The document presented an agenda for a Lean Six Sigma presentation given by Latoya Wall of The Bulsard Group. The agenda covered an introduction to Lean Six Sigma including who the presenter and company are, the business case for adopting Lean Six Sigma now, what could be accomplished through Lean Six Sigma, how Lean Six Sigma methodology would be applied, and next steps. Key points included an overview of Lean and Six Sigma approaches to eliminating waste and reducing variation, respectively, as well as how Lean Six Sigma has helped other organizations save billions of dollars through process improvements.

1. National Association of Health Services Executives
Empowering the Next Generation of Health Care Leaders Today
Lean and Six Sigma Presentation
Latoya L. Wall
The Bulsard Group, LLC
September 2012

2. Agenda
 Who are we? - Introduction
 Why now, Why me? – Business Case
 What will we accomplish? – Lean and Six Sigma
 How will we accomplish this? – The Process
 Where and When? – Next Steps
2

3. Who are we? - Introduction
www.bulsardgroup.com 3

4. 12 Point Approach
4

5. Value Maturity Model
Business Opportunity Identified “ Value
Definition”
“Value
Optimization”
“Value
Creation”
“Value
Capture” “Value
Delivery”
5

6. 4 Measures of Organizational Performance
Dependent High
Efficiency Capability
Process
Low
Effectivity Capacity
People
Low Dependent High
6

7. Why now? – Business Case
Lean Six Sigma in Healthcare Areas of Innovation
 Lowering healthcare costs due to inefficiency, inappropriate care, duplicative care and
incomplete information
 Generating additional savings by reducing waste, decreasing medical errors and
improving quality
 Improving patient outcomes, and detecting, preventing, and managing chronic disease
 Transforming the economy with science and technology
“Each of the nation’s 5,700 hospitals must cut $2.6 million a year on average in costs in
the next 10 years to meet the demands of President Obama’s proposed health care
reform, a daunting task when half of those hospitals lose money.” USA Today
7

8. Why me? – NAHSE
National Association of Health Services Executives
• Mission is to improve quality, access to and availability of health services for those who are
poor and underserved
• Focus is on collaborative thinking as a source of energy to set the bar in delivering lasting
solutions
• Provides a powerful vehicle for the design, direction and delivery of quality health care to
all people
• At the heart of NAHSE is the powerful forward momentum to constantly refine, refocus and
renew
NAHSE Can Be a Leader: Empowering the Next Generation Through Innovation!
8

9. Why me? –Individual Involvement
Lean and Six Sigma Certification Levels and Salary Benefits
$168,138*
Median Salary
Executive
Master Black Belt
$109,141*
Leadership Training Median Salary
Global Projects at $5M
Savings and above
Black Belt $87,783*
Median Salary
5-6 Weeks In Depth Concept Training
Projects at $1M Savings and above
Green Belt
3 Week In Depth Concept Training
Projects at $500K Savings and above
Yellow Belt
2 Day Multi-tool Training
White Belt
1 Day Overview Training
*Median Salary is based on 2012 rates for Houston, TX 9

10. What will we accomplish?
Lean and Six Sigma Overview

11. Premise of Lean…
Lean was pioneered by the Toyota Production System
• Sources of waste can be eliminated in every area of production along the value stream
• Focus is on efficient operation by
• Reducing cycle time
• Improving quality
• Aligning production with demand
• Reducing inventory
• Improving process safety
• Focus areas include customer relations, product design, supplier networks, and factory
management
Before After
11 9/28/2012
Toyota Company = World Class Performance!!!

12. Sources of Waste - DOWNTIME
 Defects: Errors which cause rework, repair, and/or replacement.
 Overproduction: Producing products outside of targets or services prematurely.
 Waiting: Delays in parts, machine, signatures, etc. which increase lead time.
 Not Using People Well: Poor utilization of work force’s time and talents.
 Transportation: Nonessential transport of products or delivery of services.
 Inventory: Excess components above minimum business target objectives.
 Motion: Movement of resources not value adding to product or service delivery.
 Excess-Processing: Inefficient processing of customer product features.
12 9/28/2012

13. Premise of Six Sigma…
Six Sigma was pioneered by Motorola and developed by GE
• Sources of variation can be identified, quantified and eliminated or controlled
• Focus is on reducing defects in our strategic or core processes which undermine
customer loyalty
• Process improvements are data driven and improve overall process capability
Sigma Quality Level:
The Higher the Sigma level, the Better the Quality
Three Sigma Process Six Sigma Process
LSL USL LSL USL
-6 -3 0 +3 +6 -6 -3 0 +3 +6
LSL: Lower Specification Limit Goal
USL: Upper Specification Limit
σ: measure of variation in a process
Specs are Customer Driven
13 9/28/2012
GE 5 year savings = $12 B!!!

