerformanceStart Date: Enter DateEnd Date: Enter Date Identify Vital FewRoot Causes ofVariation Sources &ImprovementOpportunities Define PerformanceObjective(s) for KeyXs Quantify potential $BenefitStart Date: Enter DateEnd Date: Enter Date Generate Solutions Prioritize Solutions Assess Risks Test Solutions Cost BenefitAnalysis Develop &ImplementExecution Plan Formal ChampionApprovalStart Date: Enter DateEnd Date: Enter Date ImplementSustainable ProcessControls – Validate: Control System Monitoring Plan Response Plan System IntegrationPlan $ Benefits Validated Formal ChampionApproval and ReportOutAuthor: Enter NameDate: June 5, 2013Project Name:Problem Statement:Mislabeled exampleProject Scope:Enter scope descriptionChampion: NameProcess Owner: NameBlack Belt: NameGreen Belts:NamesCustomer(s):CTQ(s):Defect(s):Beginning DPMO:Target DPMO:Estimated Benefits:Actual Benefits: Not Complete Complete Not ApplicableMeasureDefineDirections:•Replace All Of The Italicized, Black Text With Your Project’s Information•Change the blank box into a check mark by clicking on Format>Bullets and•Numbering and changing the bullet.Analyze Improve Control