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DMAIC Improvement Approach

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Six Sigma® is a business strategy,Focusing On Continuous Improvement: Understanding Customer Needs,Analyzing Business Processes, and Utilizing Appropriate Performance Measures And Statistical Methodology.The central idea behind Six Sigma is that if you can measure how many "defects" you have in a process.

You can systematically figure out how to eliminate them and get as close to "zero defects" as possible.

Published in: Healthcare
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DMAIC Improvement Approach

  1. 1. Basic Six Sigma Breakthrough Improvement Process Ph. Doaa Hussein MBA, CPHQ,TQMD
  2. 2. Basic Six Sigma Breakthrough Improvement Process Date TOPIC 3rd August 2016 Introduction and Six Sigma Overview 10th August 2016 Define your project 17th August 2016 Measure and Analyze 24th August 2016 Improve and Control 31th August 2016 Group presentations
  3. 3. Content • SIPOC • Voice of the Customer • Kano Analysis BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 3
  4. 4. 4
  5. 5. What is Quality Management in Healthcare? 5 The Institute of Medicine defines quality as: The degree to which health care services for individuals and populations increase the probability of desired health outcomes and are consistent with current professional knowledge of best practice." What is Quality
  6. 6. 6 Appropriatene ss Availability/Ac cess Continuity Effectiveness Efficacy Efficiency Prevention/Ea rly Detection Respect and Caring Safety Timeliness Competency
  7. 7. Healthcare quality should be STEEEP Institute of Medicine report Crossing the Quality Chasm 7  Safe,  Timely,  Effective,  Efficient,  Equitable  Patient centered
  8. 8. Figure out quality dimensions to your place BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 8
  9. 9. Measurable Quality Three Aspects of Quality Appreciative Quality Perceptive Quality Aspects of Quality 9 THREE ASPECTS OF QUALITY “MAP”
  10. 10. Measurable Quality 10  Can be defined objectively as compliance with, or adherence to standards.  Clinically, these standards may take the form of practice parameters or protocols, or they may establish acceptable expectations for patient and organizational outcomes.  Standards serve as guidelines for excellence.
  11. 11. Appreciative Quality 11  Is the comprehension and appraisal of excellence beyond minimal standards and criteria.  Requires the judgments of skilled, experienced practitioners and sensitive, caring persons.  Peer review bodies rely on the judgments of like professionals in determining the quality or non- quality of specific patient-practitioner interactions.
  12. 12. Perceptive Quality 12  Is the degree of excellence which is perceived by the recipient or the observer of care rather than by the provider of care.  Is generally based more on the degree of caring expressed by physicians, nurses, and other staff than on the physical environment and technical competence.
  13. 13. Quality Planning Quality Measurement Quality Improvement Quality Trilogy 13 Juran trilogy
  14. 14. Performance Improvement Project Framework Effective team development and interaction Identify priority area Collecting Data And measure performance Assessing performance Taking action for improvement Assessing improvement Sustain Improvement BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 14 Use of statistical, analytical, and consensus tools at all steps
  15. 15. Six Sigma  Six Sigma® is a business strategy,  Focusing On Continuous Improvement:  Understanding Customer Needs,  Analyzing Business Processes,  And Utilizing Appropriate Performance Measures And Statistical Methodology. 15
  16. 16. Six Sigma 16 • Methodology to measure organization’s performance, practices and systems where you are. • Problem solving methodology for improving business and organizational performance. where you could be Quality Philosophy and the way of improving performance by knowing
  17. 17. Six Sigma  The central idea behind Six Sigma is that if you can measure how many "defects" you have in a process.  You can systematically figure out how to eliminate them and get as close to "zero defects" as possible. 17
  18. 18. A Six Sigma organization  Uses Methods And Tools To Improve Performance Continuously lower costs Grow revenue, Increase customer satisfaction , Improve capacity and capability, Reduce complexity lower cycle time and Minimize defects and errors 18
  19. 19. 19 SIX SIGMA METHODOLOGY  DMAIC  Six Sigma Improvement Methodology  DMADV also referred to as DFSS  Creating new process which will perform at Six Sigma
  20. 20. Define specific goals to achieve outcomes, consistent with customers demand and business strategy Measure reduction of defects Analyze problems ,cause and effects must be considered Improve process on bases of measurements and analysis Control process to minimize defects BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 20 WHAT IS DMAIC?
  21. 21. 21 WHAT IS DMAIC?  A logical and structured approach to problem solving and process improvement.  An iterative process (continuous improvement)  A quality tool which focus on change management style.
  22. 22. 22 WHAT IS DMADV?
  23. 23. 23 BENEFITS OF SIX SIGMA  Generates sustained success  Sets performance goal for everyone  Enhances value for customers  Accelerates rate of improvement  Promotes learning across boundaries  Executes strategic change
  24. 24. To achieve Six Sigma Quality, a process must produce no more than 3.4 defects per million opportunities. SIGMA LEVEL DEFECT RATE YIELD 1 691,500 dpmo 30.85% 2 308,770 dpmo 69.10000% 3 66,811 dpmo 99.33000% 4 6,210 dpmo 99.38000% 5 233 dpmo 99.97700% 6 3.44 dpmo 99.99966%
  25. 25. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 25 How to Calculate Process Sigma?
