LEAN SIX SIGMA

ANYURYSM

“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

Quality

“An essential requirement of… products is that they meet

the needs of those members of society who will actually

use them. This concept of fitness for use is universal…

The popular term for fitness for use is quality, and our

basic definition becomes quality means fitness for use.”

- J. M.

Juran

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

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

Timeline

THE EVOLUTION OF AWARENESS

• IOM - resulted in the report To Err Is Human:

Building a Safer Health System.

• Quality of Health Care in America Project

• 44,000 to 98,000 Americans die each year as a result

of medical errors in hospitals.- 1998

• A second major report by the IOM’s Committee on the

Quality of Health Care in America—Crossing the

Quality Chasm

Quality in Healthcare

“Degree to which health services for individuals

and populations increase the likelihood of

desired health outcomes and are consistent with

current professional knowledge”.

- IOM

SIX SIGMA

• Six sigma is a business statistical Strategy identifying

defects and removing them from the process of

products to improve quality using Statistical measures.

• A defect is defined as any process output that does not

meet customer specifications.

History

• Carl Fredrick Gauss (1777-1855), who introduced the

concept of the normal curve or distribution.

• Walter Shewhart introduced three sigma as a

measurement of output variation in 1922

HISTORY

• The Six sigma was founded by Motorola in the 1980s.

• They founded a connection between increases in

quality and decreases in costs of production.

• Bill Smith, “Father of six sigma” introduce this quality

improvement Methodology to Motorola.

• Malcom Baldrige National Quality Award (MBNQA)-

1988

• Quality management program developed by Motorola

in the 1980s.

• Management philosophy focused on business process

improvements to:

• Eliminate waste, rework, and mistakes

• Increase customer satisfaction• Increase profitability and competitiveness

Sigma (S.D)

• Standard Deviation shows the variation in

data. If the data is close together, the standard

deviation will be small. If the data is spread out,

the standard deviation will be large.

• Standard Deviation is often denoted

by the lowercase Greek letter sigma

Standard Deviation Formula

The standard deviation formula can be represented using Sigma Notation:

2( )xn

s

Notice the standard deviation formula is the square root of the variance.

L6sWhat’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

Six Sigma Methods

DMAICDMADV

• Define • Measure• Analyze• Improve• Control

• Define • Measure• Analyze• Design• Verify

Define

• Identify the customer and which type of a product and

hope from it. These are analyze by using flow

cause/effect diagrams, check sheets, pareto analysis.

2. Measure

• Collect the baseline data to determine where the

process stands as compare to where it needs to be

• Quality characteristics an estimate current process

capability.

• Then find out the current sigma level according to

those identified characteristic that are mostly important

to the customer

Analyze

• This shows the amount of improvement necessary to

make the Critical to quality characteristics the best in

the industry.

• For this phase -descriptive statistical methods like

mean, mode, median…etc.

Improve

• Implement the suggested improvements in this phase

and also test possible solutions to the process problem.

• Collect data from the all possible solutions and test them

on a small scale

• Then choose the best solution

Control

• Measures are implemented to ensure improvements

are maintained.

• To monitor the process improvements, basically use

tools like statistically process control charts.

• Monitor the process to ensure that the process is in the

control limits.

what is LEAN ?

• The term “Lean Thinking” was coined by James P.

Womack and Daniel T. Jones in their book, Lean Thinking

• The goal is to minimize work and all non- value adding

activities to increase value and reduce opportunities for

defects and errors

• Customer satisfaction increases and production costs

decreases

Goals of LEAN

• Eliminate waste ( or in Japanese “muda”)

• Improve Quality

• Reduce operating cost

• Manage Inventory control

• Toyota Management System ( TMS)-1960s

What Is Typically FoundLean Value Stream Management starts with defining value in terms of products and process capabilities to provide the customer with what they need at the right time and at an appropriate price.

Valueadded

Non-value added/waste

8 wastes - Lean

1. Overproduction—making or doing more than is required or earlier than needed.

2. Waiting—for information, materials, people, maintenance, etc.

3. Transport—moving people or goods around or between sites.

4. Poor process design—too many/too few steps, non-standardization, inspection rather than prevention, etc.

1. Inventory—raw materials, work-in-progress, finished goods, papers, electronic files, etc.

2. Motion—inefficient layouts or poor ergonomics at work-stations or in offices.

3. Defects—errors, scrap, rework, non-conformance.

4. Underutilized personnel resources and creativity—ideas that are not listened to, skills that are not utilized.

Lean Six Sigma

• Lean Six Sigma is an approach to integrating the

power of Six Sigma Tools and Lean Enterprise Tools

which can be applied within an organization to

create the fastest rate of improvement, maximize

shareholder value, and increase customer delight.

The Methods

Lean&

Six Sigma

Improve Speed

Achieve Breakthrough Dashboard Results

Lower Costs

Culture ChangeSustain Performance

Higher Quality

Methods Results

The Application of Lean Six Sigma in Healthcare Delivery

• Dissatisfaction with being “average”

• Physicians not engaged with prior approaches

• Insufficient tools to execute vision

• Need for structure and discipline in decision-making processes

Driving force in healthcare

• Need for higher level analysis

• Need to “shine a light” on processes

• Need for a new platform/bar for leadership skills

• Market positioning• Current quality

programs need resuscitation

44,000 to 98,000 Preventable Hospital Deaths

(IOM study, 1998)

In-Hospital Deaths from Medical Errors at 195,000 per Year. Patient Safety Incidents In Hospitals Account for $6 Billion per Year in Extra Costs

(HealthGrades - July, 2004)

How Safe is Healthcare?

Defects in healthcare are costly -- unlike manufacturing, you can’t simply shut down the line until you find and fix the problem.

Reduction in Blood Stream Infections in ICU Stroke Patient Length of Stay Reduced Number of Inpatient Transfers Emergency Department Patient Wait Time Improved Patient Throughput in Radiology Reduction in Lost Films MR Exam Scheduling Improvement Staff Recruitment and Retention Operating Room Case Cart Accuracy Quality of Care and Satisfaction of Families in Newborn ICU

Examples of Projects Across a Health System

Key Success Factors

• Top man leadership with clear vision for the initiative

• Invest in resources and make a long term commitment

• Dedicate “best and brightest”

• Change the systems and structures to support the effort

• Select and scope projects carefully: Focus on critical issues tied to business priorities, with measurable and manageable parameters

• Use change management tools to identify cultural barriers, gain acceptance and build momentum

• Establish shared need, values and vision

o Customer Service/Satisfactiono Reduced Wait Timeso Consistent Service

o Delivered Quality of Careo Reduced Medical Errorso Use of Appropriate Technology

o Cost Managemento Increased Productivity and

Throughputo Decreased Cost through Reduced

Variationo Compliance requirements

Align opportunities with organizational objectives

key issues in healthcare:

This is a journey – not a destination

Lean Six Sigma is a solid approach, but not a “magic bullet” -- Transforming healthcare will also likely require changes in technology, legislation/regulation, transparency and culture.

Over 60% of quality efforts fail. To be among the successful 40%, pay attention to the people side of change.

The Effectiveness (E) of the result is equal to the Quality (Q) of the solution times the Acceptance (A) of the idea.

Conclusion

• Six Sigma is a toolset, not a management system and

is best used in conjunction with other more

comprehensive quality standards such as Lean for

Performance Excellence and customer satisfaction

which can also be applied in a Healthcare settings.