14. Industry Sigma Rankings*
1,000,000
DPMO IRS - Tax Advice
(phone-in)
PPM (140,000 PPM)
Restaurant Bills
Doctor Prescription Writing
100,000 Payroll Processing
• Order Write-up
Journal Vouchers
Wire Transfers
10,000 Airline Baggage Handling
Purchased Material
Lot Reject Rate
1,000
Average Best-in-Class
100 Company Domestic Airline Flight
Fatality Rate (0.43 PPM)
10
1
1 2 3 4 5 6 7
Sigma Scale of Measure
*Courtesy of Six Sigma Academy
14 9/28/2012

15. Change Management
Congruence Model
To implement any type of change you should first consider the
impact to these components of an organization:
Formal
Inputs into the
Organization Outputs to the
organization organization
Work People
Informal
Organization
15 9/28/2012

16. How will we accomplish this?
Business Process Improvement

17. Example: Six Sigma in Oil & Gas – Process Mapping
Business Land Imaging
Process
Process
Sub- Document Document QC Prep Documents
processes Preparation Scanning (Image Review) for storage
Detailed
Sub-Process
Map
Tasks Procedures
17 9/28/2012

18. Detail Process Map
- PROCESS ASST
Start
- TOBIN
- DATE
- MISC.
- PROCESS ASST - BOX NO
- FILENET P8 - DOC CATEGORY
- DOC NO. - DOC NO.
- MISC.
- DATE
CHECK TO
CHECK TO SEE IF
SEE IF - QC ANALYST - QC ANALYST - QC ANALYST - QC ANALYST - QC ANALYST
SCANNED DOCUMENT - QC ANALYST
DOCUMENT
IS IN TLS
IN P8
10 - 60 MINUTE ENTER
SEND VERIFY VERIFY VERIFY
DELAY TO GET DOCUMENT
DOCUMENTS DOCUMENT DOCUMENT BOX VERIFY DATE DOCUMENT
FROM FILENET NUMBER IN
FOR FINAL QC NUMBER NUMBER TYPE
TO TLS TOBIN
- QC ANALYST
No VERIFY BAR
DOC IN P8 DELETE QC CHECK
No RE-SCAN Yes SHEET IS
? DOCUMENTS FAILED?
CORRECT
- QC ANALYST
Yes
- PROCESS ASST - PROCESS ASST - PROCESS ASST - PROCESS ASST - PROCESS ASST - PROCESS ASST - PROCESS ASST OPEN
DOCUMENT IN
TLS
CHECK FOR
CHECK IMAGE CHECK NO. OF CHECK FOR 2X CHECK FOR CHECK FOR CONFIRM PAGE
CORRECT IMAGE
QUALITY PAGES IMAGES BLANK PAGE IMAGE CUT-OFF SIZE CORRECT - QC ANALYST
CATEGORY
CHECK IMAGE
QUALITY
- QC ANALYST - QC ANALYST - QC ANALYST - QC ANALYST - QC ANALYST - QC ANALYST - QC ANALYST - QC ANALYST - QC ANALYST
CHECK FOR
CHECK IMAGE CHECK NO. OF CHECK FOR 2X CHECK FOR CHECK FOR CONFIRM PAGE QC CHECK DELETE
CORRECT IMAGE Yes RE-SCAN
QUALITY PAGES IMAGES BLANK PAGE IMAGE CUT-OFF SIZE CORRECT FAILED? DOCUMENTS
CATEGORY
No
- QC ANALYST - QC ANALYST
RETURN TO BOX MATCH
Stop TO SEND TO DOCUMENT IN
STORAGE TLS AGAINST P8
No
- QC ANALYST - QC ANALYST
- QC ANALYST
RETURN TO BOX CAN BE FIXED BY CONTACT MISMATCH
SEND TO Yes IT (E.G., CHANGE PROCESS ASST Yes CAN’T BE FIX MISMATCH DOCUMENTS
STORAGE DATE) OR IT FIXED MISMATCH
30 MINUTE ?
DELAY TO GET
FROM FILENET
TO TLS
Yes
18 9/28/2012

