beyond lean and six sigma

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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital

Beyond Lean/Six Sigma Managing Change and Spreading Innovation

Nidia Williams, CCC-SLPDirector, Quality OutcomesSix Sigma Master Black BeltSouthcoast Hospitals [email protected]: 508.679.7397

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Who We Are

Charlton Memorial HospitalFall River

St. Luke’s HospitalNew Bedford

Tobey HospitalWareham

Southcoast Health System800+ physicians & 6,300+ employees

serving 719,000 people in 33 communitiesdating back to 1884.

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Why & How We Got Started

• Be ahead of the curve

#1: Improve Quality

#2: Find Savings

• Started before the economic downturn• Improve operating margin for hospital & system

before going to bond market for project financing

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• Seek sustainable methods & processes —not just cuts

• A lifestyle change — not just a diet

• Increased focus on “real-time accountability”

• Use data to drive decision-making

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• Why do both Lean & Six Sigma?

• Improve the way we do things —not just to generate cuts/savings

• Create immediate savings through elimination of waste & hard-wiring improved processes with Six Sigma

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Action

Mobilize the entire organization

• Board• Senior Leadership• Middle Management• Physicians• Front line staff

Activate engagement

• Set targets and deadlines up front

• Set financial targets• All levels held

accountable• Include front-line staff• Communicate

Communicate Communicate

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Getting Started / Communication

• Basic set of standardized terms• Posted on intranet

• Discuss at Open Forums• Open discussion with all employees• Ask staff for brainstorming

• Communication cascades

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Improvement Cycle

• 120-day cycle with 30-day check-ins

• Disciplined, focused engagement

• Built database tracker to promote accountability & adherence to timelines

Lean

Every director/manager expected to present Waste Walk efforts

Six Sigma

Every Six Sigma team presented one DMAIC phase every 30 days

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Six Sigma …

• Certified Belts• 26 Green Belts• 4 Black Belts• 1 Master Black Belt• Yellow Belt training for ALL leadership

• Bringing the resources in-house is necessary for expanding and maintaining the Six Sigma culture

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Surprise, Surprise …

Applying Six Sigma to yourexisting processes

is an

eye-opener

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Six Sigma Project TrackerSix Sigma Project Tracker

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Improvement REQUIRES Change

• The “I” in DMAIC really means CHANGEneeds to be implemented, facilitated and managed.

• Won’t happen by CHANCE!

• Should be managed as its own sub-project

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Develop a Solution and Action Plan

“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.”

– Marilyn Ferguson

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STAGES OF TRANSITION

Neutral Zone

ENDING

NEW BEGINNING

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.

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• “Been there…Done That…”• Resistance to change• Managing People’s Expectations• Communication strategies

• Which of the reasons for change resistance are the most likely causes of resistance in this organization or for this change?

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• Value Resisters Because . . .

• They clarify the problem

• They identify other problems that need to be solved first

• They force change leaders to think before they implement the change

• Their tough questions can strengthen and improve the change

• They let us know who opposes the change

• They slow down the change

• They may be right, it is a dumb idea!

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Develop a Solution and Action PlanHuman Nature . . .

• People want to maintain control over their actions

• People develop self-confidence and psychological health by building stable and effective relationships with others

• Our sense of control, comfort, and well-beingresults from the degree of certainty we have about our life and our future

• Change disrupts our ability to predict what’s in store for us

• The more a change disrupts our ability to envision our future, the greater our confusion, fear, anxiety, and self-doubt

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Determining the Solution

• Reliance on Six Sigma, Lean or other methodology and/or tools

• Should be selected after measuring positive impact on outcome (data-driven decision)

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Goal• 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

• Generate potential solutions• Select the most effective solution• Generate all possible tasks that can be done to

implement the solution• Anticipate likely problems and develop possible

countermeasures• Create an action plan

Develop a Solution and Action Plan – including targets for improvement

The Improvement Process

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Improvement Strategy

Alternatives

• Pilots• Process Mapping• Mistake Proofing• Brainstorming• Benchmarking & Best Practices• Simulation• Generate Alternatives• Assess Risks• Test Alternatives Through Pilots or Simulation• Evaluate and Select the Best Solution

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Improvement StrategyChoose Improvement Strategy

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

My Xs are Alternatives

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Improvement Strategy

• Eliminate Obvious Sources of Variation

• People in Self-Control

• Means for knowing what they are supposed to do?

• Means of knowing what they are doing?

• Means of regulating their work?

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NEW BEGINNING

ENDINGS

Neutral Zone

Time

Reactions to Transition

Denial

Anger

Fear

Shock

Frustration

Confusion

StressCreativity

Skepticism

Acceptance

Impatience

Hope

Energy

Excitement

Implement the Solution

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Leadership Responsibility• Agree to the change• Communicate support• Ensure resources, time, money

Motivate• Address Barriers• Focus, Focus, Focus• Support the organization through the change

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1. Use Communication Skills

2. Monitor the Implementation Plan

3. Manage frequent and Effective Meetings

4. Use Data and Analyze

5. Data-Driven Decision Making

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• Review root cause(s) data, and verify if improvement will be effective

• Determine if improvement will achieve project goals

• Develop a flow diagram to illustrate how the improvement will operate

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Process Instruction

Document Process Instructions• Standard Operating Procedures• Instructions• Operational blue prints

If it’s not in writing, it does not exist

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• Simple & clear

• No novels

• Involve the “Do-ers!”

