simplifying process improvement/lean/six sigma programs for healthcare

IIE Engineering Lean and Six Sigma

Conference 2013

September 23-25, 2013

Crowne Plaza at Ravinia Atlanta

Simplifying Process Improvement/Lean/Six Sigma

Programs for Healthcare

1

The Most Efficient Doctor Visit What does excellent look like?

[email protected]

Doctor Lucy

Treatments

5 C

Creating a Team Focused Improvement

Program

Agenda

Our Foundations of CPI

This is an example text. Go ahead and replace it

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6

5

4

3

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1

3

TQM, Lean, Six-Sigma, Strategic Project Management

Three Easy To Understand Phases

Summary of PI Program Approach

Training Levels, Tools, and Big Rocks

Levels of Resources

Westbrook Stevens, Seven Attributes of

Excellent Management Model, 1990 ©

People

and

Team

Building

4

1. Excellent Leadership = Leadership

Throughout the Organization, Everyone is

Empowered to Lead Their Own Work

– What Does Excellent Leadership Look Like?

– What Does Our Leadership Look Like?

• Are Leaders On Board and Do we have a Leader for the CPI

Project?

– Where are the Gaps?

– Fix the Gaps!

Our Foundations of CPI The Seven Attributes of Excellent Management

1/7/2013 5

Improvement Efforts and Missing

Elements of Change

Adapted from Palma Buttles-Valdez, Carnegie Mellon ,Process improvement Briefing to Software Engineering

Institute, 2008 – who adapted it from and Dr. Mary Lippitt, Enterprise Management, LTD., 1987,

ttp://www.jcse.org.za/upload/events/37/organisational_culture_and_people_issues_in_process_improvementdrpalma_

buttlesvaldez.pdf 2/13 2013

Vision

Vision

Vision

Vision

Vision

Vision

Vision

Resources

Resources

Resources

Resources

Resources

Resources

Resources

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Processes

Capable Processes

Capable Processes

Capable Processes

Capable Processes

Capable Processes

Capable Processes

Organizational Culture







Incentives

Incentives

Incentives

Incentives

Incentives

Incentives

Incentives

Action Plan

Action Plan

Action Plan

Action Plan

Action Plan

Action Plan

Action Plan

Change

Confusion

Anxiety and

Frustration

False Starts

Slow or Little

Progress

Reinventing

the Wheel

Barriers to

Change

Sporadic

Change

Leadership Systems

and

Processes

Problem

Solving /

Skills

Culture Problem

Solving/Skills

Tools

People Systems

and

People

http://www.jcse.org.za/upload/events/37/organisational_culture_and_people_issues_in_process_improvementdrpalma_buttlesvaldez.pdf 2/13


2. Excellent Culture = The Culture of the

Organization, The Culture of the Group

– What Does Excellent Organizational Culture Look

Like?

– What Does Our Culture Look Like?

• Are All Stakeholders On Board and Do we have a Willing

Culture for the CPI Project?


– Fix the Gaps!


1/7/2013 7


Elements of Change





Vision

Vision

Vision

Vision

Vision

Vision

Vision

Resources

Resources

Resources

Resources

Resources

Resources

Resources

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Processes

Capable Processes

Capable Processes

Capable Processes

Capable Processes

Capable Processes

Capable Processes








Incentives

Incentives

Incentives

Incentives

Incentives

Incentives

Incentives

Action Plan

Action Plan

Action Plan

Action Plan

Action Plan

Action Plan

Action Plan

Change

Confusion

Anxiety and

Frustration

False Starts

Slow or Little

Progress

Reinventing

the Wheel

Barriers to

Change

Sporadic

Change

Leadership Systems

and

Processes

Problem

Solving /

Skills

Culture Problem

Solving/Skills

Tools

People Systems

and

People



3. Excellent Customer Focus

– What Does Excellent Customer Focus Look Like?

– What Does Our Customer Focus Look Like?


