MGMT 676

Factory Physics & Six Sigma Concepts for Healthcare Engineering & Management

Research Solutions in Healthcare: Successes, Challenges, & Lessons Learned

2008 Spring Conference

April 22, 2008

Herbert Moskowitz

Suresh Chand

Steve Shade

Table of Contents

• Perspectives

• History / Evolution

• Details: Overview, Focus, Content, & Topics

• Appendices– Tools– Team Projects

2

Perspective

• Uniqueness, Objectives

• Linking Students with Current Healthcare Practice

• Skills Obtained

• Enhancing & Expanding the Course

3

History / Evolution

• Industry

• Juran Center for Quality… University of Minnesota

• Healthcare Applications… IUMG & Regenstrief Center

• Development of Healthcare Course

4

Industry (Thomson Consumer Electronics)

• Issue– Improve Product Quality (TV’s) Using Six Sigma

Concepts

• Lessons Learned– Need to Change Habits– On Building a Successful Team for Change– IT Essential for Six Sigma Implementation– Six Sigma Training Expensive– Humans Poor Statisticians

5

Industry (Thomson Consumer Electronics)

• Research Byproduct– IT Brings Data to Process Owner / Decision Maker

– With Data, Potentially Everything Can be Modeled

– Improve Decision Making by Letting Humans & Machines Do What They Do Best…

• Humans: Creativity… Define, Measure

• Machines: Model… Analyze, Improve, Control

– Led to Use of Machine Learning Algorithms… Validation of Concept in Practice (Eli Lilly)

6

Industry (Thomson Consumer Electronics)

• Six Sigma Course for MBA’s– Product Focused– Replicate Reality

• Animated Simulation of Manufacturing Process for Process Improvement

• Team-based Competition vs. Machine Learning Algorithm

7

Juran Center for Quality - University of Minnesota

• Major Focus on Healthcare Issues

• Annual Meetings– Criticality of Healthcare to Economy &

Industry (Paul O’Neil… Former Secretary of Treasury)

– Need for Operations Professionals to Improve Healthcare Processes (Denis Cortese… CEO Mayo Clinic)

8

Healthcare Applications: IUMG & Regenstrief Center

• IUMG / Krannert Collaboration– Improve Patient Flow at Grassy Creek Clinic

– Approach• Used TCE Team Model… Champion (Dr. Deanna Willis),

Grassy Creek / Purdue Team

• Developed Animated Simulation of Patient Flow as Experimental Platform

• Integrated Six Sigma & Factory Physics Concepts / Tools

– Results Successful

9

• Birth of Regenstrief Center– Same Laws Govern Behavior of Healthcare &

Manufacturing Systems– Need for Healthcare Course Using

Manufacturing Science to Healthcare System Operational Effectiveness & Efficiency

– Emulate Model of Product-focused Six Sigma Course

Healthcare Applications: IUMG & Regenstrief Center

10

Details: Overview, Content, & Topics

• Overview– Factory Physics (FP) and Six Sigma (SS)

Complementary Concepts• Hot Button Issues in Industry to Improve Processes & Product

Quality

• Healthcare a High Priority National Issue with Direct Impact on Manufacturing Costs ($1,500 of GM Car Due to Cost of Employee Healthcare)

• Need to Transfer FP & SS Technology to Healthcare Systems… Spawn Demand for Operational Professionals

11

Details: Overview, Content, & Topics

• Focus– Tools, Applications, Research Focused– Multidisciplinary Graduate Course

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Details: Overview, Content, & Topics

• Content– Part I: Overview, Fundamentals, & Tools

• Concept & Tools• Case Studies• Guest Speakers• Active Learning Exercises (Minitab Data Files,

Patient Flow Simulation)

– Part II: Advanced Concepts, Applications, & Research to Healthcare Delivery

13

Topics• Six Sigma Concepts & Tools

– On Habits– Micro and Macro Economics of Quality– Measurement Capability– Statistical Process Control– Process Capability– Design of Experiments