• Limit the text

• Process Map

• Involve those responsible for implementation

• Be realistic

Process Instructions

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Managing Change is an Art and a Science

The devil is in the details… and the details involve PEOPLE

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Considerations for Managing Change

• People often feel they need to “agree” with every detail, or they will not submit to authority

• Resistance is often subtle• People may hold onto the history of

how change was managed in the past• Cultural Obstructions• Focus on customer needs!

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Culture as an Obstacle to ChangeCan contribute to resistance

• Self Interests• Sense of entitlement and process

ownership• Fear of unknown• Differing perception and vision• Lack of purpose driven focus• Lack of respect for leadership and position

of authority• Conservatism

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Cultural Obstacles

In today’s work world, it seems if we do NOT agree with authority or

change, we can CHALLENGE it with complaint or protest

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Reasons for Rebellion to Change

• Unclear vision, competing visions• Lack of purpose-driven focus• Demand for compliance versus

commitment

• Failure for leaders to communicate- “what’s in it for me?”- “where are we going?”- “why are we going?”

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Leaders Need to do Things Differently

• What do you think leaders need to do?

• What to leaders typically fail to address and consider?

• How can leaders assist with managing and addressing the cultural obstacles?

• What communication strategies need to be considered and/or addressed?

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Change is a ProcessJourney, not a destination• More than creating or designing a new way• More than drafting procedures• More than writing policies• More than determining best practice• More than sending emails• More than training sessions

The above are all tasks – not processes, not process changes, and only part of what needs to be managed and considered

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Requirements to Managing Change

• Stakeholder Analysis – examine and learn from past history of change

• Sponsors and Champions – a must!

• Examination of Skill Set – necessary for targeted group, addressed “fear” and for the CHANGE agents, ie. leadership

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Motivational Considerations

• Provide these up front!• Paint a picture of the future state• Communicate consequences of failure• Economic realities need to be transparent• Alliance with strategic plans and objectives• Customer demands

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GPS Guidance for the Journey

• Document the process plan in advance and share it• Include ALL the details, and identify all the

stakeholders, roles and responsibilities• Manage the process as its own project• Address and plan for controls re: obstacles

identified for consideration• Wrap the package with a purpose-driven focus

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People do NOT Reject Their Own Ideas

• Early collaboration and involvement with stakeholders

• Listen to concerns and ideas• Validate feelings• Buy-In will only help!

• Over-Communication is impossible!

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Spreading the Change

• Our tools (DMAIC, Lean, etc.) may give us solutions.. But implementation is still required.

• A systematic and process driven, managed approach had to be developed as part of the change management process

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Spreading Solutions Across Southcoast

• Hardwiring and managing solutions from Six Sigma

and Lean project teams

• Implementing corrective actions based on

TapRooT® investigation results

• Managing and evaluating best practice and

operational processes for new services

• Cannot be left to chance, needs a detailed

deployment process

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LINC Team Concept Leaders Innovating and Navigating Change

LINC Team

Six Sigma Team

Solutions

Kaizen Event

SolutionsLean

Solutions

TapRooT Corrective

Action Plans

Other Processes Requiring Deployment

across Sites/Departments

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Ingredients for Successful Deployment Projects

• Senior Leadership support (commitment to standardize)

• Key Stakeholder meetings

• Weekly/Biweekly meetings during implementation

• Project Management at organizational and local project

level

• Post-spread control plan with metrics and check-ins

• Skilled facilitation and accountability

• Project Charter and Service Level Agreement (SLA)

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LINC TeamFour driving principles

• Collaboration (each team will consist of site-specific sub-groups) and weekly/bi-weekly meetings

• Pull vs Push• Project Management, Defined

Communication Plan and Stakeholder Analysis

• One-on-One Support – BB Travels to each site to visit and provide leadership during the implementation project

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LINC Membership

• Black Belt w/Project Management Training

• Site Process Owners

• Executive Champion

• Team Members – selected by above, representing

current stakeholders in process at each site

• Rapid Cycle Deployment Plan 90-120 Days

Updates at monthly check-ins and QSC

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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

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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

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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

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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

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Other Considerations

• Outside of BB on-site visits, mtgs can be

teleconferenced or by phone

• BB uses DMAIC method and key improvement tools

to facilitate team innovation for spread of plan

• Only address proven X’s and root causes for

standardization across sites

• Ongoing communication with Executive Champion

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Our Keys to Success …

• Pick the right problems to tackle & the right people to tackle them withdefined accountability expectations

• Hard-wire the changes – good data is key

• Build strong, organization-wide, top-down commitment to keep philosophies moving forward

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Hard Lessons Learned..

• Share yours!• Most difficult component of change to

manage?• What is difficult to master?• What is difficult to plan?• What MAJOR component do you feel is

most difficult to manage or most likely to lead to failure?

• When do we acknowledge failure? And once we do…then what?

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Questions?

Feel free to contact me for more information and discussion!

Nidia WilliamsDirector of Quality OutcomesSix Sigma Master Black BeltSouthcoast Health System

508-679-7397

[email protected]

beyond lean and six sigma

Documents

hospital systembefore

change resistance

lifestyle change

change needs

change leaders

sigma culture

sigma team

new beginning new