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LEAN SIX SIGMA – AN OVERVIEW         Dr. Parag R Rindani MD MBA   Head Medical Strategy & Clinical Excellence           Wo...
Quality in Healthcare
SafetyAppropriatenessAccessConsumer centerednessEffectivenessEfficiency
Strategy“Would you tell me, please, – asked Alice, Whichway I ought to Walk from here?”That depends a good deal on where y...
• Better management through reduction in turn  around time – OPD waiting times, discharge  times, ambulance dispatch times...
What is a Process??
 Any sequence of activities that use a set of      INPUTS to produce an OUTPUT is called a      PROCESS     A Process is...
Supplier: The provider of inputs to your process    Input:    Materials, resources or data required to              execut...
Process                                    Outputs      Input    Variables                Process Variables9
What can go wrong??
 A Process may not produce the desired output leading to       CUSTOMER DISSATISFACTION.      The output from a process ...
The key deficiencies of any Process include:      VARIATION      WASTE12
How to prevent variation and waste??
 Identify Chronic Problems (diseases) in the Process Ensure that adequate Measurement Systems have been  defined to accu...
 Process Deficiencies are solved by a Project by Project approach. Each Project needs to address a specific PAIN (defici...
 Each Project needs to have a specific GOAL for  improvement in terms of either eliminating or minimizing  the deficiency...
 Each Project must have a goal to generate     savings as ELIMINATING OR MINIMIZING     DEFICIENCIES will always REDUCE C...
What is Six Sigma??
“The real problem at Motorola is that our quality stinks”                                         ……1979, Art Sundry     “...
What does Quality Mean…….        Detecting and correcting mistakes in the product such         that it meets compliance s...
Motorola believed….     “Highest Quality Producer was the Lowest Cost     Producer”     In 1987, a new approach to quality...
Sigma Level   PPM/DPMO   3 - Historical Standard                               93.32% yield    1         691,462         ...
99% GOOD (3)                (3               99.99966% GOOD (6)                                                 (620,0...
99% GOOD (3)                (3              99.99966% GOOD (6)                                                (62 SHOR...
What is Sigma?• Sigma is used in statistics to denote standard  deviation.• A sigma value is used to relate the ability of...
Standard Deviation:Metric that displays variation from it’s “target”.                            1 Std. Dev.              ...
If we can squeeze six standard deviations in between        our target and the customer’s requirements...                6...
What is Lean??
"Lean", is a practice that considers the expenditureof resources for any goal other than the creation ofvalue for the end ...
Lean is a generic process management philosophy derivedmostly from the Toyota Production System (TPS)Lean is renowned for ...
SEVEN     CLASSICAL     WASTES31
1.   Waste of over production2.   Waste of inventory3.   Waste of correction (rework)4.   Waste of motion5.   Waste of ove...
Overproduction This is the waste of producing too much at a particular point in time. This waste is generally characterize...
Inventory •   This is the waste of having excess inventory at all     stages of the service delivery process. •   Inventor...
Correction (Repair/Reject) •   Repair This is the waste of reworking on a process     output that should have been deliver...
Motion •   This is the waste of excessive motion of the human     body such as lifting heavy loads, bending awkwardly,    ...
Over Processing •   This is the waste of unnecessary inspection in a     process. •   Over processing loads a process with...
Transport •   This is the waste of transportation of materials /     people from one part of the process to another. •   T...
Waiting •   This is the waste of equipment and people in one     step of the process remaining idle as the previous     st...
Why Lean Six Sigma??
• The primary focus of Lean has been on maximizing  process velocity and eliminating waste so as to deliver  products and ...
• The primary focus of Six Sigma has been on reducing  defects and variation in a process so as to deliver near  perfect p...
• Why Lean Six Sigma ? - Because Lean provides the agility and  repeatability in many basic processes. Once repeatability ...
Quality is a state in which     value entitlement is realized     by the customer and provider        in every aspect of t...
SIX SIGMA                   LEANImprovement                                                 Improvement                   ...
• Reduce Variation • Reduce Waste            Focus • Reduce Defects            of • Delighting Customer    Lean Six • Redu...
1.        Genuine Focus on Customer                                                   Six Themes2.        Data and Fact-Dr...
Pitfalls in Deployment• Projects drift away from strategic management priorities• Scoping projects very broadly - too long...