– Fix the Gaps!


1/7/2013 9

4. Excellent Team Building = All Things People,

Team Issues, and Motivational Theories

– What Does Excellent People Management Look Like?

– What Does Our People Management Look Like?


– Fix the Gaps!


1/7/2013 10


Elements of Change





Vision

Vision

Vision

Vision

Vision

Vision

Vision

Resources

Resources

Resources

Resources

Resources

Resources

Resources

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Processes

Capable Processes

Capable Processes

Capable Processes

Capable Processes

Capable Processes

Capable Processes








Incentives

Incentives

Incentives

Incentives

Incentives

Incentives

Incentives

Action Plan

Action Plan

Action Plan

Action Plan

Action Plan

Action Plan

Action Plan

Change

Confusion

Anxiety and

Frustration

False Starts

Slow or Little

Progress

Reinventing

the Wheel

Barriers to

Change

Sporadic

Change

Leadership Systems

and

Processes

Problem

Solving /

Skills

Culture Problem

Solving/Skills

Tools

People Systems

and

People



5. Excellent Problem Solving = All Things Skills,

Core Competencies, and Problem Solving

Tools (Project Management, Six Sigma, Lean,

Accounting, Etc.)

– What Does Excellent Skills and Tools Look Like?

– What Does Our Skills and Tools Look Like?


– Fix the Gaps!


1/7/2013 12


Elements of Change





Vision

Vision

Vision

Vision

Vision

Vision

Vision

Resources

Resources

Resources

Resources

Resources

Resources

Resources

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Processes

Capable Processes

Capable Processes

Capable Processes

Capable Processes

Capable Processes

Capable Processes








Incentives

Incentives

Incentives

Incentives

Incentives

Incentives

Incentives

Action Plan

Action Plan

Action Plan

Action Plan

Action Plan

Action Plan

Action Plan

Change

Confusion

Anxiety and

Frustration

False Starts

Slow or Little

Progress

Reinventing

the Wheel

Barriers to

Change

Sporadic

Change

Leadership Systems

and

Processes

Problem

Solving /

Skills

Culture Problem

Solving/Skills

Tools

People Systems

and

People



6. Excellent Continuous Improvement = All

Things Change Related, Continuous

Improvement, Systems, and Processes

(Systems Thinking, CPI)

– What Does Excellent Change Management (Systems

and Process Improvement) Look Like?

– What Does Our Change Management (Systems and

Process Improvement) Look Like?


– Fix the Gaps!


1/7/2013 14


Elements of Change





Vision

Vision

Vision

Vision

Vision

Vision

Vision

Resources

Resources

Resources

Resources

Resources

Resources

Resources

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Workforce

Capable Processes

Capable Processes

Capable Processes

Capable Processes

Capable Processes

Capable Processes

Capable Processes








Incentives

Incentives

Incentives

Incentives

Incentives

Incentives

Incentives

Action Plan

Action Plan

Action Plan

Action Plan

Action Plan

Action Plan

Action Plan

Change

Confusion

Anxiety and

Frustration

False Starts

Slow or Little

Progress

Reinventing

the Wheel

Barriers to

Change

Sporadic

Change

Leadership Systems

and

Processes

Problem

Solving /

Skills

Culture Problem

Solving/Skills

Tools

People Systems

and

People



7. Excellent Performance Measures

– What Do Excellent Performance Measures Look Like?

• Seven Steps (1. Know the Rules, 2. Know the Goals, 3. Know

the Criterion for the Goals, 4. Know the Indicators of the

Criterion, 5. Collect the Data, 6. Analyze the Data, and 7. Use

the Data)

– What Does Our Performance Measures Look Like?


– Fix the Gaps!


