© Kim Marques 2014

1

Lean Basic Intro

April 9, 2015

Kim MarquesKimberly Dawn, Inc.

© Kim Marques 2014

2

What LEAN Looks Like

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3

Lean Applications

© Kim Marques 2014

4In Process On Radar

Area Task / Issue Description

Blast Improve Lighting and Reduce Daily Maintenance

Engineering Capacity and Scheduling of Resources

Engineering Dryer Documentation Book - Accuracy and OTD

Engineering Weld Traveller Documentation

Engineering BOM Accuracy - ECN / Parts Late

Final Assy PC's In Production

Hydro Hydro Test SMED Event

Inventory Storage Trailer Inventory Reduction

Material Handling Desiccant Filling of Dryers Hoppers vs Bags

Material Handling Welders Material Handling

Material Handling Material Handling Study

Metrics Create a 360 Degree Metrics Board for Daily

Paint Post Paint Staging

Planning Scheduling Shop Floor

Quality Dock to Stock Purchased Items

Quality Rework Non Conformance

Utilities Switchgear Power Study and Billing Errors

Warehouse Parts Presentation

Warehouse Point of Use "C" Items for Assembly

Warehouse Valve Assembly Kanban

Weld & BRAIR New Tag/Label Printing Machine

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5

Six Sigma Lean Fundamentals

1. Specify value in the eyes of the customer.

2. Identify the value stream and eliminate waste.

3. Make value flow at the pull of the customer.

4. Involve and Empower employees.

5. Continuously improve in pursuit of perfection.

PLAN DO

CHECKACT

Lean is Logical

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6

Lean + Six Sigma = Success

LeanFlow5SWaste EliminationCICustomer PullWork Concentration

6 SigmaVariation ReductionScrap / Rework EliminationProcess ControlCICritical Thought

Together…A Force Multiplier.

SPEED + ACCURACY = $$$

StandardWork

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7

A1

A3

A4

A5

A6

A7A2

Remember: Pilot A Met The Specification. Was That Good Enough?

Given: seven landing points, similar conditions, two pilots.

So… pilot A or pilot B?

Choose The Pilot

B1B3

B4B5

B6

B7B2

The Effect Of Variation

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8

Six Sigma

A statistical term that defines the amount of variation exhibited by a given process, symbolized by the Greek letter “s” (“σ”).

Quality levels:

6 sigma = 2 parts per million (PPM) defective

5 sigma = 230 PPM defective

4 sigma = 6,210 PPM defective

3 sigma = 308,000 PPM defective

1 sigma = 690,000 PPM defective

© Kim Marques 2014

9

House DetailsCustomer• VOC

• Takt

• QFD

Just

In

Time

Built

In

Quality

Quality Systems• Autonomation

• Mistake-proofing

People• Policy Deployment

• HPWO• values

• HP Org design

• Steering Comm

• Design Teams

• Kaizen

• Multi-process

• Safety• process improvement

• ergonomics

Materials Systems• Production Smoothing

• Flow / Pull• Line Design

• Kanban

• SMED

• P-O-U

Stability• Six Sigma

• 5S - Visual Controls

• Standard Work

• DFM

• TPM

© Kim Marques 2014

10

Lean 2012 Fishbone

10Choose Tools to Align with GOALS!

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11Successful Product Delivery Results From Connected Processes.

Customer

Engineering

Suppliers

Production

TestSupport

F L O W

Supplier Engineering Materials Manufacturing

Administration Support

Customer

Customer

The Customer Focused Value Chain

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12

Order

Entry

Order and

Delivery of

Components

Subassembly

Manufacturing

Unit Assembly

and TestDistribution A/R

TIME

Consider the cumulative effect

All processes have Raw Materials and Finished Goods

Every process has value- and non-value added time:

RM FG

Find the REAL Opportunities

Looking At The Whole Business

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13

Value Added:☻ Transforms fit, form, or function

☻ Is done right the first time

☻ Increases value from the customers perspective

☻ Customer is willing to pay for

Non-Value BUT needed:Required by the customer.

Required by the process or design.