  26. 26. How to Calculate Process Sigma?  Step 1:  Identify what constitutes an "opportunity" and a "defect." For example, in a hospital, a single administration of a medication is an "opportunity" and delivering the wrong drug or the wrong dose constitutes a "defect.“ In general, opportunities and defects should be black-or- white propositions; you either succeed or fail. 26
  27. 27. How to Calculate Process Sigma?  Step 2 : Quantify opportunities and defects with precision. 27
  28. 28. How to Calculate Process Sigma?  Step 3 Calculate your yield. Subtract the number of defects from the total number of opportunities, then divide by the number of opportunities and express the result as a percentage. 28
  29. 29. How to Calculate Process Sigma?  Step 3 For example, if a hospital administered 145,250 correct doses last month and erred in 250 of them, then the yield is 145,500 minus 250 divided by 145,500, or 99.828 percent. 29
  30. 30. How to Calculate Process Sigma?  Step 4  Compare your yield to the standard threshold for six-sigma performance. To meet six sigma levels, the yield must be greater than or equal to 99.99966 percent. 30
  31. 31. 31 99.9997 per cent of parts close to the average value, if the average is the same as your print spec, it essentially means “zero defects”.
  32. 32. To achieve Six Sigma Quality, a process must produce no more than 3.4 defects per million opportunities. SIGMA LEVEL DEFECT RATE YIELD 1 691,500 dpmo 30.85% 2 308,770 dpmo 69.10000% 3 66,811 dpmo 99.33000% 4 6,210 dpmo 99.38000% 5 233 dpmo 99.97700% 6 3.44 dpmo 99.99966%
  33. 33. How to Calculate Process Sigma?  Step 5 Find : Process sigma , Substitute the given values in the formula, DPMO = (Total defect / Total Opportunities) x 1000000 33
  34. 34. How to Calculate Process Sigma? Process sigma = 0.8406 + √(29.37)-2.221*(log(DPMO)) 34
  35. 35. Example Find 60 errors for 6 critical characteristics on 20 orders in a random sample of 400 orders . Assuming there are 6 Opportunities per order (six critical characteristics). BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 35
  36. 36. Example The Defects per Opportunity (DPO) is calculated as:  Opportunities = (400 Orders * 6 Opportunities / Order) = 2400 Opportunities  Defects per Opportunity (DPO) = 60 Defects / 2400 Opportunities = 0.025 Defects per Opportunity BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 36
  37. 37. Example  DPMO = (0.025 Defects / Opportunity) *106 Opportunities / Million Opportunities = 25,000 DPMO  This corresponds to a Sigma Level of approximately 3.45, based on Six Sigma BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 37
  38. 38. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 38 Define Your Project
  39. 39. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 39 Identify Establish Define Your Project problem statement Form a Team Verify the mission Nominate Projects Evaluate Projects Select a Project
  40. 40. WHO Can Nominate A Project ? EMPLOYEES Process Owners knows every detail and they front line who face the customer/client/ patient Department Head Impact on the department ability to meet organizational goal and objectives Senior Management Impact on quality throughout the entire organization 40
  41. 41. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 41 Source Of Information to Nominate Projects Customer/Client/ Patient(E/I) Complaints Suggestions Questionnaires Focus groups Tip: Give Feedback *Logs and Indexes *Clinical review findings, e.g.: -Operative/other procedure -Medical record review -Medication use - Pharmacy and therapeutics function -Mortality reports - Autopsy reports -Functional outcome status -Variance reports, e.g., clinical paths -Demographics/ registration data -Infection control reports -Patient/client records -Blood component use
  42. 42. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 42 Source Of Information to Nominate Projects Monitoring Reports (KPIs) OVRs & Errors Reports Ongoing quality control/measurement summaries Strategic and Business Plan of the organization Goal External Data Source --Benchmarks --Reference databases/performance measure systems/ compilations
  43. 43. Projects of significance may require participation of several departments = Interdisciplinary Project BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 43
  44. 44. Evaluate Project BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 44  Evaluate the nominated projects against preset criteria :  Retaining customer  Attracting new customers  Reducing the cost of poor quality  Enhancing employee satisfaction.
  45. 45. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 45 Criteria For Selecting a Project How chronic is the problem? The project should correct a continuing problem not a recent specific episode. How significant the results will be ? When project is completed the results should be significant and evident and worth the effort . Measure of potential Impact? Retain customer . Reduce cost of poor quality, ROI, enhance customer satisfaction , enhance employee satisfaction .
  46. 46. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 46 Criteria For Selecting a Project Urgency of the problems: -Problems make the organization highly vulnerable to the competition -Issues crucial to key customers All Quality Improvement Projects should be measurable. Size :project should be of manageable size Project time should be to long (shouldn’t take more than 12 months)
  47. 47. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 47 Criteria For Selecting a Project What Kinds of resistance might the project create ? Change normally is face by resistance . What is the source of resistance and how to face it ? What are the project suspected risks ? How uncertain is the outcome? What is your risk management plan? Choose A project that will be a winner specially if you are at the beginning ?