19. Process Mapping - Classification
Value Added
– A step in the process that the customer/company is willing to pay for
• Includes those activities that are required by contract or law
• If it were left out, it would impact customer satisfaction
Business-Value Added
– Any activity, when left out, that does not directly impact the customer and
may incur no dissatisfaction
• These steps may be necessary to support value added steps
• Any activity required by the business
Non-Value Added
– Any activity, when left out, that does not directly impact the customer and
may incur no dissatisfaction
19 9/28/2012

20. Analysis of Process Map
- PROCESS ASST
Start NO VALUE
- TOBIN
BUSINESS ADDED
- DATE VALUE ADDED
VALUE ADDED OR
- MISC.
- PROCESS ASST LOW VALUE
- BOX NO
- FILENET P8 - DOC CATEGORY
- DOC NO. - DOC NO.
- MISC.
- DATE
CHECK TO
CHECK TO SEE IF
SEE IF - QC ANALYST - QC ANALYST - QC ANALYST - QC ANALYST - QC ANALYST
SCANNED DOCUMENT - QC ANALYST
DOCUMENT
IS IN TLS
IN P8
10 - 60 MINUTE ENTER
SEND VERIFY VERIFY VERIFY
DELAY TO GET DOCUMENT
DOCUMENTS DOCUMENT DOCUMENT BOX VERIFY DATE DOCUMENT
FROM FILENET NUMBER IN
FOR FINAL QC NUMBER NUMBER TYPE
TO TLS TOBIN
- QC ANALYST
No VERIFY BAR
DOC IN P8 DELETE QC CHECK
No RE-SCAN Yes SHEET IS
? DOCUMENTS FAILED?
CORRECT
- QC ANALYST
Yes
- PROCESS ASST - PROCESS ASST - PROCESS ASST - PROCESS ASST - PROCESS ASST - PROCESS ASST - PROCESS ASST OPEN
DOCUMENT IN
TLS
CHECK FOR
CHECK IMAGE CHECK NO. OF CHECK FOR 2X CHECK FOR CHECK FOR CONFIRM PAGE
CORRECT IMAGE
QUALITY PAGES IMAGES BLANK PAGE IMAGE CUT-OFF SIZE CORRECT - QC ANALYST
CATEGORY
CHECK IMAGE
QUALITY
- QC ANALYST - QC ANALYST - QC ANALYST - QC ANALYST - QC ANALYST - QC ANALYST - QC ANALYST - QC ANALYST - QC ANALYST
CHECK FOR
CHECK IMAGE CHECK NO. OF CHECK FOR 2X CHECK FOR CHECK FOR CONFIRM PAGE QC CHECK DELETE
CORRECT IMAGE Yes RE-SCAN
QUALITY PAGES IMAGES BLANK PAGE IMAGE CUT-OFF SIZE CORRECT FAILED? DOCUMENTS
CATEGORY
No
- QC ANALYST - QC ANALYST
RETURN TO BOX MATCH
Stop TO SEND TO DOCUMENT IN
STORAGE TLS AGAINST P8
No
- QC ANALYST - QC ANALYST
- QC ANALYST
RETURN TO BOX CAN BE FIXED BY CONTACT MISMATCH
SEND TO Yes IT (E.G., CHANGE PROCESS ASST Yes CAN’T BE FIX MISMATCH DOCUMENTS
STORAGE DATE) OR IT FIXED MISMATCH
30 MINUTE ?
DELAY TO GET
FROM FILENET
TO TLS
Yes
20 9/28/2012
Defects Overproduction Waiting Not Using People Well Transportation Inventory Motion Excess-processing

21. CT Scan Throughput Project Example
 Issue: North Shore-Long Island Jewish Health System
 Radiology throughput
 facility struggled to meet the demands of patients, providers and
physicians
 Solution: A Lean Six Sigma team addressed the problem
through a Kaizen event
 Outcome: Increase in Capacity
 In 30 days, daily number of patients scanned increased
 Previous average of 45 with a standard deviation (SD) of 7, to 51
patients scanned, with a SD of 4
 Procedure improvements
 from 30.6 percent to 22.7 percent
 200 additional procedures per month
 60 outpatient procedures per month
21 9/28/2012
Approximately $375,000 in additional annual revenue!!!