Necessary with current technology.

Non-Value WASTE:No value created.

Undone or redone within the value stream.

Could be immediately avoidable.

The Value Stream

Problem Solving * Information Management * Transformation

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14

Non-Value Add Activities

Definition: unnecessary effort (processes, communication, requests, etc.) that serves no purpose or function

Examples:Doing something the way it was previously done even though new faster, more efficient technology has been installed

Doing something because someone thinks it is important

Functions that add no value to the product

NVA activities often times get added to processes instead

of dealing with the root cause. For example, adding extra

checks and paperwork to catch errors instead of dealing

with the reasons they happened in the first place.

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15

AdministrationInformation Incomplete

Information Inaccurate

Information Interpretation

Clarifying Information

Unnecessary Information

Wrong Information

Wrong format of Information

Handoffs

Checks/Double checks

Barriers to Communication

Data Entry

Call backs

Keypunching

Reading E-mails

Non-Value Add Examples

• Receiving

• Unpacking

• Stocking

• Transporting

• Estimating

• Ordering

• Scheduling

• Planning

• Inspecting

• Packing

• Shipping

• Expediting

• Customer Approval

• Work Order Release

• Warehousing

• Invoicing

• Collections

• Bill Paying

• Forecasting

• Facility Maintenance

• Management

Manufacturing

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16

A tool for visually

depicting information

on a process or

operation to identify

opportunities for

improvement or

problems.

When you want to

visually depict or

understand steps in a

process, flow of

information and/or

key metrics.

Value Stream Map (VSM)

16

© Kim Marques 2014

17

Time Value And Opportunity

Value Added Steps

Non Value Added Steps

DAY 0 DAY 76

Value Added

2 Days

Total VA and NVA Activity = 4.5 Days

Non-Value Added

2.5 Days

Queue

A ‘Faster Machine’ Does Not Get Us To The Finish Line.

Tim

e: 76 D

ays

Queue

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18

The 8 Wastes

The acronym DOWNTIME will help us remember the 8 Forms of Waste:

1. Defects

2. Overproduction

3. Waiting

4. Non-Utilized Talents/Skills

5. Transportation

6. Inventory

7. Motion

8. Extra (Over) Processing

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19

Cost of Poor Quality

1. Prevention ?5%

2. Appraisal ?47%

3. Internal Failure ?46%

4. External Failure ?2%

TypicalEnterprise

Lean 6σEnterprise

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20

As set of repeatable steps, actions and/or tools the

PLAN – DO – CHECK – ACT cycle grows culture

when inter-woven into various tasks across

multiple departments

• Plan a change or test aimed at

improvement, once the root

cause is determined

• Do carry out the change or the

test, preferably in a pilot or on a

small scale

• Check to see if the desired result

was achieved, what or if anything

went wrong and what was

learned

• Act to adopt the change if the

desired result was achieved. If

results not favorable, repeat the

cycle

Deming Cycle

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21

DMAICSix Sigma projects follow the same process in a systematic and uniform methodology known as DMAIC – an acronym made up from the first letters of each element:

Define – sets the context: scope, problem statement, etc.

Measure – baseline metrics & process constraints recorded

Analyze – metric review, root cause analysis completed

Improve – solutions developed and deployed

Control – control plans and required documentation to sustain improvement(s) created

© Kim Marques 2014

22

Kai = To take apart Zen = To make good!

Kaizen = Continuous Improvement

What can be Taken Apart and Improved?

Administrative Business Processes

Manufacturing Processes

Supply Chain Processes

Services

Distribution Center Processes

Anything!

Kaizen

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23

The Blitz or Event is a focused, intense, short-term project to improve a process.

Substantial resources- Engineering, Maintenance, Cell Operators, and others are available for immediate deployment.

An event starts with an approved charter, includes training followed by analysis, design, and re-engineering of a process, service, product line or area. A Leader orchestrates with the support of a Sponsor and a Lean Facilitator

The Event (start to end) normally takes 2-5 days. Outstanding actions are noted (a Newspaper) and

completed within 2 weeks. The results are immediate, dramatic and satisfying.