  48. 48. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 48 Identify Establish Define Your Project problem statement Form a Team Verify the mission problem statement Form a Team Verify the mission
  49. 49. Prepare a Problem Statement WHO? Management Seniors. WHY? Written instruction to the team selected . What ? The problems to be solved The Goal of the project. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 49
  50. 50. Problem Statement:  Problem statement should quantitatively describe the pain in the current process  What is the pain ?  Where is it hurting?  When – is it current? How long it has been?  What is the extent of the pain?  What a Problem Statement should not do is Assign a Cause or Blame and Include a Solution. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 50
  51. 51. Example  “In the last 3 months (when), 12% of our customers are late, by over 45 days in paying their bills (what) . This represents 20% (magnitude) of our outstanding receivables & negatively affects our operating cash flow (consequence) .”  (when), Our ALOS (what) for total hip replacement surgery is 7 days which is 2 days longer (magnitude) than average in the area which affects our reimbursements' (consequence) . BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 51
  52. 52. Goal Statement  Defines the improvement the team is seeking to accomplish. It starts with a verb.  It Should not presume a cause or include a solution. It has a deadline.  It is actionable and sets the focus. It should be SMART (Specific, Measurable, Attainable, Relevant and Time Bound). BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 52
  53. 53. Goal Statement Example:  To reduce the percentage of late payments to 15% in next 3 months, and give tangible savings of 500KUSD/ year.  To reduce the ALOS to 6 days in next 3 months, and increase hospital profit by 2%. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 53
  54. 54. Project Scope:  Project Scope helps us to understand the start and end point for the process .  Gives an insight on project constraints and dimensions. It’s an attempt to define what will be covered in the project deliverables. Scoping sharpens the focus of the project team & sets the expectations right. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 54
  55. 55. Selecting Project Team  Cross Functional team .A cross-functional team is simply a team made up of individuals from different functions or departments within an organization.  Teams like this are useful when you need to bring people with different expertise together to solve a problem, or when you want to explore a potential solution. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 55
  56. 56. Selecting Project Team  For example, you might put together a team made up of people from pharmacists ,finance, engineering , and procurement to come up with a solution to reduce the lead-time of admixture medications .  Representation from various departments brings a broad working knowledge of the process to be improved , promotes acceptance and implementation of the remedy BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 56
  57. 57. To select a Cross Functional team  Scope of the problem :where is the problem is observed or experienced?  Who has special knowledge, information, or skills in uncovering the root cause of the problem ?  Who might be helpful when developing a remedy ? BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 57
  58. 58. To build a Cross Functional team Set Objectives Define Roles and Select the Right Team Members Consider Resources and Logistics Establish Ways of Working Adopt the Right Leadership Style Negotiate and Communicate BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 58
  59. 59. Participatory leadership style  The TQM Leadership/Management Style.  The leader/manager presents a tentative decision, "draft" of an idea, or a problem to staff/team, receives suggestions, and then makes the decision, based on what is deemed best for the organization. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 59
  60. 60. Stages of Team Growth 60  Forming  Storming  Norming  Performing
  61. 61. Team Responsibility 61  Accept or identify improvement projects  Investigate the cost of poor quality  Describe the specific problems/opportunities  Gather and analyze data  Identify root causes  Develop alternative processes  Apply alternative processes and track results  Recommend replication  Feedback helpful experiences (lessons learned)
  62. 62. Project Charter Problem statement Business case Goal Statement Project Scope Team Members Project timeline BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 62
  63. 63. Project Charter Guidance  The listed questions are for guidance and direction purposes (although they can be answered directly)  The listed statements/descriptions are to be completed in full  Keep to one page to be concise & clear and to ensure focus on the key elements BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 63
  64. 64. Project Charter Guidance  Expect to create numerous iterations before the final version is approved  Do not proceed until all key stakeholders are in agreement with the document  Use as a high-level communication tool  Retain during the project life-cycle and refer often to ensure the original purpose and direction are being maintained BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 64
  65. 65. 65 Project Charter Template Business Case Problem Statement Who is the Client (internal and/or external)? What is the current situation? What is the business climate and/or environment? What is the trend? What are the business gaps? What are the drivers for change? What are the Client/Market/Regulatory requirements? What is the level of importance and/or urgency? How does the project connect with the overall business strategy/goals? What are the projected benefits from the change? What is the problem? How do you know it is a problem? When did the problem first occur? Where is it occurring? What is the frequency? What are the defects and/or areas of waste? What are the variations? What is the level of complexity? What are the impacts? What is the cost of poor quality (soft and hard)? Goal Statement Project Scope Who will benefit? What is to be achieved? How will success be measured? Why is it important? When are improvements required by? In scope activities: Out of scope activities: Process start point: Process end point: Critical to quality: Primary metric: Consequential metric: High-Level Timeline Stakeholders & Key Project Members Define – Dates from/to: Measure – Dates from/to: Analyse – Dates from/to: Improve – Dates from/to: Control – Dates from/to: Executive sponsor: Activity/Business Line/Product sponsor/champion: Client/Business Partner champion(s): Project manager: Key project team members:
