An Introduction to Lean Six Sigma

“We don’t know what we don’t know.We can’t act on what we don’t know.We won’t know until we search.We won’t search for what we don’t question.We don’t question what we don’t measure.Hence, we just don’t know.”

Dr. Mikel Harry

Process Improvement1. Initial Perception of problem

2. Clarify Problem3. Locate Point of Cause4. Root Cause Analysis

5. Design Solutions6. Measure Effectiveness

7. Standardize

Lean Six Sigma Process ImprovementLean Six Sigma Seeks to improve the

quality of manufacturing and business process by:identifying and removing the causes of

defects (errors) and variation.Identifying and removing sources of waste

within the processFocusing on outputs that are critical to

customersDefine

Measure

Analyze

Improve

Control

Lean Six Sigma Process ImprovementLSS is a management philosophy that

seeks to drive a quality culture change through a multi-level based program

Level Training

Green Belt LSS Methodology and basic tool set

Black Belt Green Belt content plus advanced data analysis

Master Black Belt Black belt content plus program management, leadership skills, some advanced tools

L6s

1930 19501900

L E A N

S i x S i g m a

Ford Assembly Line

Guinness Brewery

Shewhart Introduces SPC

Gilbreth, Inc.•Management Theory•Industrial Engineering

Deming•14 Points•7 Deadly Diseases

Toyota Production System

Lean Six Sigma Timeline

L6s

1990 20001980

Motorola Introduces Six Sigma

S i x S i g m a

L E A N

Just – in–Time

SPC

Lean Mfg.

TQMAlliedSIgnalGE Adapt LSS to Business Processes

Lean

Six Sigma

Lean Six Sigma Timeline

Background on LeanLean comes out of the industrial engineering worldTaiichi Ohno – Toyota Production System.

1940s-1950s company was on verge of bankruptcyDynamics of industry were changing – moving from mass

production to more flexible, shorter, varied batch runs (people wanted more colors, different features, more models, etc).

Ohno was inspired by 3 observations on a trip to AmericaHenry Ford’s assembly line inspired the principle of flow (keep

products moving because no value is added while it is sitting still)

The Indy 500 – Rapid ChangeoverThe American Grocery Store – led to the Pull system – material

use signals when and how stock needs to be replenished

Path To LeanTheory Waste is DeadlyApplication 1. Define Value – act on what is

important to the customer2. Identify Value Stream –

understand what steps in the process add value and which don’t

3. Make it flow – keep the work moving at all times and eliminate waste that creates delay

4. Let customer pull -- Avoid making more or ordering more inputs for customer demand you don’t have

5. Pursue perfection -- there is no optimum level of performance

Focus Flow FocusedAssumptions Non-Value added steps exitResults Reduced cycle time

Waste Defined in medical organizationWastes Healthcare Examples

Transport 1. Moving patients from room to room2. Poor workplace layouts, for patient services3. Moving equipment in and out of procedure room or

operating room

Inventory 1. Overstocked medications on units/floors or in pharmacy2. Physician orders building up to be entered 3. Unnecessary instruments contained in operating kits

Motion 1. Leaving patient rooms to:• Get supplies or record• Documents care provided

2. Large reach/walk distance to complete a process step

Waiting 1. Idle equipment/people2. Early admissions for procedures later in the day3. Waiting for internal transport between departments

Over-Production

1. Multiple signature requirements2. Extra copies of forms3. Multiple information systems entries4. Printing hard copy of report when digital is sufficient

Over-Processing

1. Asking the patient the same questions multiple times2. Unnecessary carbon copying3. Batch printing patient labels

Defects 1. Hospital-acquired illness2. Wrong-site surgeries3. Medication errors4. Dealing with service complaints5. Illegible, handwritten information6. Collection of incorrect patient information

Skills 1. Not using people’s mental, creative, and physical abilities2. Staff not involved in redesigning processes in their

workplace3. Nurses and Doctors spending time locating equipment

and supplies4. Staff rework due to system failures

Lean FoundationsStandardized Work – people should analyze their work

and define the way that best meets the needs of all stakeholders. “The current one best way to safely complete an activity

with the proper outcome and the highest quality, using the fewest possible resources”

Standardized not Identical – mindless conformity and the thoughtful setting of standards should not be confused

Written by those who do the work.Level loading – smoothing the workflow and patient

flow throughout the hospital.Kaizen – continuous improvement

Lean MethodsKaizen Events (or SCORE events)

Planned and structured process that enables a small group of people to improve some aspect of their business in a quick, focused manner. Select Clarify Organize Run Evaluate

5S – this methodology reduces waste through improved workplace organization and visual management Sort, Store, Shine, Standardize and Sustain

Kanban – a Japanese term that can be translated as “signal,” “card,” or “sign.” Most often a physical signal (paper card of plastic bin), that indicates

when it is time to order more, from whom, and in what quantity.

