process improvement workshop introduction to lean/six sigma€¦ · •lean: improving flow in the...

Process Improvement WorkshopIntroduction to Lean/Six Sigma

Amanda Gourley

Why change?

Introduction to LEAN/Six Sigma

Laboratory Layout

The 5 Steps of LEAN

Summary

Performance

Productivity

Accuracy

Speed

Space Profitability

Morale

Efficiency

Compliancy

Value

Lab Challenges

What is the Problem?Systematic errors need to be addressed

Harvard Medical School’s consensus statement

following an adverse event

The most effective way to prevent errors is to fix systems and

procedures rather than blame individuals

Approximately 80 percent of medical errors are system-derived

Achieving Safe and Reliable Healthcare: Strategies and

Solutions

Speed Cost

Accuracy and consistency of patient results

Time to result reported Effectiveness of operations

Quality

Using Process mapping to Streamline processesReduce Non-Value Added Steps to Reduce Complexity

60%30%

10%

Value vs Waste

Non-Value Added

Business Value Added

Value Added

NVA % Traffic

>70%

60-70%

<60%

Construct value stream map to understand current processes

Assess process complexity in terms of non-value added % based on industry

standard

LEAN Thinking

Doing more with existing

resources

Technology Leverage

technology to deliver more

Leverage existing resources as well as new

technology to reduce process complexity

Construct future value stream map with

LEAN and technology improvements

1. MapCurrent Processes

2. IdentifyValue and Wastes

3. ReduceComplexity

4. MapNew Processes

5S, LEAN and Six SigmaContinuous Improvement is a Never-Ending Journey

Continuous Improvement

LEAN Thinking

Six Sigma

Focus：• Quick Fix• Simple Problem

Solving

Tools：• 5S• PDCA

Focus：• Identify Value and

Waste• Improve Flow• Eliminate Waste

Tools：• Value Stream

Mapping• Root Cause Analysis• LEAN Concepts

Focus：• Eliminate Defects• Reduce Variation

Tools：• DMAIC Problem

Solving• Statistical Tools

Why change?


Laboratory Layout

The 5 Steps of LEAN

Summary

LEAN History

LEAN Six SigmaCombination of LEAN thinking & Six Sigma approaches

• LEAN : Improving flow in the value stream and eliminating waste

• Six Sigma : Eliminating defects and reducing variation in processes

LEAN 6sValue vs Waste Value Stream

Flow Pull on Demand

Perfection

DMAIC Defects

Variation Process Capability Statistical Control

LEAN 6s

Why change?


Laboratory Layout

The 5 Steps of LEAN

Summary

MPLC

BSC

BSC

CAP-CTM 96

MPC

Floor plan

Main entrance

Reporting room

Reception station

Viral load roomExtraction room

Office

Deep freeze room

Cold room

PCR 1

PCR 2PCR 3

PCR 5

PCR 4

MPLC

BSC

BSC

CAP-CTM 96

MPC

Sample flow

• Single point of entry

• Arrive with request form

• Different type of samples

registeredSample

MPLC

BSC

BSC

CAP-CTM 96

MPC

Staff flow

Example Process Flow – NA Extraction Room

Sample Flow Staff Flow

Why change?


Laboratory Layout

The 5 Steps of LEAN

Summary

LEAN Six Sigma5 steps of LEAN to begin continuous improvement journey


LEANValue vs Waste Value Stream

Flow Pull on Demand

Perfection

Step 1 Specify value from patients’ perspective

Step 2 Identify the value stream and reduce the waste

Step 3 Make value flow without interruptions from start to end

Step 4 Let the customer pull value from our process

Step 5 Pursue perfection with a passion -continuous improvement

What is Value? See value from the eyes of the customers

• Learning how to see value and waste is a key concept of LEAN

What do patients really want ?

Good clinical outcomes Cost-effective

Respect & DignityConvenience

Diagnosis Treatment & Advice

What is Value?

Lab

What is Waste?See non-value from the eyes of the customers

• Anything that uses resources (time, human resources & money) that

does not add value from end-user perspective

1. Is the customer willing to pay for this activity?

2. Does this activity transform the product/service in some way?

3. Is this activity done right the first time?

3 Qs

If Answer = No, then it is a Waste!