  66. 66. VISION OF SUCCESS PROJECT MILESTONES & SCHEDULE RESOURCES • Time commitment for a 4 day Kaizen, excluding time to implement changes: Sponsor (6-10 hrs.); Team Leader (40 hrs.); Team Members (32 hrs.); Facilitator (40-50 hrs.) • External Resources: • Equipment: • Materials: < TITLE> <date> <sponsor> CONTEXT / ISSUES GOALS SCOPE (IN BOUNDS) SCOPE (OUT OF BOUNDS) CUSTOMERS/STAKEHOL DERS TEAM MEMBERS • Team Leader: • Team Members: CUSTOMER REQUIREMENTS (CTQ) Project Milestones Owner Propose d Date Actual Date 1. Set project scope and goals (prepare Project Charter, engage team, collect data) Sponsor/Team Leader, Facilitator 2. Understand the current situation Facilitator/ Team 3. Analyze the current situation (root causes) Facilitator/ Team 4. Define a vision of success Facilitator/ Team 5. Generate, evaluate and select improvements Team/ Sponsor 6. Implement changes and make adjustments Team Leader/ Staff 7. Measure performance Sponsor/Team Leader 8. Document standard work and lessons learned Team 9. Sustain improvement Team Leader/Process Owner
  67. 67. VISION OF SUCCESS • What outcomes or results do you want to see? • What does success look like for our customer? • What does success look like for other stakeholders (staff, partners)? PROJECT MILESTONES & SCHEDULE RESOURCES • Time commitment for a 4 day Kaizen, excluding time to implement changes: Sponsor (6-10 hrs.); Team Leader (40 hrs.); Team Members (32 hrs.); Facilitator (40-50 hrs.) • External Resources: • Equipment: • Materials: < TITLE> <date> <sponsor> CONTEXT / ISSUES • What is the issue and why is it important to tackle now? • What is the purpose, the business reason for choosing this project? • What are the anticipated benefits to customers and staff from the project? • What performance measure needs to improve? • Have you been to the Gemba? • What process/program/customer data do you have regarding the problem (time, cost, quality )? Show facts and processes visually using charts, graphs, maps, etc. • When did the problem start? • Where is the problem occurring? • What is the extent or magnitude of the problem? GOALS • What specific, measurable , attainable, relevant, time-bound results do you want or need to accomplish? • Show visually how much, by when, and with what impact. • NOTE: Be careful not to state a solution as a goal! SCOPE (IN BOUNDS) • What is the first step and last step in the process? • What is the program and geographic area? • NOTE: Be mindful of what you can realistically accomplish with available resources and time. SCOPE (OUT OF BOUNDS) • What is off the table due to resources? • What are the givens or assumptions for the project? • Record out of scope issues in a “Parking Lot” CUSTOMERS/STAKEHOLD ERS • Who is the end-user customer? • Who are other stakeholders who have a role or interest in the success of the process? TEAM MEMBERS • Team Leader: • Team Members: CUSTOMER REQUIREMENTS (CTQ) • What do customers/stakeholders expect and require from the process? What are their critical to quality (CTQ) requirements? • What legal requirements (laws, rules) govern the process? Project Milestones Owner Propose d Date Actual Date 1. Set project scope and goals (prepare Project Charter, engage team, collect data) Sponsor/Team Leader, Facilitator 2. Understand the current situation Facilitator/ Team 3. Analyze the current situation (root causes) Facilitator/ Team 4. Define a vision of success Facilitator/ Team 5. Generate, evaluate and select improvements Team/ Sponsor 6. Implement changes and make adjustments Team Leader/ Staff 7. Measure performance Sponsor/Team Leader 8. Document standard work and lessons learned Team 9. Sustain improvement Team Leader/Process Owner
  68. 68. Verify  Most Significant problem.  Mission statement (problem , goals statement).  Any aspects of the problem need clarification.  Team members are correctly selected.  Team members understand the mission statement and known their roles . BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 68
  69. 69. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 69
  70. 70. SIPOC Defined SIPOC is an acronym standing for 1. S =Supplier(s) 2. I =Input(s) & key requirements 3. P =Process 4. O =Output(s) & key requirements 5. C =Customer(s)
  71. 71. SIPOC Diagram Defined • A SIPOC Diagram is a visual representation of a high-level process map; including suppliers & inputs into the process and outputs & customers of the process • Visually communicates the scope of a project
  72. 72. How can SIPOC be used? • SIPOC Diagrams help a team and its sponsor(s) agree on project boundaries and scope • A SIPOC helps teams verify that • inputs match outputs of upstream processes • outputs match inputs of downstream processes
  73. 73. Suppliers Inputs Process Outputs Customers How a SIPOC works
  74. 74. Step 1: Begin with the high-level process map BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 74 Suppliers Inputs Process Outputs Customers Step 1 Step 2 Step 3 Step 4
  75. 75. Step 2: List all of the outputs from the process BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 75 Suppliers Inputs Process Outputs Customers Step 1 Step 2 Step 3 Step 4 Examples Services Products Reports Metrics Raw data
  76. 76. Step 3: Identify the customers receiving the outputs BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 76 Suppliers Inputs Process Outputs Customers Step 1 Step 2 Step 3 Step 4 Examples Services Products Reports Metrics Raw data Examples Internal External Vendors End users Management Downstream Process