1/7/2013 16


Program

Agenda


This is an example text. Go ahead and replace it

✓

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✓ TQM, Lean, Six-Sigma, Strategic Project Management




Levels of Resources

Lean

Lean

Focuses on reducing waste and improving

cycle time through continuous quality

improvement

Impact – Improves process flow and efficiency

Improvement Focused Teams

Six Sigma

Six Sigma

Focuses on reducing errors through rigorous

data analysis and statistical controls

Impact – Improves quality and reduces

process variation


Example From the HCA PI Teams

1st Order Changes or Continuous

Improvement

1/7/2013 20 Copyright © 2007, www.WestbrookStevens.Com 20

1/7/2013

Start

Adapt

Adapt

Adapt

[email protected]

Some 1st Order

Changes become 2nd

Order Changes

http://www.westbrookstevens.com/

Project Management is Required for 2nd Order

Changes (or A Major Step Change)

1/7/2013 21

Copyright © 2007, www.WestbrookStevens.Com 21 1/7/2013

Before the Change During the Change After the Change

[email protected]

http://www.westbrookstevens.com/

Project Management

Project Management

Major Changes Require Mastering

Project Management



Strategic Project Management

Strategic Project Management

Considers the overall value of the

project related to desired strategic and

tactical results


Strategic Planning Project Selection

Portfolio Management Project Management

Program Management

Process Improvement

Lean

Productivity Improvement

Indu

str

ial/S

yste

ms E

ngin

eering


Program

Agenda

Our Foundations of CPI ✓

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Levels of Resources

Three Easy to Understand and Use

Improvement Phases

26

A =

Assessments

P = Problem Solving

I = Implementation

Using Project Management Tools/Support

Assessment Phase

27

A =

Assessments

P = Problem Solving

I = Implementation


Solve Problems and

Apply GFR (Benchmarking)

28

A =

Assessments

P = Problem Solving

I = Implementation


[email protected]

GFR

GFR GFR

Step 6 – Select the Solutions and Build

a Project Portfolio

29

A =

Assessments

P = Problem Solving

I = Implementation


GFR

GFR GFR


Program

Agenda

Our Foundations of CPI ✓

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✓

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Levels of Resources

Three Types of Assessments

Level One - Self-

Assessments – Tool Box Available to All Sites

– PM Driven

– PI Supported

– Operations Follow Up

Level Two - Onsite

Assessments – Only a Few DVP/GVP Chosen Sites

– PI Driven

– PM Support (and others)


Level Three - Third-Party Supported Assessments

Level Three (A) – Third-Party Supported Assessment of Current Practices – For a Few Highly Complicated or Politically

Charged Sites

– PI Driven

– Contractor Supported


Level Three (B) – Third-Party Assessment of New Acquisition – For the Critical New Sites Chosen by

DVP/GVPs

– TM Ops/Contractor Driven

– PI Supported


31

PM Driven

Self-Assessments (Level 1)

PIP Team Onsite Assessments (Level 2)

Three Types/Levels of Assessments

32

Level One - Self-Assessments

• Materials/Tools

– On-line Tool Box

• A Menu of Tools

• Triggers for When to Use the Tools

– 30 Minutes to an Hour Audios with PowerPoint Presentation

– Example Projects (Green Flag Report Lessons Learned)

• Scheduling, Staffing/Labor, Patient Flow, Telephones

• General Assessing, Problem Solving, and Implementation Tools

• Website, SharePoint Site, Newsletter

– Lessons Learned and Materials

– Face-to-Face, WebEx, and Online Education and Training

• Organizational Support Development

– “The HCAPS Way” with a Culture of Continuous Improvement

– Obtain Resources for Improvement and Sustainability

Team Room Link: http://teamrooms.hca.corpad.net/sites/hcapsproject/OPSS/Process%20Improvement/Forms/AllItems.aspx

33

http://teamrooms.hca.corpad.net/sites/hcapsproject/OPSS/Process Improvement/Forms/AllItems.aspx