Learn to See Waste – DOWNTIME 8 Waste

Descriptions

D Defects/Rework Anything that is not done right at the first time

O Overproduction Producing services that aren’t needed now or not needed at all

W Waiting Not having the materials, information, resources or equipment at the rightplace or time to continue the flow of a service

N Not using staff Resources/Talents Not capitalizing on the ability and creativity of resources/staff

T Transportation Using resources to move materials, equipment, or personnel from one workcell, department or facility to the next

I Inventory The retention and storage of finished products, raw materials, or work inprogress which is not needed now

M Motion Unnecessary motions, movements, or activities within a work cell

E Excessive Processing Processing beyond the standard required by the customer

Learn to See Waste – DOWNTIME 8 Waste Examples

22

Example 1

D Defects/Rework 4 Re-labeling of barcode label (incorrect placing on the tube)

O Overproduction 15 Centrifuge samples that do not require centrifugation

W Waiting 1 Samples completed centrifugation but left inside centrifuge

N Not using Staff Resources/Talent 7

Only senior staff are allowed to validate or at least after senior staff has reviewed

T Transportation 6Bringing samples from Microbiology to Molecular Biology workstation

I Inventory 8 Stocking up too much reagent packs at analyzer area

M Motion 10 Looking for missing samples

E Excessive Processing 14 Auto-print 5 barcode labels at one

time

Example 2

2 Did not meet STAT TAT target

13 Perform FULL panel tests on ALL respiratory samples

12 STAT samples sitting at the order entry station

5 Manual worksheet preparation

9 Remove samples from fridge and bring to safety cabinet

3 Test delayed due to shortage of reagents

11 Poor layout resulted in excessive walking from one point to another

16 Repeat test when the first test result is positive




Flow Pull on Demand

Perfection






Value Stream Mapping (VSM)Enable you to identify value & non-value added steps

What A visual tool for identifying all activities of the planning, and manufacturing process to identify waste

Why Provides a tool to visualize what is otherwise usually invisible

Who The leaders of each product family need to have a primary role in developing the maps for their own area

When Develop a current-state map before improvements are made so that the efforts and benefits can be quantified

Where On the shop floor, not from your office. You need the real information, not opinion or old data

How Next Slide

Seven Easy Steps for Value Stream Mapping:

1. Understand the current process

2. Draw the current state value stream map

3. Identify the Value-added and Non Value-added steps

4. Reduce or if possible, eliminate waste

5. Brainstorm and prioritize solutions

6. Draw the future state value stream map

7. Implement the action plan

Value Stream Mapping (VSM)Enable you to identify value & non-value added steps

3 Levels of Value Stream Mapping (VSM)Level of details based on scope/complexity of problem

Arrive at Hospital

Visit Specialist Clinic

Collect Medicine at Pharmacy

Go HomeLEVEL 1

Arrive and Register in the Clinic

Pre-Consultation Procedure

Consultation with Doctor

Post Consultation Procedure

LEVEL 2Payment & Confirm Next Appointment

Receptionist greets Patient and asks for appointment card

Patient presents appointment card

Staff verifies visit in SAP booking system

Staff issues Q number to patient

LEVEL 3Patient collects Q number and wait at waiting area

Value vs WasteDifferentiating value and non-value

• Value Added– The customer is willing to pay for this activity– The action must somehow change the service– It must be done right the first time

• Business Value Added– A step or change made to the service which is

necessary for future– Not noticed by final customer

• No Value Added (Waste)– Activity that increases the time spent on a service

but does not increase its worth to the customer

Value vs WasteIdentify value and non-value added process steps

Value Added

13%

PBusiness

Value Added

22%

¡No Value

Added

65%

X

Identify Potential Error3 steps to identify common problems

Step 1 Step 2 Step 3Problem Prioritization

• Group the problems:

• Severity – How severe will the impact if this problem occur?

• Frequency – How often does the problem occur?