  77. 77. Step 4: List all of the inputs into the process BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 77 Examples Internal External Vendors End users Management Downstream Process Suppliers Inputs Process Outputs Customers Step 1 Step 2 Step 3 Step 4 Examples Services Products Reports Metrics Raw data Examples Data Parts Application Raw materials
  78. 78. Step 5: Identify the suppliers of the process inputs BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 78 Examples Internal External Vendors End users Management Downstream Process Suppliers Inputs Process Outputs Customers Step 1 Step 2 Step 3 Step 4 Examples Services Products Reports Metrics Raw data Examples Data Parts Application Raw materials Examples Internal External Vendors Producers Management Upstream Process
  79. 79. Voice Of Customer Voice of the Customer (VOC) is the name used to describe a process of communication where there is give and take to ensure that requirements and expectations are clearly defined, documented, and understood by all parties involved. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 79
  80. 80. Voice of the Customer (VOC) VOC is often full of emotions. We need to restate customer statements into fact based, performance requirements that we need to focus on Of course… Customers expect perfection • Why don’t you guys learn how to meet a schedule? • Your service quality to poor • When will you learn how to provide service and a Customer first attitude? • Why don’t you tell us when there is a problem? • I sent out e-mail after e-mail with no response! • Why do you try and make your customers responsible for your quality problems? • Your RMA frequency is unacceptable
  81. 81. Listen to the voice of the customer BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 81 Source of information Complaints Customer Representative Sales Representative Billing Source of information Interviews Focus Groups Surveys Observations Internal and External Data Industry Experts Secondary Data Competitors
  82. 82. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 82 TargetCTQsCCR’sVOC Critical Customer Requireme nt Critical To Quality
  83. 83. Example BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 83 Late FilmVOC TimeCCR Right TimeCTQs According to standards Target
  84. 84. Dissatisfied Feeling Satisfied Feeling Physically Fulfilled Condition (Need is met) (Need is not met) Unstated, Expected Quality “Taken for granted” Kano's "3 Arrow Diagram" Must-be Quality These attributes are taken for granted when fulfilled but result in dissatisfaction when not fulfilled
  85. 85. Winter 2016ECEn 490Lecture #4 85 Dissatisfied Feeling Satisfied Feeling Physically Fulfilled Condition (Need is met) (Need is not met) Unstated, Expected Quality “Competitive” the more the better “Taken for granted” Kano's "3 Arrow Diagram" One-dimensional Quality These attributes result in satisfaction when fulfilled and dissatisfaction when not fulfilled.
  86. 86. Dissatisfied Feeling Satisfied Feeling Physically Fulfilled Condition (Need is met) (Need is not met) Unstated, Expected Quality Exciting Quality “Surprise & Delighters” “Competitive” the more the better “Taken for granted” Kano's "3 Arrow Diagram" Attractive Quality These attributes provide satisfaction when achieved fully, but do not cause dissatisfaction when not fulfilled
  87. 87. Dissatisfied Feeling Satisfied Feeling Physically Fulfilled Condition (Need is met) (Need is not met) Unstated, Expected Quality What was exciting yesterday becomes expected tomorrow Kano's "3 Arrow Diagram"
  88. 88. Kano Customer Need Model Dis-satisfiers Those needs that are EXPECTED in a product or service. These are generally not stated by customers but are assumed as given. If they are not present, the customer is dissatisfied. Satisfiers Needs that customers SAY THEY WANT. Fulfilling these needs creates satisfaction. Exciters / Delighters New or Innovative features that customers do not expect. The presence of such unexpected features leads to high perceptions of quality.
  89. 89. Summary of define phase BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 89
  90. 90. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 90 Measure The Problem
  91. 91. Measure Measurement is critical.  Determine how the process currently performs: Value Stream Mapping/Process Mapping  Create a plan to collect the data: Data Collection Plan 91
  92. 92. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 92 Process Mapping Symbols Symbol Name Brief Definition Operation or process step Decision Point Document Generated Continuation Point Input/Output Block Flow lines Depending on the level of detail being developed, can be used to denote anything from a simple task, major activity or a whole sub-processes. Used to indicate the process is continued elsewhere on the flow diagram or on another sheet. Point at which a form or report is generated by the process. Point where a decision must be made before any further action can be taken. Optionally used to describe an input or output from a processing block. Use to connect all blocks to display the sequence in which operations are performed. Termination point Used to indicate the start and end of a process.
  93. 93. 93 Flowchart Use when:  Identifying and describing a current process  Questioning whether there is a process  Questioning whether actual process meets current policy/procedure  Analyzing problems to determine causes  Redesigning the process as part of the action  Designing a new process
  94. 94. 94 Linear Flowchart Example Yes A Start Collect inputs Draft POD Type rough Submit to XO OK ? Retype POD No Type smooth Sign POD Make copies Distribute End AProducing the “Plan of the Day”
  95. 95. 95 Levels of Flowcharts Start End Draft POD Type POD Distribute POD Start Get rough draft of POD Is it approved ? Type smooth Get approval End Turn on computer Start word proc. apply. Is rough in word proc. apply. ? Type rough POD Edit POD Are there any corrections ? Make corrections Print POD No Yes Yes No No Yes MACRO MINI MICRO
  96. 96. 96 Flowchart  Steps:  Determine the boundaries (the start and stop points) of the process under review.  Brainstorm to identify all activities and decision points in the process;  Place all activities and decision points in sequence, paying attention to seeming repetitions, disconnection's, etc.; Cont..