Create the Tools and Teach How to Find and Use

Them

Activity Tiers For Level Two

A =

Assessments

P = Problem Solving

I = Implementation


Week 1 = Off-Site Kickoff,

Surveys, and Data Gathering

Week 2 = Off-Site Data

Gathering, Interviews, and Analysis

Week 3 = Managed Assessment

and Problem Solving

Week 4 + = PMs Continue

Problem Solving and

Implementation

Using Project

Management

35

Build a Assessment Candidate Portfolio


Program

Agenda



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Levels of Resources

37

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CPI Training Modules

Training Modules Description

Suggested and Optional Modules

Leaders Tools

Only

Master CPIP

Team

Introduction and Orientation

T.001.1234 - O.10.S - PI Training

Introduction 20130208

This is a 30 Minute orientation to summarize

the program. O X X X

T.001.1234 - O.10.L - PI Training

Introduction - Hour 20130313

(one or the other)

More detailed Orientation - This is a 60

Minute summarization of the program for

those whom will not take other training.

X O O O

White Belt Training (2 hours)

T.002.1234 - W-20-X1 - PI White

Belt Training 20130208

20 Minutes - General Introduction to Lean/6

Sigma/TQM/Change Management/Project

Management

O X X X

T.002.1234 - W-20-X2 - PI White


20 Minutes - Leadership - Situational

Leadership O X X

T.002.1234 - W-20-X3 - PI White


20 Minutes - Leadership - Understanding

Empowerment and how to get results O X X

T.002.1234 - W-20-X4 - PI White


30 Minutes - Culture – Understanding

culture. O O X X

T.002.1234 - W-20-X5 - PI White


30 Minutes - General Introduction to

Customer Focus, People, Skills/Problem

Solving Tools, Change/Improvement, and

Performance Measures

O O X X

http://teamrooms.hca.corpad.net/sites/hcapsproject/OPSS/Process Improvement/HCAPS - PI Tools and Training/Training 1 - Orientation/T.001.1234 - O.10.S - PI Training Introduction 20130208.pptx








http://teamrooms.hca.corpad.net/sites/hcapsproject/OPSS/Process Improvement/HCAPS - PI Tools and Training/Training 1 - Orientation/T.001.1234 - O.10.L - PI Training Introduction - Hour 20130313.pptx











http://teamrooms.hca.corpad.net/sites/hcapsproject/OPSS/Process Improvement/HCAPS - PI Tools and Training/Training 2 - White Belt/T.002.1234 - W-20-X1 - PI White Belt Training 20130208.pptx




























































120 Min.

For Leaders

For Supervisors

1 Day – Mainly Lean Tools with some Culture,

Teams, and Motivation

For Practitioners

2 Weeks Worth of Training, Projects and Tools

For CPI Mentors and Facilitators

3 Months Worth of Implementation – Mentoring and Implementation Study

Training by Levels of Expertise

Create an Understanding with a focus on

Leadership and Empowerment (White Belt)

Be Able to Manage and Contribute to

Improvements (Yellow Belt)

Be Able to Perform Improvement

Projects Independently (Green

Belt)

Be able to Teach and

Facilitate Improvement

Projects for Others

(Black Belt)

39

White Belt – 120 Minutes of Building Leaders

40

Element

% of Introduction

Time

Minutes of a 120 Minutes Presentation

1 -Leadership 50 60

2 - Culture 25 30

3 - Customer Focus 5 6

4 - People and Teams 5 6

5 - Skills and Tools 5 6

6 - Processes and Systems 5 6

7 - Performance Measures 5 6

Goal: To Create an Understanding

1 -Leadership

2 - Culture

3 - Customer Focus

4 - People and Teams

5 - Skills and Tools

6 - Processes and Systems

7 - Performance Measures

• Situational Leadership

– When and how much to lead

• Incubation of Leaders

– About people, Empowerment

and

– how to motivate and lead

people to get results

Leadership Training - (50% of Time)