Summary     • Lean Six Sigma reduces waste and variation in a       product / service by improving the process that       ...
Summary • Direct involvement of Top Management is essential.   Lean Six Sigma cannot be delegated. • Lean Six Sigma is not...
In 2010, Quality Council of India (QCI) conceptualized a National Demonstration        Who Should Attend  Project (NDP) on...
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Lss overview

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An overview about Lean Six Sigma in Healthcare by Dr.Parag Rindani

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  1. 1. LEAN SIX SIGMA – AN OVERVIEW Dr. Parag R Rindani MD MBA Head Medical Strategy & Clinical Excellence Wockhardt Hospitals Ltd
  2. 2. Quality in Healthcare
  3. 3. SafetyAppropriatenessAccessConsumer centerednessEffectivenessEfficiency
  4. 4. Strategy“Would you tell me, please, – asked Alice, Whichway I ought to Walk from here?”That depends a good deal on where you want toget to,” said the Cat.“I don’t much care where…” said Alice“Then it doesn’t matter which way you walk,” saidthe Cat. - From Alice in Wonderland’ - Lewis Carroll
  5. 5. • Better management through reduction in turn around time – OPD waiting times, discharge times, ambulance dispatch times• Increase in clinical efficiency – Emergency room assessment and triage, standardization of protocols for stroke, myocardial infarction, trauma• Decrease in negative outcomes – infections, falls, injuries
  6. 6. What is a Process??
  7. 7.  Any sequence of activities that use a set of INPUTS to produce an OUTPUT is called a PROCESS  A Process is a means for doing work  Every Process has a CUSTOMER. A Customer is the immediate recipient of the Output from the Process7
  8. 8. Supplier: The provider of inputs to your process Input: Materials, resources or data required to execute your process Process: A collection of activities that takes one or more kinds of input and creates output that is of value to the customer Output: The products or services that result from the process Customer: The recipient of the process output – may be internal or external8
  9. 9. Process Outputs Input Variables Process Variables9
  10. 10. What can go wrong??
  11. 11.  A Process may not produce the desired output leading to CUSTOMER DISSATISFACTION.  The output from a process may have defects or errors in it and this leads to REWORK or REJECTION. This leads to the generation of WASTE.  The produced output may be unpredictable in its ability to meet customer requirements and this is caused due to high VARIATION in a Process.  The process may be unstable and this leads to generation of WASTE in the process itself11
  12. 12. The key deficiencies of any Process include:  VARIATION  WASTE12
  13. 13. How to prevent variation and waste??
  14. 14.  Identify Chronic Problems (diseases) in the Process Ensure that adequate Measurement Systems have been defined to accurately measure the damage i.e. Rework, Rejections, Variation, etc caused by these problems Use structured Problem Solving Methodologies to permanently eliminate or minimize the Waste and Variation Improve the Capability of the Process to meet customer requirements Consistently at Optimized Costs 14
  15. 15.  Process Deficiencies are solved by a Project by Project approach. Each Project needs to address a specific PAIN (deficiency) in the process Each Project is a structured approach to Problem Solving involving the five steps;  Defining the Problem  Measuring the Problem  Analyzing the Root Causes  Implementing the Improvements  Sustaining the gains 15
  16. 16.  Each Project needs to have a specific GOAL for improvement in terms of either eliminating or minimizing the deficiency. Each Project needs to be conducted by a CROSSFUNCTIONAL TEAM consisting of members from the functions most affected by the pain. Each Project needs to be TIMEBOUND 16
  17. 17.  Each Project must have a goal to generate savings as ELIMINATING OR MINIMIZING DEFICIENCIES will always REDUCE COSTS. This reduction in costs translates to SAVINGS TO THE BOTTOMLINE17
  18. 18. What is Six Sigma??