  97. 97. 97 Flowchart  Design the flowchart, placing:  each activity in a box (square or rectangle)  each decision in a diamond,  ovals or circles for the start and stop points,  connecting arrows indicating the flow.  If there is more than one "output" arrow from an activity box, it probably requires a decision diamond; Cont...
  98. 98. 98 Flowchart  Analyze the flowchart, looking for process "glitches": inefficiencies, omissions/gaps, redundancies, barriers, etc.  Also look for the smooth parts of the process to use as models or "best practices" for improvement;  Decide whether to correct steps within the current process, design a new process, or do corrections first, then redesign in the future.
  99. 99. 99 Interpreting a Flowchart  Step 1 - Examine each process step Bottlenecks? Poorly defined steps? Ineffective sequence? Delays? Weak links?  Step 2 - Examine each decision symbol Can this step be eliminated?  Step 3 - Examine each rework loop Can it be shortened or eliminated?  Step 4 - Examine each activity symbol Does the step add value for the end-user?
  100. 100. 100 A Yes No Yes No Yes No NoYesYes No Yes NoFirst drill in set? A Inform the drill leader and improvise Props? Search Torpedo Room Radios still not available ? Borrow from Quartermasters Check with Radiomen Radios available? Props available? Enough red hats? Drill monitors test the radios Monitors go to Logroom to get red hats, radios, and drill props Complete the Drill Brief Drill monitors take station Search the boat for red hats No No Yes Yes Discrepancy? All personnel on station ? Correct it Put simulation on the appropriate gages Drill leaders walk around to ensure all monitors are on station Spot check safety intervention points Order initial conditions set Find them and put them on station Fire Drill Preparation Flowchart
  101. 101. Data Collection Process Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD • Define data elements; • Determine data collection plan;
  102. 102. Sampling Purposes:  To measure only a portion of a total group or population, such as for high volume aspects of care and service;  To achieve accurate representation of the entire target population, such as all ambulatory patients; a specific procedure, diagnosis, or DRG; or all cardiologists;  To generalize the results to the larger population based on sample findings. Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD
  103. 103. Non-probability Sampling  An intentionally-biased way to sample, involving qualitative judgment about an issue that is suspected to be common or widespread.  Examination of relatively few cases is assumed to be enough to reveal the nature of any problem and its probable causes.  This methodology does not include techniques to estimate the probability that each case will be included,  The results cannot be generalized to the entire population without further study. Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD
  104. 104. Types of non-probability sampling  Convenience:  Using data most readily available, e.g., all patients seen in the ED in a given week.  Quota:  Portions or percentages of persons/cases in a stratified population (subset), e.g., 10% of male patients with diabetes and heart disease over age 55.  Purposive:  Persons/cases/issues selected because they demonstrate a desired characteristic and can be measured against specific, predetermined criteria, e.g., all patients over age 60 with total hip replacements Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD
  105. 105. Probability sampling: Introducing statistical techniques into the selection process, thus permitting the reviewer to draw inferences about a population. It assures that each case in the population has an equal and independent (random) chance of being selected and is, therefore, truly "representative" of the entire population being sampled. Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD
  106. 106. Types of Probability Sampling  Simple random: Using a Table of Random Digits (available in all statistical software) to select the persons/cases from a list of every case in the defined population.  Stratified random: Creating 2 or more homogeneous categories or dimensions of a population and selecting an appropriate number of persons/cases that are representative of the whole. Patients with IVs in home care might be sampled by diagnosis,type of solution, or with and without complications. Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD
  107. 107. Types of Probability Sampling  Systematic random:  Randomly selecting the first case and then selecting every nth case thereafter based on standard/fixed intervals, e.g., every 5th referral to a specialist by a primary care physician in an HMO after random selection of the first case.  Multistage random  In large studies, sampling could be done in stages, a sample is drawn from each stage randomly. Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD
  108. 108. Sampling  Sample Size & Effect Size  Sampling error  Consequences Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD
  109. 109. Joint Commission general guidelines for sampling: These sample sizes for these populations (total cases meeting criteria) are considered statistically significant and can be applied to measurement activities for the specified time period, e.g., monthly, quarterly: Population Size Sample Size Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD
  110. 110. Sampling strategy  The characteristics of the population that the sample must represent;  The location and time period from which the sample must be drawn;  The type of sampling technique that will assure that the sample accurately represents the population;  The selection of a sample that will not introduce a bias Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD
  111. 111. DATA COLLECTION TOOLS Keep the tool as short and simple as possible;  Include all data elements necessary to monitor the specified issue/indicator;  Consider computerizing whenever feasible;  Provide appropriate definition of terms  key for using the tool. Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD
  112. 112. Types of Data Collection Tools  Data Sheet or Work Sheet: Form for recording data; requires subsequent processing for analysis and interpretation; Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD
  113. 113. Types of Data Collection Tools Check sheet: Form for recording data; designed to facilitate interpretation directly from form; Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD
  114. 114. Types of Data Collection Tools  Interview or Focus Group: Questionnaire format; can be open-ended discussion to obtain input from people; Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD
  115. 115. Types of Data Collection Tools  Download: Automated retrieval from a computerized data source. Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD
  116. 116. Surveys Surveys are methods by which we can measure customer satisfaction, get feedback on written materials and oral presentations. Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD
  117. 117. How to Develop a Survey  Know your audience  Remember who will be answering your survey and imagine how they might interpret the questions you are asking.  KISS (Keep It Short and Simple), People tend not to answer lengthy surveys.  Be direct. Ask exactly what you want to know.  Make your statements or questions neutral. If you state your question in a negative manner, you may be swaying the respondent. Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD
  118. 118. Measuring Effectiveness Of The Tool Checklist for adequacy of the tool:  Does the tool really measure the process or aspect of care and its indicator?  Will you get the information you really need?  Will you get more than you need?  Will the data you get be interpretable? Will it help to gather other data to facilitate interpretation, e.g., age, weight, secondary diagnosis, etc.?  Too much time? Can it be cut down? Dr.Doaa Hussein MBA,CPHQ,DTQM,HRM,CPT,APD
  119. 119. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 119 Analyze Phase
  120. 120. Analyze phase  Having completed the Measure phase, the project team should have already established a clear problem statement which specifies what the problem is and under what circumstances it occurs.  They should have already gathered and analyzed data to establish the baseline performance of the process, relative to the Critical To Quality measures (CTQs) established based on customer input. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 120
  121. 121. Analyze phase seeks The question that the Analyze phase seeks to answer is “Why is this problem occurring?“ Another way to ask it is, “What is the cause of the problem?“ It is not possible to make improvements to the process until the causal factors are identified. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 121
  122. 122. ANALZE PHASE  1- Data Analysis : Analyzing data relative to a particular project.  2-Root Cause Analysis: The other is that the goal of Analyze is to determine root causes, which requires digging deeper than what is apparent on the surface. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 122
  123. 123. Steps in DATA Analyze 1. Define your performance objectives. 2. Identify independent variables (X’s). 3. Analyzing Sources of Variation : The goal of this step is to use visual and statistical tools to better understand the relationships between dependent and independent variables (X’s and Y’s).
  124. 124. Process variation  Process variation can be classified as Variation for a period of Time and Variation Over Time.  Variation for a period of time can be defined for discrete and continuous data types as below : Discrete Data: Bar Diagram, Pie Chart, Pareto Chart Continuous Data: Histogram, Box Plot, Run Chart, Control Chart. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 124
  125. 125. Tools for Analyzing Sources of Variation Scatter Diagram • To correlate variables A bar diagram is a graphical representation of attribute data. It is constructed by placing the attribute values on the horizontal axis of a graph and the counts on the vertical axis. Pie Chart • Illustrate numerical proportion BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 125
  126. 126. Tools for Analyzing Sources of Variation: Histogram A histogram is a graphical representation of numerical data. It is constructed by placing the class intervals on the horizontal axis of a graph and the frequencies on the vertical axis. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 126
  127. 127. Cause and Effect Diagram / Fish Bone Diagram / Ishikawa Diagram:  This is a visual tool used to brainstorm the probable causes for a particular effect to occur. Effect or the problem is analogously captured as the head of the fish and thus the name. The causes for this effect or problem is generated through team brainstorming and are captured along the bones of the fish. The causes generated in the brainstorming exercises by the team will depend on how closely the team is related to the problem. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 127
  128. 128. Potential Root Causes 1-Cause and Effect Diagram / Fish Bone Diagram / Ishikawa Diagram. 2- Pareto Charts BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 128
  129. 129. Cause and Effect Diagram / Fish Bone Diagram / Ishikawa Diagram: BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 129
  130. 130. The potential causes could be due to any of the 6(M's) , 8 (P's), & 4 (S's)  6M's - Machines, method, material, maintenance, man & mother nature  8P's - Price, promotion, people, process, place, policy, procedure, product  4S's -Surrounding, suppliers, systems, skills BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 130
  131. 131. HIGH TAT BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 131
  132. 132. Pareto Chart: A data display tool for numerical data that breaks down discrete observations into separate categories for the purpose of identifying the "vital few". BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 132
  133. 133. Wrapping Up the Analyze Phase At the end of the Analyze phase, the project team should have at least one confirmed hypothesis regarding the root causes of the problem the project aims to resolve. Once the root cause is known, action can be taken in the Improve phase to counter it. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 133
  134. 134. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 134 IMPROVE
  135. 135. Objectives of Improve Phase The goal of the DMAIC Improve phase is to identify a solution to the problem that the project aims to address. This involves brainstorming potential solutions, selection solutions to test and evaluating the results of the implemented solutions. Often a pilot implementation is conducted prior to a full-scale rollout of improvements. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 135
  136. 136. Identifying Potential Solutions  In the first stage of Improve it is important to include the people who are involved in performing the process. Their input regarding potential improvements is critical, and this step should not be completed by the project team alone.  A variety of techniques are used to brainstorm potential solutions to counter the root cause(s) identified in Analyze. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 136
  137. 137. Identifying Potential Solutions Brainstorming • Create as many ideas as possible in as short a time as possible Lotus Diagrams • A tool to expand thinking around a single topic Affinity Diagram • organize large volumes of ideas or issues into major categories. 137
  138. 138. Organizing Ideas Lotus Diagram Affinity Diagram BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 138
  139. 139. Selection between alternatives 139  The goal of this step is to determine the appropriate solutions to implement using objective means, rather than making a decision based on assumptions or preferences.  This is a common theme throughout the Six Sigma methodology. Prioritization Matrix Selection Grids can be used to help in decision making.
