Lean Six Sigma Projects

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<ul><li> 1. Lean Six Sigma Projects &amp;Lean Six Sigma Projects &amp; Value Stream Mapping inValue Stream Mapping in Action!Action! CPT Sylvia BeadyCPT Sylvia Beady Chief, Ancillary ServicesChief, Ancillary Services R.W. Bliss Army Health CenterR.W. Bliss Army Health Center Ft. Huachuca, AZFt. Huachuca, AZ </li></ul> <p> 2. ObjectivesObjectives An introduction to the basic definition andAn introduction to the basic definition and steps of Lean Six Sigma (LSS)steps of Lean Six Sigma (LSS) An overview of how the LSS tools works inAn overview of how the LSS tools works in other part of the healthcare servicesother part of the healthcare services besides the laboratory (i.e. radiology &amp;besides the laboratory (i.e. radiology &amp; pharmacypharmacy A live demonstration of value streamA live demonstration of value stream mapping (VSM) simulationmapping (VSM) simulation 3. Basic Definitions: The Keys to LSSBasic Definitions: The Keys to LSS 4. Example 1Example 1 5S Overview: Taking Action!5S Overview: Taking Action! SortSort Set in OrderSet in Order (simplified)(simplified) Shine (sweep)Shine (sweep) StandardizeStandardize SustainSustain Anchoring Success in the Lab 5. Anchoring Success Shipping Lean Six SigmaShipping Lean Six Sigma Improving Efficiencies Improving Efficiencies 6. To create and maintain an organized,To create and maintain an organized, clean, safe, and high-performanceclean, safe, and high-performance workplaceworkplace PURPOSE:PURPOSE: 7. Why Implement 5S?Why Implement 5S? Enables anyone to distinguish betweenEnables anyone to distinguish between normal &amp; abnormalnormal &amp; abnormal Its the foundation for continuousIts the foundation for continuous improvement, zero defects, costimprovement, zero defects, cost reduction &amp; safe work areareduction &amp; safe work area Its a systematic way to improve theIts a systematic way to improve the workplace, processes, &amp; productsworkplace, processes, &amp; products through employee involvementthrough employee involvement MinimizeMinimize Non-Value AddedNon-Value Added:: eliminateeliminate waste that does not add value to thewaste that does not add value to the process or productprocess or product 8. What is ValueWhat is Value AddedAdded Value Added:Value Added: any activity thatany activity that increasesincreases thethe form or function of the product. (These areform or function of the product. (These are things the customer is willing to pay for)things the customer is willing to pay for) Non-Value Added:Non-Value Added: any activity that does notany activity that does not add value to the form or function or is notadd value to the form or function or is not necessary.necessary. Customer is not willing to pay for non-value added.Customer is not willing to pay for non-value added. Non-value added activities should be eliminatedNon-value added activities should be eliminated simplified, reduced or integrated into other activitiessimplified, reduced or integrated into other activities 9. 1S: SORT1S: SORT Goal:Goal: Remove all items from theRemove all items from the workplace that are not needed forworkplace that are not needed for current production or taskscurrent production or tasks It doesIt does notnot mean that you removemean that you remove only the items that you know you willonly the items that you know you will never neednever need It doesIt does notnot mean that you simplymean that you simply arrange things in a neater fashionarrange things in a neater fashion When you sort, you leave only theWhen you sort, you leave only the bare essentials When in doubt,bare essentials When in doubt, move it outmove it out 10. The goal is to Set in Order:The goal is to Set in Order: Ensures what is needed for aEnsures what is needed for a job is in place and easy tojob is in place and easy to find, use, and put back!find, use, and put back! Find ways to preventFind ways to prevent the need for futurethe need for future cleaning!cleaning! 