  19. 19. “The real problem at Motorola is that our quality stinks” ……1979, Art Sundry “A product found defective and corrected during manufacturing had high probability of failing during early use by customer” ……1985, Bill Smith19
  20. 20. What does Quality Mean…….  Detecting and correcting mistakes in the product such that it meets compliance standards. OR  Preventing defects in the first place through process controls and product design such that it meets performance standards.20
  21. 21. Motorola believed…. “Highest Quality Producer was the Lowest Cost Producer” In 1987, a new approach to quality came out of Motorola’s Communication Sector – 6 Six Sigma21
  22. 22. Sigma Level PPM/DPMO 3 - Historical Standard 93.32% yield 1 691,462 10 Times Improvement 2 308,538 4 - Current Standard 3 66,807 99.38% yield 4 6,210 1800 Times Improvement 5 233 6 – New Standard 6 3.4 99.99966% yield 22
  23. 23. 99% GOOD (3) (3 99.99966% GOOD (6) (620,000 LOST ARTICLES OF MAIL SEVEN LOST ARTICLES OF MAILPER HR. PER HR.UNSAFE DRINKING WATER 15 UNSAFE DRINKING WATER FORMIN. PER DAY ONE MINUTE EVERY SEVEN MONTHS5,000 INCORRECT SURGICAL 1.7 INCORRECT SURGICALOPERATIONS PER WEEK OPERATIONS PER WEEK 23
  24. 24. 99% GOOD (3) (3 99.99966% GOOD (6) (62 SHORT OR LONG LANDINGS AT ONE SHORT OR LONG LANDINGMOST MAJOR AIRPORTS EACH EVERY FIVE YEARSDAY200,000 WRONG DRUG 68 WRONG DRUGPRESCRIPTIONS EACH YEAR PRESCRIPTIONS EACH YEARNO ELECTRICITY FOR ALMOST 7 NO ELECTRICITY FOR ONEHOURS PER MONTH HOUR EVERY 34 YEARS 24
  25. 25. What is Sigma?• Sigma is used in statistics to denote standard deviation.• A sigma value is used to relate the ability of a process to perform defect free work.• The higher the sigma value the better the process is performing and the lower the probability that a defect will occur.25
  26. 26. Standard Deviation:Metric that displays variation from it’s “target”. 1 Std. Dev. (“Sigma”) One standard deviation around the mean is about 68% of the total “opportunities” for meeting customer requirements!26
  27. 27. If we can squeeze six standard deviations in between our target and the customer’s requirements... 6 5 4 3 2 1 1 2 3 4 5 6…….99.99966% of “opportunities” to meet customer requirementsare included! 27
  28. 28. What is Lean??
  29. 29. "Lean", is a practice that considers the expenditureof resources for any goal other than the creation ofvalue for the end customer to be wasteful, and thusa target for elimination.Working from the perspective of the customer whoconsumes a product or service, "value" is defined asany action or process that a customer would bewilling to pay for29
  30. 30. Lean is a generic process management philosophy derivedmostly from the Toyota Production System (TPS)Lean is renowned for its focus on reduction of the sevenwastes in order to improve overall customer value.“All we’re trying to do is shorten the time line…. fromorder receipt to collecting cash for the goods or servicesprovided.” …….1975, Taiichi Ohno 30
  31. 31. SEVEN CLASSICAL WASTES31
  32. 32. 1. Waste of over production2. Waste of inventory3. Waste of correction (rework)4. Waste of motion5. Waste of over processing6. Waste of transportation7. Waste of waiting 32
  33. 33. Overproduction This is the waste of producing too much at a particular point in time. This waste is generally characterized by:  Producing more than is needed by the next process or customer  Producing earlier than is needed by the next process or customer  Producing faster than is needed by the next process or customer33
  34. 34. Inventory • This is the waste of having excess inventory at all stages of the service delivery process. • Inventory is considered waste as it does not add value and only increases the cost of service delivery. • High inventory only means high costs of storage, handing, preservation and movement. • Economic Order Quantity – Healthcare !!34
  35. 35. Correction (Repair/Reject) • Repair This is the waste of reworking on a process output that should have been delivered right the first time and added value to the customer. • Any repair or rework reduces the value of the output and also increases the cost of delivery. • Reject This is the waste of scrapping the output of a process. • Rejections nullify the purpose of the value creation process and double the cost of service delivery35
  36. 36. Motion • This is the waste of excessive motion of the human body such as lifting heavy loads, bending awkwardly, repeatedly climbing staircases, stretching too far, etc. • Such work environments create plenty of safety hazards and may lead to injuries and lost time or resources. • This leads to increase in time and cost of service delivery.36
  37. 37. Over Processing • This is the waste of unnecessary inspection in a process. • Over processing loads a process with additional steps that do not add any value to the process output, but are included because the team has low confidence in the capability of the process. • Over processing only helps to slow the process speed and increase cost.37
  38. 38. Transport • This is the waste of transportation of materials / people from one part of the process to another. • This leads to long cycle times and also increases the cost of service delivery. • The waste of transportation promotes the practice of working in batch mode.38
  39. 39. Waiting • This is the waste of equipment and people in one step of the process remaining idle as the previous step of the process is far too slow in servicing the next step. • This leads to low utilization of resources and in turn increases time and cost of service delivery.39
  40. 40. Why Lean Six Sigma??