Kaizen Blitz

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24

Kaizen Principles1. If there is no need or no goal, there is no kaizen. Fully

understand the present state and the goal to fully understand what is needed to close the gaps to success.

2. Establish a Kaizen Cadence -follow the same process for the event and report out. Rank is checked at the door.

3. Anyone can improve by spending money – try first to think of improvements that are free. Rally for ideas.

4. Look for wisdom from ten people rather than one. Value diversity in teams and have respect for the knowledge of others. Teach, learn, improve simultaneously!

5. Help others see waste constructively. The more you improve together, the more opportunity for improvement for all to see.

6. Do it now, during the kaizen – follow PDCA, measure immediate results – adjust process. It is much harder to get it done later. Quick and crude is better than slow and elegant.

7. Be persistent to eliminate all muda (waste).

© Kim Marques 2014

25

Repeatable CI Grows Culture4 Week Project Cycle

Week 1 – Charter Completion, Approvals & Mgmt

Reviews, Event Selected – Funnel Review

Week 2 – Team Initialize/Charter Review and

Pre-Work Completion, Initial Gemba

Week 3 – Event/Kaizen Week with Mgmt Report-

Out

Week 4 – Project Brainstorming, Review Ideas

Submit ted, Create CI Project Charters,

Sustainment Walk, Close Newspaper items

GM and Senior Staff commitment to support a

repeatable process is CRITICAL to success!

© Kim Marques 2014

26

Ocala Engineering Excellence Team

RAPID IMPROVEMENT EVENTS (KAIZEN)

Derek Murray, PE, CSSBB Senior Engineer Management Engineering Consulting Services (MECS)

Agenda

• MECS Overview

• Rapid Improvement Event

• Root Cause Analysis Tools

• Solution Selection Tools

• Interactive Kaizen Event

–Needle Localization Surgical Process

Management Engineering Consulting Services (MECS)

• Originated in 1968

• 9.0 FTE’s (Currently) • Director

• Senior Engineers

• Staff Engineers

• Internship Program

• Ad-Hoc Projects with MHA Interns, Student project groups

• Educational Background • Minimum BSIE required

• Various Masters Degrees in Management and Engineering

Rapid Improvement Event (Kaizen)

• Focused on SPECIFIC problem solving events achieving gradual, orderly, and continuous improvement

• Carefully planned, well structured team-based activity focused on solving problems in a process

• Usually multi-disciplined

– Very effective to break down cultural barriers in solving problems

Rapid Improvement Event (Kaizen)

• Customer-driven and is based on a plan, do, check, act approach to problem solving

• Very intensive full day workshops or broken up into multiple short sessions

– Analyzes a process and implements change

– Individual roles, responsibilities or expectations are outlined

Rapid Improvement Event (Kaizen)

• Preparation for the Event

– Current metrics

• Metrics that quantify the current situation

– Process Flows

• How does the current system look?

– Stakeholder Identification

• Who impacts or is impacted by the situation?

– Agenda

• What is the agenda/objectives for the meeting that will ensure maximum results?

Rapid Improvement Event (Kaizen)

• Resources available:

– Projector, computer, printer

– Name plates, flip charts and Post-It notes

– Wall space

Rapid Improvement Event (Kaizen)

• Typical agenda:

– Introductions and opening

– Set event rules and review current state

– Define process gaps and root causes

– Brainstorm opportunities

– Define optimal future state process

– Discuss measures for success

– Design implementation plan

– Determine barriers and resolution for implementation

Root Cause Analysis

• 5-Why’s

• Fish Bone Diagram

Recognizing the Root Causes

• First Order:

– A quick temporary fix

– Does nothing to prevent the problem from repeating

• Second Order:

– Gets at the root cause

– Solves the problem for future patients and clinicians

– Aligns with process improvement

Plan

Do Check

Act

5 Whys

• Simple probing tool that helps you get to the root

cause of a problem

• At each level of explanation, ask “Why?” until you

get to the true underlying reasons

• Never take the first answer as the true reason

Why?

Why?

Why?

Why? Why?