Se v e r it y

3

1

2

Frequency 1 2 3

Brainstorming

• Everyone to participate

• One problem on one post-it

• Accept all ideas and do not criticize, ridicule or belittle any idea during initial brainstorming session

Affinity Diagram

• Sort the ideas and Scrap the repeated ones

• Group the ideas in the similar topics/categories

• Classify under:

i. Pre-analytics

ii. Analytics

iii. Post-Analytics

Pre-Analytics

1Unable to scan barcode labels due to quality of labels (poor printing, crooked, uneven, etc…)

2 Assign tests/samples to the wrong instrument

3 Scan the wrong sample by sequence number

4Delay (>5 mins) in taking samples out from centrifuge after completion

5 Sample drop and serum disrupted, need to re-centrifuge

6 Sample tube breakage

7 STAT status not indicated in samples

8 Sample volume clearly/visibly not enough

Analytics

1 LIS did not send order to instrument

2 Insufficient blood in samples

3 Sample clot/fibrin

4 Sample badly haemolyzed

5 Barcode read error

6 Hardware error

7 Human error

8 Insufficient reagent resulting in delay in analysis

9 Missing Sample (>5 mins to search for samples)

Post-Analytics

1 Missed out some test items

2 Verify test results wrongly

3 Missing samples

4 Do more test than requested

5 Interim results reported as final

6 Wrongly/forgot to archive samples

7 Retrieved wrong samples for retest

Potential Error ExamplesProblems that may delay TAT or affect quality of results

Occur Frequently

Seldom Occur

Prioritize Potential ErrorsClassify errors by frequency and severity

Seve

rity

Severe

Not that Severe Frequency

Focus on errors with high

frequency and high severity

High (3)

Low (1)

Medium (2)

Low (1)

Medium (2)

High (3)

• Start with Frequency

• Distribute errors equally in each box of Frequency (1, 2 & 3)

• Move on to Severity

• Distribute errors equally in each box of Severity (1, 2 & 3)

• Write the Frequency x Severity score (e.g. 3x3 = 9) on each error post-it

Root Cause Analysis Effective problem solving

Problem

Solution

Common Approach

Problem

Solution

Root Cause

Right Approach Problem

Solution

Prevent Re-occurrence

Check Results

Root Cause

Best Approach

• Toyota’s method of asking 5 Whys è proven easy & enlightening

• A Concept è can be > or < 5 Whys

• Objective è Drill into the problem to understand deeply and arrive at a root cause

• Root cause will be the detailed focus of improvement è required changes will become clear

Root Cause Analysis Determine Root Causes with 5 Whys

• We are not making our TAT for STAT samples (1st Why?)

• Because the STAT samples take too long to process (2nd Why?)

• Because the STAT samples take too long to reach the analyzers (3rd Why?)

• Because the order entry is slow (4th Why?)

• Because the order entry staff cannot differentiate between routine and STAT

samples (5th Why?)

• Because the STAT status is not indicated on the test request forms (Root Cause)

35

Root Cause Analysis5 Whys example

36

Problem: Insufficient sample volume

Do not have to be Why.

Can be Why, What, Where,

Who, How, etc…

1st Why Why is there insufficient sample volume? Answer Blood volume in tube is too low

2nd Why Where did the sample come from? Answer Satellite blood taking center

3rd Why Who collected the blood with low volume? Answer Phlebotomists

Root Cause: No protocol for regular training/assessment for phlebotomists

4th Why Any pattern in these Phlebotomists? Answer Those who don’t do full time blood taking

5th Why How will this affect their skills? Answer They may not have enough “practice”

Solution: Set-up protocol to conduct regular assessment and training for phlebotomists at a set interval

Root Cause AnalysisDetermine root causes with 5-Why analysis

Workflow Analysis : Quality (Process Efficiency & Staff Safety)Observation

No. Risk of Error/ Non-value added Step Suggestions/ Recommendations

1Missed out labelling of requesting location on the main sample bag – additional clarification is required to confirm origin of request

• Create and provide stickers with standardized information template to sales personnel

• Implement Laboratory Information system (LIS) to capture required information upon sample registration

2

No dedicated field for manual entry of information, such as nucleic acid (NA) concentration, NA integrity, sample archival position and staff initial – risk of transcription error and missed out entry

• Revise request form and packing list to a standardized format and include entry fields for the required information

• Implement LIS to facilitate data entry and minimize manual data transcription3

No indication of page number and total number of pages for request form and packing list with more than a page. No header to indicate continuation of request form/ packing list from the same requesting location – risk of mix up

4 Risk of sample falling off workbenches when samples are being delivered to the NA extraction room – missing samples

• Rearrange main workbench area to place dedicated tray for incoming samples in the NA extraction room