2S: SET IN ORDER:2S: SET IN ORDER: 11. Cleanliness: get the area looking clean and new Make it a habit:Make it a habit: Assign responsibilities Make cleaning and organizing part of regular work duties Perform regular 5S audits and post results Prevention (take it to the next level):Prevention (take it to the next level): Make it difficult toMake it difficult to NOTNOT put things awayput things away 3S: SHINE3S: SHINE 12. Goal: Creating a consistent way of implementing the tasks performed daily, including Sort, Set in order, &amp; Shine. It should be obvious at a glance when an item is not in its designated place Doing the right things the right way, every time 4S: STANDARDIZE4S: STANDARDIZE 13. This takes discipline on everyones part. Sustain, make it a habit to follow the procedures Practice, practice, practice!Practice, practice, practice! Teamwork! PersonalTeamwork! Personal accountability!accountability! Sustain ties Sort, Set inSustain ties Sort, Set in order and Shine together.order and Shine together. 5S: SUSTAIN5S: SUSTAIN 14. With 5S, ANYONE should be able to tellWith 5S, ANYONE should be able to tell the difference between normal &amp; abnormalthe difference between normal &amp; abnormal Celebrate accomplishment &amp; continueCelebrate accomplishment &amp; continue improvingimproving Make time each week to brainstorm &amp;Make time each week to brainstorm &amp; implement improvement suggestionsimplement improvement suggestions SUMMARYSUMMARY 15. Example 2:Example 2: DMAICDMAIC Define Measure Analyze ImproveDefine Measure Analyze Improve Control (DMAIC) Control (DMAIC) A structured, data-based problem-A structured, data-based problem- solving process. That meanssolving process. That means Doing specific activities in a specificDoing specific activities in a specific sequence (thats the structured &amp;sequence (thats the structured &amp; process partsprocess parts Gathering data in nearly every phase toGathering data in nearly every phase to help you make decisions (the data-help you make decisions (the data- based part)based part) Making sure that the solutions your teamMaking sure that the solutions your team decides to use will eliminate the causedecides to use will eliminate the cause of the problem youre trying to fix (theof the problem youre trying to fix (the problem-solving part)problem-solving part) Tracking TAT in Radiology 16. Radiology Unverified ReportsRadiology Unverified Reports Turn-around Time (TAT)Turn-around Time (TAT) 17. Unverified Reports TATUnverified Reports TAT Objective:Objective: Benefits:Benefits: ProjectProject Team:Team: Schedule:Schedule: The purpose of this project is to improve the unverified reports TAT within SOP guidelines of 3 working days. Providers and Patients will receive timely reports and minimize delays in patient care. Chief, Ancillary Services Assistant Chief, Ancillary Services NCOIC Radiology Radiologists Radiology Technician Measurement: In progressMeasurement: In progress Analyze: TBDAnalyze: TBD Improvement: TBDImprovement: TBD Control: TBDControl: TBD D M A I C 18. Baseline DataBaseline DataD M A I C Base line information 1434 unverified studies 140 unread 12 dictated status Data period: 11/1/02 9/30/06 FY07 unverified status are tracked separately 19. High Level Map Project OutputHigh Level Map Project Output D M A I C 20. Low Level Process MapLow Level Process Map (1 of 2)(1 of 2) D M A I C 21. Radiology Study Process (With Severity Scores) HCP orders a study HCP send Pt to Rad Pt shows up @ Rad Rad staff check-in Pt Rad staff checks validity of order Return to HCP via telephone Rad staff determines if exam is done T or sched Pt recd prep info &amp; scheduled Pt examined No Yes No Yes BB: CPT Beady Tech or Clerk takes Pt to exam Rm Images Taken Process Images QC Check Not O.k. O.k. Retake Images sent to Radiologist Radiologist checks validity Start Not O.k. O.k. Radiologist Evaluate Film Return to step 1 Priors Needed (this is standard) No Yes Tech request prior images from originating facility Proceed to Radiologist read films Prior images received Yes No Sub Process for later A A Radiologist reads &amp; dictate films/ reviews priors Fwd to transcription for editing of texts (dictation) Radiologist receives, reviews, corrects, &amp; electronically signs Power-scribe sends completed rpt to CHCS &amp; AHLTA Power-scribe sends alert to ordering HCP HCP reviews report Stop Pt may not show (1) Pt may show w/o order (2) non-valid order (3) What % problem? 