Beyond Lean/ Six Sigma - Managing Change and Spreading Innovation


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  • Challenges promoting consistency of practice and standardization across campuses
  • Challenges promoting consistency of practice and standardization across campuses
  • Staff attitude – let’s just wait’em out, this will blow over, this too shall pass, flavor of the month
  • Board members focused on quality – excellent trustee participation in committee work and executive goal setting around quality initiatives Middle management in need of a tool kit Physician engagement was spotty
  • We Learned: Not all managers are as “ computer competent” as assumed, especially in Excel
  • Eliminate Obvious Sources of Variation 1. Have personnel been provided with the means to know what they are supposed to do? a) Have written policies, guidelines, or procedures been developed? b) Have quality standards been developed? c) Do personnel have ready access to a and b ? d) Do they fully understand a and b and use them? e) Do they know whom to consult to interpret a and b ? f) Do they know how the results of their activity will be used? g) Do they know the consequences to the user if they fail to meet the requirements in a and b ? h) Are changes in a and b transmitted rapidly to personnel affected? i) Do personnel know what to do when inputs to them contain errors or omissions? 2. Have personnel been provided with the means to know what they are doing? a) Are personnel provided with some means to evaluate the adequacy and completeness of their work, e.g., quality standards, checklists, etc? b) Are they told how often to sample their work? Is time allowed to do the checking? c) Are they required to record the results of checking their work? d) Is there any independent check of the work? e) Are personnel provided with feedback on the quality of their work? f) Are there provisions for periodically checking the accuracy of records prepared by support and administrative personnel? g) Do supervisors have a record of performance for individual personnel? 3. Have personnel been provided with the means to regulate their work? a) Has the quality capability of the activity been evaluated in quantitative terms and compared to the goal? b) Do personnel have criteria for defining when their activity requires correction? c) Do personnel know what to do when the criteria for action are exceeded? d) Have the actions which cause errors been diagnosed and told to personnel? e) Have the actions which prevent errors been diagnosed and told to personnel?
  • Challenges promoting consistency of practice and standardization across campuses
  • Challenges promoting consistency of practice and standardization across campuses
  • Staff attitude – let’s just wait’em out, this will blow over, this too shall pass, flavor of the month
  • Staff attitude – let’s just wait’em out, this will blow over, this too shall pass, flavor of the month
  • Staff attitude – let’s just wait’em out, this will blow over, this too shall pass, flavor of the month
  • Staff attitude – let’s just wait’em out, this will blow over, this too shall pass, flavor of the month
  • Staff attitude – let’s just wait’em out, this will blow over, this too shall pass, flavor of the month
  • Beyond Lean/ Six Sigma - Managing Change and Spreading Innovation

    1. 1. Beyond Lean/Six Sigma Managing Change and Spreading Innovation Nidia Williams, CCC-SLP Director, Quality Outcomes Six Sigma Master Black Belt Southcoast Hospitals Group [email_address] Tel: 508.679.7397
    2. 2. Who We Are <ul><li>Charlton Memorial Hospital </li></ul><ul><li>Fall River </li></ul>St. Luke’s Hospital New Bedford Tobey Hospital Wareham Southcoast Health System 800+ physicians & 6,300+ employees serving 719,000 people in 33 communities dating back to 1884.