5 Whys Example

A patient failed to respond to therapy and his condition deteriorated

Why? • The patient received the wrong medication

Why? • Because the nurse gave it to him by mistake

Why? • Because she misread the drug name

Why? • Because we have two drugs with similar names stored side by side

Why? • Because we store them in alphabetical order so we can find them quickly

Source: http://phprimer.afmc.ca/Part3-PracticeImprovingHealth/Chapter13AssessingAndImprovingHealthCareQuality/Investigatingquality

5 Whys Example

There is a delay in patients being moved from the emergency unit to the ward

Why? • Because there are no more beds in the ward

Why? • Because there are still patients waiting to be discharged

Why? • Because they are waiting for their medication and discharge documentation

Why? • Because the courier has not delivered the prescription to the pharmacy and the

patient’s file to the central records office

Why? • Because they are waiting for the nursing manager to initiate the process

Source: http://www.phcfm.org/index.php/phcfm/article/viewFile/598/860/6587

Fishbone

• Cause and Effect Diagram

• Visual tool to determine root cause

• The resulting diagram illustrates the main causes and sub-causes leading to an effect

Fish Bone Diagram Process

• Agree on a problem statement (effect)

• Brainstorm the major categories of causes of the problem

• Some generic categories are:

Fish Bone Diagram Process

• Brainstorm all the possible causes for each category

– Continually Ask: “Why does this happen?”

• When the group runs out of ideas, focus attention to places on the chart where ideas are few

Fish Bone Diagram Example

Solution Selection

• Time-Impact Matrix

Time Impact Matrix

• A simple diagramming technique that helps you choose which activities to prioritize (and which ones you should drop) if you want to make the most of your time and opportunities

Time Impact Matrix – Process

1. Brainstorm problem areas within your objective

2. After the list is generated, assess for time and impact

a. Impact – When this problem is solved, what kind of impact would it have on your objective?

b. Term – How long would it take to implement it?

3. According to your determinations, find where each problem would fall in the matrix

Prioritization Tools Time Impact Matrix – Example

Needle Localization Rapid Improvement Event

Project Background

• Patient flow complaints occurred regarding the Needle localization process in the South Tower Operating Room (OR)

• FMEA was conducted by Risk Management

– Needle localization patients were experiencing increasing wait times on surgery days.

FMEA Findings

Multidisciplinary Team Organized to Analyze Contributing Factors:

• OR Day: – Multiple locations were needed for multiple procedures

– Timing of procedures was restricted by involved department schedule

– Limited half-life of nuclear isotope needed for lymphoscintigraphy

– Unexpected Surgical or Radiology delay

– Not Up-to-date consents

• Scheduling: – Scheduling multiple appointments in multiple locations requires precise

coordination—exposure to a cascade of delays

• OR Day Prior Notification: – Multiple calls/notifications regarding surgery schedule by multiple

people

Breast Surgery – Coordination of Care

Patient arrives at clinic Determination for

surgery made.

Doctor orders: 1. Surgery

2. Needle Loc 3. Lymphocentigraphy (if

necessary)

Patient arrives at the OR

Radiology (Needle Loc and

Lymphocentrigraphy (if necessary) are

performed

Pre-Op (Consents, IV, etc.)

Patient goes to surgery

CLINIC

SURGERY DAY

Multiple systems inform the

patient of schedule. (My Chart, OR, Radiology,

Clinical Coordinatorl

Different departments had different schedules not

coordinated to the surgery schedule.

As the next patient arrives surgery wait times increase

throughout the day.

Patient Number vs. Time Between Needle Loc End and OR Case Start

(Wheels In) - Fiscal 2013

0

10

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40

50

60

70

80

90

100

0:00

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1 2 3 4 Total

Box and Whisker Plot

Nu

mb

er o

f P

atie

nts

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e B

etw

een

Nee

dle

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c En

d

and

OR

Cas

e St

art

(h:m

m)

Patient Number

Patient Number 1 2 3 4 Total

Number of Patients 59 21 6 2 88

Average Time Between Needle Loc End

and OR Case Start (Wheels In) (h:mm:ss)1:08:07 1:31:26 2:03:10 2:48:30 1:19:43

Agenda

• Introductions, rules, and opening • Define process gaps and root causes - current state

– We will concentrate on each discipline and explore root causes of how patient wait time is affected by each function individually.