5

Commonly used consumables, such as extraction tubes and pipette tips and personal protective equipment (PPE) are stored in drawers under main workbenches – difficulty in retrieval and disruptive to routine work

• Place and mount additional trays and PPE holders on walls in NA extraction room for easy access

Workflow Analysis : Quality (Process Efficiency & Staff Safety)Observation

No. Risk of Error/ Non-value added Step Suggestions/ Recommendations

6NA extraction kits are placed at different locations within the NA extraction room – difficulty in locating and retrieving the correct kit for extraction

• Adopt 5S approach (with Kanban system) to allocate space for the various NA extraction kits

7Wash buffer (with and without ethanol) are placed together on the same reagent shelf – risk of retrieving the wrong wash buffer for routine work

• Adopt 5S approach (with visual management and Kanban system) for proper segregation of wash buffer

8 Frequent and repetitive work motion between the main workbenches and the instrument bench

• Reduce work motion of staff by installing electrical outlets at the main workbenches for relocation of centrifuges

9Gel electrophoresis equipment for DNA and RNA samples are placed next to each other along the same workbench – risk of repeat NA quality assessment and release of inaccurate results

• Adopt 5S approach (with visual management) for proper segregation of DNA and RNA gel electrophoresis equipment

10 Frequent walking between NA extraction room and Quality Inspection room for NA QC result entry

• Rearrange instrument bench to allocate space for additional workstation in NA extraction room for NA concentration result entry




Flow Pull on Demand

Perfection






The LEAN CellVisual

Management

5S

Standard WorkPull

1 Piece Flow

Ability to See

Move away from batching

& backlog

Create signals to pull on demand

Reduce variation &Complexity

1. Sort2. Straighten3. Shine4. Standardise5. SustainLEAN

§ When anyone can walk into a workplace and

visually understand the current situation

and work processes at a GLANCE

§ Why Visual Management (VM)?

§ Visual Display – Aid in effective

information sharing or encourage

standardization in processes

§ Control – Help prevent defects or

warn of defects

LEAN Tool 1: Visual ManagementAbility to tell what is going on with one look

42

LEAN Tool 1: Visual ManagementAbility to tell what is going on with one look

APPLY VISUAL TOOLS

VISUAL WIPINDICATORS

STATUSUNITS VS PLAN

ALARMSLOCATIONS

CORRECTIVE ACTION

SEE

AT-A-GLANCE(5 seconds)

NORMAL

ABNORMAL

Should transmit a non-verbal message in

5 sec

Should tell us what we need to do (action)

Adapted from Simpler Consulting

LEAN Tool 1: Visual ManagementPicture tells a thousand words

Different color coding is used to standardize the individual port and its cable. The matching of the port and cable color ensure that the right cable is

connected to the right port.

Bed No.

Patient Name Admission Date

Tasks to complete before discharging a patient

LEAN Tool 1: Visual Management Examples1. Process Control Board

• Green Magnet –

Task Completed

• Yellow Magnet -

Ongoing

• Red Magnet –

Not Done

Expected Discharge Date

A visual prompt

to track the

progress towards

the expected date

of discharge

Kan Ban

Look Board

• Is translated as a card system and developed into a total

pull concept using a number of various pull signals

Traffic light system to show stock status

Mobile App•Buses that stop at the bus stop •Time of next bus•Route of bus

LEAN Tool 1: Visual Management Examples2. Kanban

AN DON

行灯

Go/Do Light

• A light system, and is used to

instantly call for help when you

have an abnormal situation

LEAN Tool 1: Visual Management Examples3. Andon

The LEAN CellVisual

Management

5S

Standard WorkPull

1 Piece Flow

Ability to See


& backlog




LEAN Tool 2: 5S OverviewFive elements of 5S

5SSafety

50

Create an Effective, Organized & Safe Work Environment

S a f e t y

1S Sort Categorize the needed, scrap what is not needed

2S Straighten A place for everything and everything in its place

3S Shine CLEANing and looking for ways to keep it cLEAN& organized

4S Standardize Consistent and standardized work practices

5S Sustain Maintain & review standards, stick to the rules & keep it up!