    3. 3. Why & How We Got Started <ul><li>Be ahead of the curve </li></ul><ul><ul><li>#1: Improve Quality </li></ul></ul><ul><ul><li>#2: Find Savings </li></ul></ul><ul><ul><li>Started before the economic downturn </li></ul></ul><ul><ul><li>Improve operating margin for hospital & system before going to bond market for project financing </li></ul></ul>
    4. 4. Why & How We Got Started <ul><li>Seek sustainable methods & processes — not just cuts </li></ul><ul><ul><li>A lifestyle change — not just a diet </li></ul></ul><ul><ul><li>Increased focus on “real-time accountability” </li></ul></ul><ul><ul><li>Use data to drive decision-making </li></ul></ul>
    5. 5. Why & How We Got Started <ul><li>Why do both Lean & Six Sigma? </li></ul><ul><ul><li>Improve the way we do things — not just to generate cuts/savings </li></ul></ul><ul><ul><li>Create immediate savings through elimination of waste & hard-wiring improved processes with Six Sigma </li></ul></ul>
    6. 6. Action <ul><li>Mobilize the entire </li></ul><ul><li>organization </li></ul><ul><ul><li>Board </li></ul></ul><ul><ul><li>Senior Leadership </li></ul></ul><ul><ul><li>Middle Management </li></ul></ul><ul><ul><li>Physicians </li></ul></ul><ul><ul><li>Front line staff </li></ul></ul><ul><li>Activate engagement </li></ul><ul><ul><li>Set targets and deadlines up front </li></ul></ul><ul><ul><li>Set financial targets </li></ul></ul><ul><ul><li>All levels held accountable </li></ul></ul><ul><ul><li>Include front-line staff </li></ul></ul><ul><ul><li>Communicate Communicate Communicate </li></ul></ul>
    7. 7. Getting Started / Communication <ul><li>Basic set of standardized terms </li></ul><ul><ul><li>Posted on intranet </li></ul></ul><ul><li>Discuss at Open Forums </li></ul><ul><ul><li>Open discussion with all employees </li></ul></ul><ul><ul><li>Ask staff for brainstorming </li></ul></ul><ul><li>Communication cascades </li></ul>
    8. 8. Improvement Cycle <ul><li>120-day cycle with 30-day check-ins </li></ul><ul><li>Disciplined, focused engagement </li></ul><ul><li>Built database tracker to promote accountability & adherence to timelines </li></ul>
    9. 9. Six Sigma … <ul><li>Certified Belts </li></ul><ul><ul><li>26 Green Belts </li></ul></ul><ul><ul><li>4 Black Belts </li></ul></ul><ul><ul><li>1 Master Black Belt </li></ul></ul><ul><ul><li>Yellow Belt training for ALL leadership </li></ul></ul><ul><li>Bringing the resources in-house is necessary for expanding and maintaining the Six Sigma culture </li></ul>
    10. 10. Surprise, Surprise … <ul><li>Applying Six Sigma to your existing processes is an </li></ul><ul><li>eye-opener </li></ul>
    11. 11. Six Sigma Project Tracker Six Sigma Project Tracker
    12. 12. Improvement REQUIRES Change <ul><li>The “I” in DMAIC really means CHANGE needs to be implemented, facilitated and managed. </li></ul><ul><li>Won’t happen by CHANCE! </li></ul><ul><li>Should be managed as its own sub-project </li></ul>
    13. 13. Develop a Solution and Action Plan <ul><li>“ It is not so much that we are afraid of change or so in love with the old ways, but it’s that place in between that we fear... It’s like being caught between trapezes. It’s Linus when his blanket is in the dryer. There’s nothing to hold on to.” </li></ul><ul><li>– Marilyn Ferguson </li></ul>
    14. 14. Develop a Solution and Action Plan STAGES OF TRANSITION Ending - Process of letting go of the old way before beginning the new. Neutral Zone – The period between the ending and new beginning. The wilderness. New Beginning - New status quo takes shape. Neutral Zone ENDING NEW BEGINNING
    15. 15. Develop a Solution and Action Plan <ul><li>“ Been there…Done That…” </li></ul><ul><ul><li>Resistance to change </li></ul></ul><ul><ul><li>Managing People’s Expectations </li></ul></ul><ul><ul><li>Communication strategies </li></ul></ul><ul><li>Which of the reasons for change resistance are the most likely causes of resistance in this organization or for this change? </li></ul>
    16. 16. Develop a Solution and Action Plan <ul><li>Value Resisters Because . . . </li></ul><ul><ul><li>They clarify the problem </li></ul></ul><ul><ul><li>They identify other problems that need to be solved first </li></ul></ul><ul><ul><li>They force change leaders to think before they implement the change </li></ul></ul><ul><ul><li>Their tough questions can strengthen and improve the change </li></ul></ul><ul><ul><li>They let us know who opposes the change </li></ul></ul><ul><ul><li>They slow down the change </li></ul></ul><ul><ul><li>They may be right, it is a dumb idea! </li></ul></ul>