  140. 140. Selection between alternatives Prioritization Matrix Selection Grids 140  A Prioritization matrix is a tool used to select one option from a group of alternatives, be they problems or solutions.  It promotes objective decision making.
  141. 141. 141 Prioritization Matrix  Steps:  Limit the list of options (of problems or solutions) to no more than eight (8);  Select the criteria against which each option will be rated, stated in either positive or negative terms, but not both;  Determine the weight (relative value) of each criterion; perhaps some are more important to meet than others;  Determine the desired score, what number of criteria must be met, etc. for the option to remain under consideration;  the matrix with options down the left side and criteria/total score column across the top.
  142. 142. Implementing Improvements  Planning the implementation is largely a matter of basic project management. The team needs to plan the budget and time line of the implementation, determine roles and responsibilities, and assign and track tasks.  Tools for planning include gantt charts, action plans and flowcharts. A deployment flowchart can be created for the implementation process itself, as well as for the new process that will be followed as a result of the improvements being implemented. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 142
  143. 143. 143 Action Planning  Once the team selects a solution, an action plan need to be developed.  Action plans at a minimum identifies:  what to be done? (deliverables)  How a certain task will be done?(Implementation Strategies)  who will do it?( Responsible person)  Time Frame (due date)  A mean of verification that a certain task has been done (target , KPI). what to be done? (deliverables) Implementation Strategies Responsible person Due Date Evaluation
  144. 144. GANTT CHART  Definition: A Gantt chart is a project-planning tool for developing schedules; a graphic display—a type of bar chart—of the individual parts of a quality improvement process as bars on a horizontal time scale.  The Gantt chart includes a list of tasks (process steps) and estimates of time and people resources required to complete the quality improvement effort.  Most project-planning software includes Gantt charts. 144
  145. 145. 145 Gantt Chart 1 2 3 4 5 6 7 8 9 10 1- 2- 3- Responsibility Resources Month or WeeksList of Tasks Goal:………………………………….
  146. 146. Pilot The selected solution The most common piloting options include either making changes only in one group or department or making changes for a limited time period. The benefit of a pilot test is that the project team can ensure the changes result in the desired improvements before a full roll out. In addition, the team can gain insights to allow a more effective implementation during the full roll out. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 146
  147. 147. Slide 147 Improve: Implement and Check  Verify effectiveness by checking current performance against original baselines;  Apply statistical comparative methods if necessary. Before Pareto Chart After Pareto Chart
  148. 148. Wrapping Up the Improve Phase  By the end of the Improve phase, the project team has demonstrated that the solutions implemented do in fact counter the identified root causes and thus result in substantial improvement in the CTQ metrics.  The new process is in place and the team is ready to create a plan to maintain the gains and close out the project. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 148
  149. 149. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 149 Control Achieved Improvement
  150. 150. © Max Zornada (2005)Slide 150 Control  Standardise the solution by making it part of the standard procedure for the process;  Update the performance measurement scorecard for the process;  Implement control charts;  Document the project.  Share and celebrate your success.  Ensure the process is being managed and monitored properly.  Continuously improve the process.  Apply new knowledge to other processes in your organization.
  151. 151. Wrapping Up the Control Phase  By the end of the Control phase, the project team has successfully  Standardized and documented the new process,  Created training and reference materials and established a plan for ongoing process monitoring.  The improvements are fully established and a plan exists for updating the process in response to changes in the environment.  The team is now ready to close out their six sigma dmaic project and hand the process off to the process owner. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 151
  152. 152. Closing Out the Project  The five phases of DMAIC have been completed. The Six Sigma project team has:  Established the customer requirement (CTQ)  Measured the process against that requirement  Clarified the problem that had to be addressed  Confirmed one or more root causes of that problem  Identified one or more solutions to counter the root causes  Demonstrated that the solutions implemented result in substantial improvement in the CTQ metrics  Rolled out the new process BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 152
  153. 153. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 153
  154. 154. © Max Zornada (2005)Slide 154 Future Plans  Review the previous non-pareto causes to see which ones have upgraded themselves and assess whether these are worth going after;  Review any obvious opportunities to apply the solution in other areas;  Communicate the solution to other parts of the organisation where it may also apply;  Review and document lessons learnt and institutionalise the learning.
  155. 155. 155
  156. 156. BY Dr. Doaa Hussein Abdelghani MBA, CPHQ,DTQM,HRMD,APD,CPT 156

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