22. On-Time MRI Scans Project Example
 Issue: Radia Inc., a large radiology and vascular surgery
practice
 Wanted to improve efficiencies at one center that was falling
behind
 Solution: A Lean Six Sigma team addressed the problem
through a Kaizen event
 Outcome:
 50 percent improvement in the number of on-time MRI scans
 Created the potential for more than $1.4 million in annualized
incremental revenue
 Maintained optimal patient safety and quality of care
22 9/28/2012
More than $1.4 Million in annualized incremental revenue!!!

23. Exercise
Tools
Brainstorm
Affinitize
 Step 1: Answer the following question: What “keeps you up at night” concerning your current operations?
 Step 2: Brainstorm all possible process bottlenecks and process design gaps
 Step 3: Transcribe bottlenecks/gaps to post-its (1 per Post-it)
 Step 4: Identify as a source of waste using DOWNTIME.
 Step 5: Affinitize gaps and create a single statement as the “major gap” for each affinitized group for an outbrief
xxx xxx
xxx
xxx xxx xxx
xxx xxx
xxx xxx
Step 1 Step 2 Step 3
23

24. Questions????
“Empowering the Next Generation of Health Care Leaders Today”
24

25. Back-up
Latoya L. Wall, President

26. The Operational Excellence Connection
Opportunity Statement Standardization & Sustainment Opportunity Statement
Focus: Value Drivers (IT Example)
(Supply Chain Example)
Strategy Deployment Currently Engineering and Earth
Science practitioners spend 60% of
Implement an integrated, Focus: Strategy
their time looking for and QCing
comprehensive Materials data. Improve the productivity and
Management System to improve effectiveness of these practitioners by
Training & Development
financial compliance, and optimize establishing a data management
Focus: Vision
material visibility, quality, and infrastructure focusing on data access
availability. and data quality.
Change Management
Focus: Measures
Current State Future State
Strategy Development
Focus: Processes 5 Focus Areas
5 Focus Areas
 Establish core roles and
Capability Assessment
 Implement standard work governance for data management
Focus: Governance
processes efforts
 Leverage enabling technology  Implement standard processes for
 Establish the required storage Stakeholder Integration data governance
infrastructure Focus: Organization 3. Reduce redundant systems
4. Improve financial compliance which store data
5. Optimize material visibility, 4. Increase Decision Quality
quality, and availability 5. Optimize data visibility, quality,
 Represents successes to date Individual Employee and availability
Through the use of Lean , Six Sigma, and Change Management principles, the 7-6-5 plan provides a clear path to achieve
Operational Excellence

27. 7-6-5 Plan: Stages 1-3 – “Develop”
27

28. Develop: Stages 1-3 (Supply Chain)
Define Measure
Process Affinitization Macro Process Flow Map
IPO Diagram Value Stream Map

29. Develop: Stages 1-3 (Supply Chain)
Analyze Improve
Current State Analysis Barrier-Aid-Countermeasure Tool
Process Flow Development High Level Process Flow Map