LEAN Tool 2: 5S OverviewFive elements of 5S

LEAN Tool 2: 5S Example - Sample ReceptionColored baskets with labels to prevent sending wrong samples

BEFORE 5S AFTER 5S

• Standardized and bright coloured baskets with laminated labels for different test sections

• Improves image of Lab as this area is the start of the lab process and often visited by visitors

• Help to prevent sending samples to the wrong test section

Big baskets – Routine

Small baskets – STAT

• Baskets are in poor condition

• Difficult for test sections to visually differentiate which baskets belong to them

• Samples are sometimes sent to the wrong test sections

51

The LEAN CellVisual

Management

5S

Standard WorkPull

1 Piece Flow

Ability to See


& backlog




§ Promotes First Time Quality

§ Everybody doing it right the first time & every time

§ Reduces variation

§ In order to create consistency

§ Improves morale

§ Expectations become clear, making relationships between leaders

and frontline employees better

LEAN Tool 3: Standard WorkStandard work reduces variation and promotes quality

The LEAN CellVisual

Management

5S

Standard WorkPull

1 Piece Flow

Ability to See


& backlog




LEAN Tool 4: Pull SystemProduce or process an item only when the customer needs it

DEFINITION

Method of controlling

the flow of resources

by replacing only what

has been consumed

Pull Signals

Pull ProcessManpower

Materials

LEAN Tool 4: Pull SystemTAT monitoring of lab specimen

Red: Samples exceeded TAT target

Yellow: Samples with 80% of TAT target

Green: Samples with results sent out

Kanban system to pull lab

resources to ensure TAT target is met

The LEAN CellVisual

Management

5S

Standard Work

Pull

1 Piece Flow

Ability to See


& backlog




LEAN Tool 5: One Piece FlowEliminate/reduce batching to achieve continuous flow

§ Items are processed and moved directly to

the next process one piece at a time

§ Make One, Move One (Continuous Flow)

§ Clear and waste-free processes providing physical and information

flow with no interruptions with no idle time between the units

§ Achieve single piece flow in every operation possible

58

Impa

ct

High impact on improvement

Less impact on improvement Easy

Easy to implement

Difficult to implement

Solution Selection MatrixPrioritize the solutions

Focus on the high impact and easy to

implement ideasHigh (3)

Low (1)

Medium (2)

Low (1)

Medium (2)

High (3)

59

Action PlanAction Plan to implement solution

• Implementation plan is a management tool designed to manage and monitor

implementation effectively

• Select 5 Solutions to implement AFTER prioritizing the solutions according to Ease

of Implementation and Impact

Task What By Whom By When

1

2

3

4

5

Clear, detailed description on how to carry out action item selected (bullet points)

Indicate name of assigned

person

Only list tasks achievable within next 12 months

(stepwise improvement, prioritized by

ease of implementing

solution)

Brainstorm SolutionsHow to simplify processes

Eliminate Combine Rearrange

• Identify steps that can be avoided

• Eliminate redundant steps without jeopardizing quality

• If steps cannot be eliminated, try to innovate

• Combine some steps to reduce time taken to perform the steps

• If steps cannot be eliminated or combined, try to rearrange

• Fully utilize existing resources to improve quality and reduce time

LEAN Visual Management 5S Standard

Work Pull System One Piece Flow

Technology Automation Consolidation IT System Alarm Systems

Wireless/ Remote




Flow Pull on Demand

Perfection






Why change?


Laboratory Layout

The 5 Steps of LEAN

Summary

5S, LEAN and Six SigmaContinuous Improvement is a Never-Ending Journey

Continuous Improvement

LEAN Thinking

Six Sigma

Focus：• Quick Fix• Simple Problem

Solving

Tools：• 5S• PDCA

Focus：• Identify Value and

Waste• Improve Flow• Eliminate Waste

Tools：• Value Stream

Mapping• Root Cause Analysis• LEAN Concepts

Focus：• Eliminate Defects• Reduce Variation

Tools：• DMAIC Problem

Solving• Statistical Tools

LEAN Success FactorsTop down AND Bottom up approach

Ideal

Top Down

Leadership

Traditional

Top Down

Leadership

• Directing

• Controlling

• Decision Making

• Change Initiating

• Silos

• Guiding

• Leading

• Communicating Vision

• Developing Strategy

• Systematic Organizational Change

• Empowered Cross Functional Teams and Individuals

Empl

oyee

sBottom Up

Doing now what patients need next

process improvement workshop introduction to lean/six sigma€¦ · •lean: improving flow in the...

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