1-2% ~30/month on average (4) 98-99% ~10% found invalid by Radiologist only 2 cassette readers (5) 1 down- slows down process TAT (7) non-responsive facilities delay in treatment/diagnosis occasional problem w/ upload (5) HCP notification DINPACS, CHCS, AHLTA checks &amp; balance in place (7) outside script 22. Low Level Process MapLow Level Process Map (2 of 2)(2 of 2) D M A I C 23. Measure Phase Data CollectionMeasure Phase Data Collection(1 of 2)(1 of 2) D M A I C 24. Measure Phase Data CollectionMeasure Phase Data Collection D M A I C Note: FY07 Tracking data; no decrease in baseline data report between Nov 2002 Sep 2006 25. Analyze Phase - StatusAnalyze Phase - Status D M A I C 26. Example 3:Example 3: Lean + Six SigmaLean + Six Sigma Process FlowProcess Flow DMAICDMAIC Fishing for Success in Pharmacy 27. Baseline GOAL units Wait Time 25 90 % Satisfaction Survey Report 36 90 % Project Ys Purpose: Improve efficiency in pharmacy, wait time and patient satisfaction report card Project Goal: 90% improvement in wait time within 30 minutes 90% patient satisfaction survey report card 28. FishboneFishbone Define Phase:Define Phase: 29. Efficiency Method Lack of/limited Information to patients TV (Tom) Increased patient Wait time Improving Pharmacy Efficiency Producing Results with Little WasteImproving Pharmacy Efficiency Producing Results with Little Waste [Define Phase: 5Ms &amp; 1P] Grey Cart (Lisa) Key Box Flammable Storage Red Bins Shred it: Move to new side (Tom) Key Control Interview Rm Mother Nature (environment) Copy Rm Q-Matic estimated Wait Time vs. transaction time Data South Printer location Zebra Printers Machine Help w/ Office Supply Stop Pick-point Support Exemption from duty (golf cart) Prepackaging (volunteers) Materials (???) Service after P2K Safety (ECC) Prepacks (fast mover) Men (personnel) LCD Screen Mail boxes Schedules (2wk/4wk/6wk) Sign in board posted Staff office (mbr teams: 58,59,60,61 Cork board (break room) Measurement Faxed orders not recd or incomplete Macessan software more steps &amp; more training Staff shortage per day Patient complaints Increased Staff workflow System failure (audio care, computer) 30. CurrentCurrent ProcessProcess FlowFlow Lean Tool Box:Lean Tool Box: 31. Process Observation: 32. Process Flow chart: 33. Window #3Window #1 Window #2 Window #4 Window #5 Window #6 BakerCell Door Admin Area Supply Office Sterile Room Staff Work Stations RxShelf FillStation RxShelf Fax RxShelf RxShelf Rx Shelf Rx Shelf RxShelf RxShelf RxShelf FillStation 1 3 2 4 5 6 7 8 Refill Refill 2 13 RefillBins Refill Bins 2 1 3 4 5 6 34. Box PlotBox Plot Chart &amp;Chart &amp; FMEAFMEA Analyze Phase:Analyze Phase: Note: MeasureNote: Measure Phase used C&amp;E Matrix similar to RadiologyPhase used C&amp;E Matrix similar to Radiology 35. WeekDay Wait Time Fri Thur Wed Tues Mon 1:30:001:00:000:30:000:00:00 1:30:001:00:000:30:000:00:00 Fri Thur Wed Tues Mon Fri Thur Wed Tues Mon 1:30:001:00:000:30:000:00:00 1:30:001:00:000:30:000:00:00 7:00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 Panel variable: Hour Sept 2006 Wait Time vs Week Day Analyze: Wait Time vs. Week DayAnalyze: Wait Time vs. Week Day 36. CHCS-Volume Summary Report Mon Mon Tue Tue Wed Wed Thur Thur Fri Fri 0 500 1000 1500 2000 2500 3000 3500 Jul Aug Main Total#Rx Wait Time Frequency 120100806040200 35 30 25 20 15 10 5 0 120100806040200 Morning Afternoon Pharmacy Wait Time by Time of Day Q-Matic Daily Category August 2006 Wait Time Frequency 120100806040200 50 40 30 20 10 0 Pharmacy Wait Time August 2006 Q-Matic Daily Category Area to improve Longest wait time 37. Failure Mode &amp; Effects Analysis 38. KeyKey PointsPoints Improve Phase:Improve Phase: 39. Processes Under Improvement: Communication Organization Staff involvement/awareness Overall wait times 40. Example 4Example 4 VSM SimulationVSM Simulation 41. QUESTIONS.QUESTIONS. 42. References:References: George, M., Rowlands, D., Kastle B. WhatGeorge, M., Rowlands, D., Kastle B. What is Lean Six Sigma? 2004 George Groupis Lean Six Sigma? 2004 George Group Phillips Corporation presentationPhillips Corporation presentation </p>