30. Develop: Stages 1-3 (IT)
Inputs Outputs
(Leading Indicators) (Lagging Indicators)
Ensure Efficient
Data Access Build CapableUsers
•Standardize and optimize
,
common core petro -technical
Data Process Improved data quality (reduction in #
of errors) (performance)
•ReduceCycle Time to finddata workflows Data Management Failure
•Remove constraints to create
Business Rules
•Improve governance and visibility Identification Process
Improved risk controls/compliance (cost)
process efficiency of current and future efforts (Innerlogix tool used)
•Increase Decision Quality •Delivertraining and development Data Producers
Reduction in number of business
E2C 2 with a quality data management analyst needed to monitor the
Innerlogix tool (cost)
Data Stewards
Develop Effective DM Network IncreaseUser Capacity Reduction in number of incidents and problems
discovered with Business Rules (performance)
System of Record
•Remove constraints to create
productivity in users (decisions) Data Consumers
Reduction in technical research time
by end-user (time)
• Create a strategic program to •Improve the quality and
solve the data management gaps accessibility of this data Data Errors Reduction of ticketing/logging/auditing
• Create communication channels •Create single point of contact for Supplier
Data Consumer (DC)/
Customer
Data Steward (Help
downtime (performance)
for clear messaging across entire the various data management Data Quality Business Analyst
Data Management
System Identifies
Desk Rep) Receives
value stream
DQM Failure Ticket
efforts from GU Business Rule Failure
or Data Error
Define Measure
Process Affinitization Macro Process Flow Map
Gulf of Mexico Data Management
Data Data Data Data
Extraction Extraction Extraction Extraction
Value Stream Map
Data Type 1
Location Location Location Location
1.1.1 1.1.2 1.1.3 1.1.4
Output Stewardship and Operations Governance
Data Data Data Data
Extraction Extraction Extraction Extraction
Extraction Data Type 2 Location Location Location Location Data Errors and
ILX
1.2.1 1.2.2 1.2.3 1.2.4 Business Rule
Failures CUSTOMERS
SUPPLIERS
Ticketing System
Data Data Data Data (New Scale?) DM Community
Data Producers: Updated SOR
Extraction Extraction Extraction Extraction System of Record Updated Business
Data Type N Location Location Location Location Data Stewards:
RCats (or Asset Database??? Training Database
Rules
Business Rules
1.N.1 1.N.2 1.N.3 1.N.4 equivalent) Web
Access
LMS?
1.
Business Planning Database??? BHP System
Web
Access
Webform
Yearly Asset Classification and Reconciliation Process Webform
DQM Web
Access
Resolve Data
Output
DM Failure DM Ticket Data Management Decision
Errors and Access Data and Rules Receive and Process Data Quality
Resolution Business Rule Identification Response Failure Resolution Matrix for (Bottom Hole Pressure) Issues
Resolve Data Quality Issues Review Data Quality Management Train and Develop Data Management Maintenance
Process Process Process Data Types Data Management
Failures 2.1 2.2 2.3 2.1.1 Failure Resolutions Subprocesses:
Stop Sheet
Subprocesses: Subprocesses:
Data
Subprocesses:
Data Gap
Subprocesses: Subprocesses:
MOC Form
1. Request Load Send MMS OE Engineer MMS Waiver Data DM Failure Identification Data Data Management Failure Gap Assessment and Data Quality Training Data SOR Update Process Data
Help Desk Identified Consumer Steward Training Modules
2. Single Point Entry Form Form/CC111 Errors Consumer Data Assessment
2. 3. Load Historic Data, Legacy
Tech
AD Engineer Single Point
Entry Form
Business
Rule
Process
Data Ticket Form
Data
Quality
Resolution Process
Data Final Quality
Trending Process
Information Report
Improvement
Plans
Process Steward
IT Training MOC Form MOC Business Rule Update
Steward
Functional
Spreadsheets Custodian Final Issues Steward Resolution Resolutions Management Group Training Rep
Vendor Next Wells List Failures DM Ticket Response DQ Monthly Review DM Monthly Management of Change Communications
Process
5a. Export to MBAL PROSPER Data Information Delegate
DQM Rep Loader Resolution and Ticket Meeting and Information
Gap Process Steward Management Process Information Process Management
IM Analyst Spreadsheet and Ticket Closure Dashboard Developmen
5. Summary Report and DQ Analyst Canned Report DM Help Champion Management Management of Change Delegate
Closure Information Form Champion Report t Plan
Information for Decision Making (offshore) Template Desk Team Process Management
6. Request for a Waiver Email of QC Form Management Level 1 DM Template
SuperUser of Change
8. Data Quality Issues Delegate Documents Governance Owner
User Request Board
9. Add, Remove, Modify Users
Form
Output
10. Modify MMS 140 Template
Analyze Data
Standard email
for user request
DM Monthly Standard Email
Errors and Gap Assessment for user request
# Handoffs:
Analysis
refusal
Review Meeting
# Handoffs: # Handoffs: # Handoffs: # Handoffs: # Handoffs:
MMS140 Tem
Business Rule /Auditing Process
Guidelines
Failures 3.1 3.2 Improvement
Opportunities
3. ??-?? Hours ??-?? Hours ??-?? Hours ??-?? Hours ??-?? Hours ??-?? Hours
??-?? Days ??-?? Days ??-?? Days ??-?? Days ??-?? Days ??-?? Days
Standardize Output ??-?? Hours
Maintain Legend Process Totals:
Standardization and Sustain SOR Update DM Training
??-?? Days
Business Electronic Information Flow
DM Process Process
Rules Process
Governance Updated SORs and Scope Process ??-?? Hours
4.1 4.2 4.3 Business Rules Information/Data Transfer by Webform Totals: ??-?? Days
4.
Completed Training Information/Data Transfer by Email
Information/Data Transfer by Telephone
Information/Data Transfer by Computer Interface/Web Access
IPO Diagram Work in Process
Inventory
Value Stream Map
Roles
Forms Used