    17. 17. Develop a Solution and Action Plan <ul><li>Human Nature . . . </li></ul><ul><ul><li>People want to maintain control over their actions </li></ul></ul><ul><ul><li>People develop self-confidence and psychological health by building stable and effective relationships with others </li></ul></ul><ul><ul><li>Our sense of control, comfort, and well-being results from the degree of certainty we have about our life and our future </li></ul></ul><ul><ul><li>Change disrupts our ability to predict what’s in store for us </li></ul></ul><ul><ul><li>The more a change disrupts our ability to envision our future, the greater our confusion, fear, anxiety, and self-doubt </li></ul></ul>
    18. 18. Determining the Solution <ul><li>Reliance on Six Sigma, Lean or other methodology and/or tools </li></ul><ul><li>Should be selected after measuring positive impact on outcome (data-driven decision) </li></ul>
    19. 19. <ul><li>Goal </li></ul><ul><li>Helps the team develop practical solutions and an action plan to effectively address the root cause(s) of a problem, and produce a desired effect or outcome </li></ul><ul><ul><li>Generate potential solutions </li></ul></ul><ul><ul><li>Select the most effective solution </li></ul></ul><ul><ul><li>Generate all possible tasks that can be done to implement the solution </li></ul></ul><ul><ul><li>Anticipate likely problems and develop possible countermeasures </li></ul></ul><ul><ul><li>Create an action plan </li></ul></ul>The Improvement Process Develop a Solution and Action Plan – including targets for improvement
    20. 20. Improvement Strategy <ul><li>Alternatives </li></ul><ul><ul><li>Pilots </li></ul></ul><ul><ul><li>Process Mapping </li></ul></ul><ul><ul><li>Mistake Proofing </li></ul></ul><ul><ul><li>Brainstorming </li></ul></ul><ul><ul><li>Benchmarking & Best Practices </li></ul></ul><ul><ul><li>Simulation </li></ul></ul><ul><ul><li>Generate Alternatives </li></ul></ul><ul><ul><li>Assess Risks </li></ul></ul><ul><ul><li>Test Alternatives Through Pilots or Simulation </li></ul></ul><ul><ul><li>Evaluate and Select the Best Solution </li></ul></ul>
    21. 21. Improvement Strategy Choose Improvement Strategy My Xs are Alternatives Optimize process flow issues Standardize the process Develop a practical solution to the problem My improvement strategy is . . . If . . . ... my vital Xs are process flow issues ... my vital Xs stem from a lack of standardized operations ... I have identified a specific problem
    22. 22. Improvement Strategy <ul><li>Eliminate Obvious Sources of Variation </li></ul><ul><ul><li>People in Self-Control </li></ul></ul><ul><ul><ul><li>Means for knowing what they are supposed to do? </li></ul></ul></ul><ul><ul><ul><li>Means of knowing what they are doing? </li></ul></ul></ul><ul><ul><ul><li>Means of regulating their work? </li></ul></ul></ul>
    23. 23. Implement the Solution NEW BEGINNING ENDINGS Neutral Zone Time Reactions to Transition Denial Anger Fear Shock Frustration Confusion Stress Creativity Skepticism Acceptance Impatience Hope Energy Excitement
    24. 24. Implement the Solution <ul><li>Leadership Responsibility </li></ul><ul><ul><li>Agree to the change </li></ul></ul><ul><ul><li>Communicate support </li></ul></ul><ul><ul><li>Ensure resources, time, money </li></ul></ul><ul><li>Motivate </li></ul><ul><ul><li>Address Barriers </li></ul></ul><ul><ul><li>Focus, Focus, Focus </li></ul></ul><ul><ul><li>Support the organization through the change </li></ul></ul>
    25. 25. Implement the Solution <ul><li>Use Communication Skills </li></ul><ul><li>Monitor the Implementation Plan </li></ul><ul><li>Manage frequent and Effective Meetings </li></ul><ul><li>Use Data and Analyze </li></ul><ul><li>Data-Driven Decision Making </li></ul>
    26. 26. Implement the Solution <ul><li>Review root cause(s) data, and verify if improvement will be effective </li></ul><ul><li>Determine if improvement will achieve project goals </li></ul><ul><li>Develop a flow diagram to illustrate how the improvement will operate </li></ul>
    27. 27. Process Instruction <ul><li>Document Process Instructions </li></ul><ul><ul><li>Standard Operating Procedures </li></ul></ul><ul><ul><li>Instructions </li></ul></ul><ul><ul><li>Operational blue prints </li></ul></ul>If it’s not in writing, it does not exist