Lean vs. Six SigmaLean tends to be used for shorter, less complex problems.

Often time driven. Focus is on eliminating wasteful steps and practices.

Six Sigma is a bigger more analytical approach – often quality driven – it tends to have a statistical approach. Focus on optimizing the important steps – reducing defects.

Some argue Lean moves the mean, SixSigma moves the variance. But they are often used together and should not be viewed as having different objectives.Waste elimination eliminates an opportunity to make a defectLess rework means faster cycle times

Six Sigma training might be specialized to the “quality” department, but everyone in the organization should be trained in Lean

L6s

VOC vs. VOP

Voice of Customer

Voice of Process

The Voice of the Process is independent of the Voice of the

Customer

SigmaCapabili

ty

Defects per Million Opportunities

% Yield

2 308,537 69.15%3 66,807 93.32%4 6,210 99.38%5 233 99.98%6 3.4 99.99966%

L6s

What’s good enough?99% Good (3.8 Sigma) 99.99966% Good (6 Sigma)

20,000 lost articles of mail per hour (based on 2,000,000/hr)

7 articles lost per hour

Unsafe drinking water for almost 15 minutes each day

1 unsafe minute every 7 months

5,000 incorrect surgical operations per week

1.7 incorrect operations per week

2 short or long landings daily at an airport with 200 flights/day

1 short or long landing every 5 years

2,000,000 wrong drug prescriptions each year

680 wrong prescriptions per year

No electricity for almost 7 hours each month

1 hour without electricity every 34 years

L6s

Goals of Lean Six SigmaLSL

USL

Customer Target

Defects

Defects

Prevent Defects byReducing Variation

LSL

USL

Customer Target

Defects

Prevent Defects byCentering ProcessLS

LUSL

Customer Target

Meet Customer Requirements

What Makes a Good Lean Six Sigma Project?There is no known solutionThe root cause is not knownThe problem is complex and needs statistical

analysisThe problem is part of a processThe process is repeatableA defect can be defined Project will take 3-6 monthsThere are data available

The DMAIC MethodologyDefine – describe the problem quantifiably and the

underlying process to determine how performance will be measured.

Measure – use measures or metrics to understand performance and the improvement opportunity.

Analyze – identify the true root cause(s) of the underlying problem.

Improve – identify and test the best improvements that address the root causes.

Control – identify sustainment strategies that ensure process performance maintains the improved state.

DefineDefine Scope of the Problem

Document the ProcessCollect and Translate the Voice of the

CustomerDetermine Project Objective and Benefits

Define Metrics and DefectsEstablish Preliminary BaselineDevelop Problem & Objective StatementsEstimate Financial Benefit

Define (continued)Create Project Charter

Confirm Improvement MethodologyDefine Project Roles and ResponsibilitiesIdentify RisksEstablish TimelineManagerial Buy-in

Focus here is on the problem

Measure Measure what is measurable, and make measurable what is not so” – Galileo

Define “As Is” processValue stream map/process flow diagram

Validate Measurement System for OutputsDon’t assume your measurements are accurate

– measuring system must accurately tell what is happening

Quantify Process PerformanceCollect data (Y’s)Examine process stability/capability analysis

AnalyzeIdentify Potential Causes (X’s)Investigate Significance of X’s

Collect data on x’sGraphical/Quantitative analysis

Pareto Chart Fishbone Diagram (cause and effect) Chi Square Test Regression Analysis Failure Mode Effects Analysis

Identify Significant Causes to focus on (y=f(X))Evaluate the impact of x’s on y

Here you identify the critical factors of a “good” output and the root causes of defects or “bad” output.

ImproveGenerate Potential SolutionsSelect & Test SolutionDevelop Implementation Plan

ControlCreate Control & Monitoring Plan

Mistake proof the processDetermine the x’s to control and methodsDetermine Y’s to monitor

Implement Full Scale SolutionRevise/develop processImplement and evaluate solution

Finalize TransitionDevelop transition planHandoff process to owner