  41. 41. • The primary focus of Lean has been on maximizing process velocity and eliminating waste so as to deliver products and services to customers at the lowest cost with maximum speed. That is why Lean has been the primary weapon in the War on Waste.• Lean Principles help to bring agility in a process by using a combination of highly effective process speed tools within a structured framework. 41
  42. 42. • The primary focus of Six Sigma has been on reducing defects and variation in a process so as to deliver near perfect products and services to customers at lowest possible cost. That is why Six Sigma has been the primary weapon in the War on Variation.• Six Sigma helps to bring stability and consistency in a process by using a combination of highly effective process quality tools within a structured framework. 42
  43. 43. • Why Lean Six Sigma ? - Because Lean provides the agility and repeatability in many basic processes. Once repeatability has taken hold, much of the variation due to human intervention goes away. The data collected to support Six Sigma activities thereby becomes much more reliable and accurate.• Lean Six Sigma’s ability to achieve NEAR PERFECT PRODUCTS AND SERVICES AT AN ACCELERATED SPEED offers an organization a powerful tool to achieve their strategic goals with faster pace. 43
  44. 44. Quality is a state in which value entitlement is realized by the customer and provider in every aspect of the business relationship.44
  45. 45. SIX SIGMA LEANImprovement Improvement Improvement Time Time LEAN SIX SIGMA Time 45
  46. 46. • Reduce Variation • Reduce Waste Focus • Reduce Defects of • Delighting Customer Lean Six • Reduce Cost Sigma • Reduce Delivery Time46
  47. 47. 1. Genuine Focus on Customer Six Themes2. Data and Fact-Driven Management of3. Processes are where the Action Is Lean Six4. Proactive Management Sigma5. Boundary Less Collaboration6. Drive for Perfection; Tolerate Failure 47
  48. 48. Pitfalls in Deployment• Projects drift away from strategic management priorities• Scoping projects very broadly - too long, loss of focus• Undertaking too many projects at the same time• Inadequate tracking of results• Little or no sharing of Best Practices• Forgetting people not directly involved in deployment 48
  49. 49. Summary • Lean Six Sigma reduces waste and variation in a product / service by improving the process that delivers the product / service. • Lean Six Sigma is equally effective on manufacturing and service processes. • Effective Lean Six Sigma implementation requires the allocation of correct resources.49
  50. 50. Summary • Direct involvement of Top Management is essential. Lean Six Sigma cannot be delegated. • Lean Six Sigma is not completely new. It uses the same tools in a structured manner through the various phases of problem solving.50
  51. 51. In 2010, Quality Council of India (QCI) conceptualized a National Demonstration Who Should Attend Project (NDP) on Lean Six Sigma (LSS) in Healthcare. The project was executed by  Hospital management representatives Qimpro with great success.  Hospital administrators  Healthcare professionals Over 50 healthcare professionals and hospital administrators were trained on LSS.  Healthcare management students  Hospital quality managers Thereafter they used the LSS methodology to successfully complete improvement  Everybody from healthcare projects that resulted in significant change in the efficiency of hospital processes who believe in “change” and patient experience. This success is proof of confirmation that LSS is equally effective in improving hospital processes. Course Faculty Quality in healthcare is a deep concern amongst patients and society at large. The QCI, recognizing this issue, have underlined the criticality of Continuous Quality Improvement as a key factor for NABH Accreditation. In this scenario it has become essential for healthcare professionals and hospital administrators to have Lean Six Sigma Green Belt (LSSGB) credentials. Dr Parag Rindani Anirudha Chakravarty Head - Medical Director Strategy Qimpro Healthcare & Clinical Excellence Six Sigma Master Black Wockhardt Hospitals BeltContact: Vidhya Unni, Qimpro Consultants Tel: (91-22) 6634 8701 |Email: healthcare@qimpro.com
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