    28. 28. <ul><li>Simple & clear </li></ul><ul><li>No novels </li></ul><ul><li>Involve the “Do-ers!” </li></ul><ul><li>Limit the text </li></ul><ul><li>Process Map </li></ul><ul><li>Involve those responsible for implementation </li></ul><ul><li>Be realistic </li></ul>Process Instructions
    29. 29. Managing Change is an Art and a Science <ul><li>The devil is in the details… and the details involve PEOPLE </li></ul>
    30. 30. Considerations for Managing Change <ul><li>People often feel they need to “agree” with every detail, or they will not submit to authority </li></ul><ul><li>Resistance is often subtle </li></ul><ul><li>People may hold onto the history of how change was managed in the past </li></ul><ul><li>Cultural Obstructions </li></ul><ul><li>Focus on customer needs! </li></ul>
    31. 31. Culture as an Obstacle to Change <ul><li>Can contribute to resistance </li></ul><ul><li>Self Interests </li></ul><ul><li>Sense of entitlement and process ownership </li></ul><ul><li>Fear of unknown </li></ul><ul><li>Differing perception and vision </li></ul><ul><li>Lack of purpose driven focus </li></ul><ul><li>Lack of respect for leadership and position of authority </li></ul><ul><li>Conservatism </li></ul>
    32. 32. Cultural Obstacles <ul><li>In today’s work world, it seems if we do NOT agree with authority or change, we can CHALLENGE it with complaint or protest </li></ul>
    33. 33. Reasons for Rebellion to Change <ul><li>Unclear vision, competing visions </li></ul><ul><li>Lack of purpose-driven focus </li></ul><ul><li>Demand for compliance versus commitment </li></ul><ul><li>Failure for leaders to communicate </li></ul><ul><li>- “what’s in it for me?” </li></ul><ul><li>- “where are we going?” </li></ul><ul><li>- “why are we going?” </li></ul>
    34. 34. Leaders Need to do Things Differently <ul><li>What do you think leaders need to do? </li></ul><ul><li>What to leaders typically fail to address and consider? </li></ul><ul><li>How can leaders assist with managing and addressing the cultural obstacles? </li></ul><ul><li>What communication strategies need to be considered and/or addressed? </li></ul>
    35. 35. Change is a Process <ul><li>Journey, not a destination </li></ul><ul><li>More than creating or designing a new way </li></ul><ul><li>More than drafting procedures </li></ul><ul><li>More than writing policies </li></ul><ul><li>More than determining best practice </li></ul><ul><li>More than sending emails </li></ul><ul><li>More than training sessions </li></ul>The above are all tasks – not processes, not process changes, and only part of what needs to be managed and considered
    36. 36. Requirements to Managing Change <ul><li>Stakeholder Analysis – examine and learn from past history of change </li></ul><ul><li>Sponsors and Champions – a must! </li></ul><ul><li>Examination of Skill Set – necessary for targeted group, addressed “fear” and for the CHANGE agents, ie. leadership </li></ul>
    37. 37. Motivational Considerations <ul><li>Provide these up front! </li></ul><ul><li>Paint a picture of the future state </li></ul><ul><li>Communicate consequences of failure </li></ul><ul><li>Economic realities need to be transparent </li></ul><ul><li>Alliance with strategic plans and objectives </li></ul><ul><li>Customer demands </li></ul>
    38. 38. GPS Guidance for the Journey <ul><li>Document the process plan in advance and share it </li></ul><ul><li>Include ALL the details, and identify all the stakeholders, roles and responsibilities </li></ul><ul><li>Manage the process as its own project </li></ul><ul><li>Address and plan for controls re: obstacles identified for consideration </li></ul><ul><li>Wrap the package with a purpose-driven focus </li></ul>
    39. 39. People do NOT Reject Their Own Ideas <ul><li>Early collaboration and involvement with stakeholders </li></ul><ul><li>Listen to concerns and ideas </li></ul><ul><li>Validate feelings </li></ul><ul><li>Buy-In will only help! </li></ul><ul><li>Over-Communication is impossible! </li></ul>
    40. 40. Spreading the Change <ul><li>Our tools (DMAIC, Lean, etc.) may give us solutions.. But implementation is still required. </li></ul><ul><li>A systematic and process driven, managed approach had to be developed as part of the change management process </li></ul>
    41. 41. Spreading Solutions Across Southcoast <ul><li>Hardwiring and managing solutions from Six Sigma and Lean project teams </li></ul><ul><li>Implementing corrective actions based on TapRooT® investigation results </li></ul><ul><li>Managing and evaluating best practice and operational processes for new services </li></ul><ul><li>Cannot be left to chance , needs a detailed deployment process </li></ul>