1/7/2013 41

• What is Culture

• How to Assess the

Culture

• How to Create a

Cultural Desire to

Improve


Training – (25% of Time)

1/7/2013 42

120 Min.

For Leaders

For Supervisors

1 Day – Mainly Lean Tools with some Culture,

Teams, and Motivation

For Practitioners











Belt)



Projects for Others

(Black Belt)

43

Yellow Belt – 1 Day – Building Direct Supervisors

Element % of Leaders’

Time Minutes of 1

Day

1 -Leadership 2 10

2 - Culture 2 10






Goal: To Be Able to Manage and

Contribute to Improvements

44

1 -Leadership

2 - Culture

3 - Customer Focus





• Highest Impact Tools and Solutions

– Doctor Schedule Templates

– Patient Throughput

– Phones

– Room Utilization

– Staffing

• Green Flag Reports

Yellow Belt – Problem Solving (Skills and Core Competiveness) (63%of time)

1/7/2013 45

Yellow Belt – Problem Solving (Skills and Core Competiveness) (63%of time)

1/7/2013 46

[email protected]

• Introduce Lean Tools – In addition to the Big Rocks & GFRs

– Observations

– Value Stream Mapping

– Flow Charting

– A3 Processing and Reporting

– Spaghetti Diagram

– 5 S Events

120 Min.

For Leaders

For Supervisors

1/2 Day – Culture, Teams, Motivation

For Practitioners











Belt)



Projects for Others

(Black Belt)

47

Green Belt – 4 Days & Project – Building Practitioners

Element

% of Practitioners’

Time Hr

Training

1 -Leadership 2 1/2

2 - Culture 2 1/2






Goal: To Be Able to Perform

Improvement Projects

Independently

Requires Completion of a Complete Improvement Project

1 -Leadership

2 - Culture

3 - Customer Focus





48

Green Belt – Select a Green Belt

Project that Relates to Your Work Area

1/7/2013 49

[email protected]

• Use the Three Phases

– Assess Using the Seven Attributes

• Plant Green and Red Flags

• Build Red Flag Portfolio

– Perform Problem Solving On One or More of the Red Flags

• Facilitate a Team Problem Solving Effort

• Build a Solution Portfolio and Select the Best (May Be a Real Project)

– Implement Solutions

• Build a Project Portfolio Based on the Solutions

• Implement some Quick Fixes and

• Select and Use PM tools to Implement a Real (Larger) Project

• Learn the Key Six Sigma Tools

– Stats and Use the Lean Tools

• Review and Expand on the Other

Subjects

• Apply to The Selected Project

• Learn Project Management Tools

Green Belt – Training

1/7/2013 50

120 Min.

For Leaders

For Supervisors

1/2 Day – Culture, Teams, Motivation

For Practitioners




Training by Levels of Expertise HCAPS Improvement Focused Teams







Belt)



Projects for Others

(Black Belt)

51

Black Belt – 6 Months Experience, Training, & 4

Projects for CPI Facilitators

Element

% of Facilitators'

Time Hours over 6

Months

1 -Leadership 5 2

2 - Culture 5 2






Goal: To Be able to Teach and

Facilitate Improvement Projects for

Others

Requires Facilitating the Successful Completion of 4

Complete Improvement Projects for Others

1 -Leadership

2 - Culture

3 - Customer Focus





52

• Review and Expand on the

Attributes and Tools

• Add Systems Thinking

Archetypes

• Apply to The Selected Projects

• Have a Strategic Focus

• Focus on Mentoring Others

• Focus on Training-the-Trainer

Black Belt – Training

1/7/2013 53


Program

Agenda



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Levels of Resources

54

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Results

55

A =

Assessments

P = Problem Solving

I = Implementation


GFR

GFR GFR

simplifying process improvement/lean/six sigma programs for healthcare

Documents

excellent culture

willing culture

excellent look like

excellent leadership

processes problem

enterprise management

foundations of cpi

cpi project