• Brainstorm opportunities for improvement • We will concentrate on each discipline and explore

opportunities to improve patient wait time for each function individually.

Meeting Rules

Stay on track Goal: Identify opportunities to improve patient flow within the units

Focus only on identifying the root causes to:

Patient Wait time on Surgery Day

Open mind Minimize the use of “No, that won’t work”

Everyone’s opinions are equally valuable and can lead to solutions

Full participation All ideas are welcome

Eliminate (or minimize) use of cell phones

Minimize small group conversation The best ideas might be missed if the rest of the group cannot hear it

Brainstorming Key Issues

People Do they possess the necessary skills, training?

Material/ Information Does the material being used have poor quality? Is information easy to

understand and accurate? Are materials accessible?

Technology Does technology function properly? Is it reliable/ user friendly?

Process Is process defined/ easy to follow? Is there a standard process?

Performance Measurements Are performance expectations defined/ communicated/ monitored?

Work Environment Is there adequate space? Physical locations?

Comfortable atmosphere?

Patient wait times on

the day of surgery

Measurement Process

Technology Environment

Materials

People

IMP

AC

T

TIME

I II

III IV

Actual Results from the Project

Solutions Implemented

• Day of Surgery – All pre-surgical procedures are performed on 1st floor radiology

– 1st case lymphoscintigraphy performed day prior to surgery.

– Timing of surgery individualized to each surgeon

– Needle localization procedures were linked with OR surgery schedule time – Patients to arrive 2 ½ hours prior to surgery.

– Final surgical planning and consenting completed at pre-surgical visit.

– Designated a pre-operative “Breast” nurse

– Scripts developed for patient communication

Solutions Implemented

• Scheduling – Created Inter-departmental access to OR/Radiology

schedule

– Linked procedure times in Optime

• Prior Day Notification of Surgery – Surgery Notification completed by OR staff only

– Scripts developed for patient communication

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Patient Arrival to Needle Loc End (Hours)

Average: 2.32 Hrs Goal: 2.50 Hrs

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t 1

8

/13

- P

atie

nt

1

8/1

3 -

Pat

ien

t 2

8

/13

- P

atie

nt

3

8/1

5 -

Pat

ien

t 1

8

/22

- P

atie

nt

1

8/2

2 -

Pat

ien

t 2

8

/25

- P

atie

nt

1

8/2

7 -

Pat

ien

t 1

8

/29

- P

atie

nt

1

9/3

- P

atie

nt

1

9/3

- P

atie

nt

2

9/3

- P

atie

nt

3

9/8

- P

atie

nt

1

9/5

- P

atie

nt

1

9/1

2 -

Pat

ien

t 1

9

/12

- P

atie

nt

2

9/1

7 -

Pat

ien

t 1

9

/22

- P

atie

nt

1

9/2

2 -

Pat

ien

t 2

9

/22

- P

atie

nt

3

9/2

4 -

Pat

ien

t 1

9

/24

- P

atie

nt

2

9/2

4 -

Pat

ien

t 3

9

/24

- P

atie

nt

4

9/2

6 -

Pat

ien

t 1

9

/26

- P

atie

nt

2

9/2

9 -

Pat

ien

t 1

A

VER

AG

E

Needle Loc End to Surgery Start (Hours) BASELINE AVERAGES

Average = 1.21 Hours

Median = .65 Hours

Takeaways from Metrics

• Patient Arrival to Needle Loc end

– Process Goal: 2.50 hours

– Process Average (first 5 months post go live): 2.32 hours

• Needle Loc End to Surgery Start

– Process shows consistent patient wait times less than 1 hour

• 57 of 87 occurrences less than 1 hour (66%)

• 30 of 87 occurrences greater than 1 hour (33%)

– Majority of outliers (greater than 1 hour) pertained to previous surgery delay.

Questions