    42. 42. LINC Team Concept Leaders Innovating and Navigating Change <ul><li>Kaizen Event Solutions </li></ul>LINC Team Six Sigma Team Solutions Lean Solutions TapRooT Corrective Action Plans Other Processes Requiring Deployment across Sites/Departments
    43. 43. Ingredients for Successful Deployment Projects <ul><li>Senior Leadership support (commitment to standardize) </li></ul><ul><li>Key Stakeholder meetings </li></ul><ul><li>Weekly/Biweekly meetings during implementation </li></ul><ul><li>Project Management at organizational and local project level </li></ul><ul><li>Post-spread control plan with metrics and check-ins </li></ul><ul><li>Skilled facilitation and accountability </li></ul><ul><li>Project Charter and Service Level Agreement (SLA) </li></ul>
    44. 44. LINC Team <ul><li>Four driving principles </li></ul><ul><li>Collaboration (each team will consist of site-specific sub-groups) and weekly/bi-weekly meetings </li></ul><ul><li>Pull vs Push </li></ul><ul><li>Project Management, Defined Communication Plan and Stakeholder Analysis </li></ul><ul><li>One-on-One Support – BB Travels to each site to visit and provide leadership during the implementation project </li></ul>
    45. 45. LINC Membership <ul><li>Black Belt w/Project Management Training </li></ul><ul><li>Site Process Owners </li></ul><ul><li>Executive Champion </li></ul><ul><li>Team Members – selected by above, representing current stakeholders in process at each site </li></ul><ul><li>Rapid Cycle Deployment Plan 90-120 Days Updates at monthly check-ins and QSC </li></ul>
    46. 46. LINC Flowchart LiNC Team Planned BB verifies solutions from original project Solutions Significant? Sr. Leaders delay start until significance and results are proven BB measures baseline process performance at each site Sr. Leaders articulate and introduce project at each site at leadership mtgs Yes No
    47. 47. LINC Flowchart Sr. Leaders verify Champion support for deployment Needed Resources Available? Sr. Leaders delay start until resources are available or identified LiNC Team identified and drafts project charter, completes stakeholder analysis BB schedules and facilitates team meetings Sr. Leaders ID Champion and Process Owners at each site Yes No
    48. 48. LINC Flowchart LiNC team determines live dates and trials for process changes at each site. Communication plan defined LiNC team continues with on-site visits and working bi-weekly mtgs – Work on completing SLA LiNC Team discuss, revise SLA items and issues LiNC Team fully implements SLA BB and LiNC team visit sites and meet regularly, discuss implementatio plans and processes
    49. 49. LINC Flowchart LiNC Team identifies control plan Process owners transition to oversight and monitoring for 90 days LiNC Team project closed BB and LiNC team conduct on-site audits every 30 days to verify solutions are hard-wired and effective. SLA fully implemented End of Deployment Project
    50. 50. Other Considerations <ul><li>Outside of BB on-site visits, mtgs can be teleconferenced or by phone </li></ul><ul><li>BB uses DMAIC method and key improvement tools to facilitate team innovation for spread of plan </li></ul><ul><li>Only address proven X’s and root causes for standardization across sites </li></ul><ul><li>Ongoing communication with Executive Champion </li></ul>
    51. 51. Our Keys to Success … <ul><li>Pick the right problems to tackle & the right people to tackle them with defined accountability expectations </li></ul><ul><li>Hard-wire the changes – good data is key </li></ul><ul><li>Build strong, organization-wide, top-down commitment to keep philosophies moving forward </li></ul>
    52. 52. Hard Lessons Learned.. <ul><li>Share yours! </li></ul><ul><li>Most difficult component of change to manage? </li></ul><ul><li>What is difficult to master? </li></ul><ul><li>What is difficult to plan? </li></ul><ul><li>What MAJOR component do you feel is most difficult to manage or most likely to lead to failure? </li></ul><ul><li>When do we acknowledge failure? And once we do…then what? </li></ul>
    53. 53. <ul><li>Feel free to contact me for more information and discussion! </li></ul><ul><li>Nidia Williams </li></ul><ul><li>Director of Quality Outcomes </li></ul><ul><li>Six Sigma Master Black Belt </li></ul><ul><li>Southcoast Health System </li></ul><ul><li>508-679-7397 </li></ul><ul><li>[email_address] </li></ul>Questions?