• Full Factorial Designs• Fractional Factorial Designs• Response Surface Design• Single & Multiple Response Optimization

14

Topics

• Factory Physics– Concepts & Principles

– Tools & Applications

• Case Studies– Applicability of Management Models from Production

Industries to Healthcare Delivery (Toyota Production System)

– Physician Order Entry (Electronic Medical Records)

15

Topics

• Guest Speakers– Application of Lean Systems in the Healthcare

Industry– Improving Efficiency & Operational

Effectiveness of an Eye Clinic– About the Regenstrief Center for Healthcare

Engineering

16

Perspectives

• Uniqueness– Mulitdisciplinary– Integrate Factory Physics and Six Sigma,

Transfer Technology from Manufacturing to Healthcare

– Active Learning• Physical & Computer Simulations

• Live Team Projects in Healthcare Practice17

Perspectives

• Objectives– Identify Research Opportunities in

Healthcare… Theses, Dissertations, Research Funding

– Concepts/Tools for Improving Healthcare System Performance from Manufacturing

– Multidisciplinary Project Teams

18

Perspectives• Linking Academics & Practice

– Case Studies– Guest Speakers– Active Learning

• Animated Simulations• Live Healthcare Team Projects

• Skills Learned– Manufacturing Science Technology is Transferrable to

Healthcare Systems– Concepts / Tools of Factory Physics & Six Sigma to

Improve Performance19

Perspectives

• Enhancing / Expanding Course– University-wide Course Orientation

• Professionals• Researchers

– Executive Education Course for Healthcare Professionals

– Virtualization… Develop More Animated Simulations of Real Processes for Active Learning & Experimentation

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Appendix 1: Course Content

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Factory Physics Concepts

• Factory Physics is study of laws governing behavior of manufacturing systems. Both Factory Physics and Six Sigma focus on process variation reduction, and thus are highly complementary. The authors of the book Factory Physics state, “Factory Physics is a systematic description of the underlying behavior of manufacturing systems. Understanding it enables managers and engineers to work with the natural tendencies of manufacturing systems to: (1) Identify opportunities for improving existing systems, (2) Design effective new systems, and (3) Make the tradeoffs needed to coordinate policies from disparate areas.”

• In this course, we will see that the manufacturing and healthcare systems are similar in many ways, and the same laws govern the behavior of healthcare systems also. Some specific concepts/tools covered are:

1. Effect of process time variability on performance2. Sources of variability in process time3. How variability propagates from one stage to the next4. Pooling of resources to reduce effect of variability

• Reference: Wallace J. Hopp and Mark L. Spearman, Factory Physics, Irwin McGraw-Hill, 2001

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Six Sigma Concepts and ToolsMacroeconomics of Quality

Microeconomics of Quality

Where Can Six Sigma Be Deployed

Define Phase

DMAIC Steps Tools Used

• Identify Customers and Requirements

• Define Problem: QFD & House of Quality

• Create Process Map

• Flowcharting

• QFD & House of Quality

• CTQ & CTC Definitions

23

Six Sigma Concepts and ToolsMeasure Phase

DMAIC Steps Tools Used

• Define Defect, Defectives, and Opportunity

• Validate the Measurement System

• Collect the Data

• Determine Process Capability and Sigma Baseline

• Process Flowchart

• Pareto Analysis w/ and w/out Data

• Cause-Effect Analysis

• Failure Modes and Effects Analysis (FMEA)

• Measurement Capability Analysis

• Process Sigma Analysis

24

Six Sigma Concepts and ToolsAnalyze Phase

DMAIC Steps Tools Used

• Define Performance Objectives

• Identify Sources of Variation

• Histogram

• SPC Charts

• Statistical Analysis

• Hypothesis Testing (Continuous and Discrete)

• Non-normal Data Analysis

25

Six Sigma Concepts and ToolsImprove Phase

DMAIC Steps Tools Used

• Perform Design of Experiments

• Validate Potential Improvement Using Simulation

• Correct / Re-evaluate Potential Solution

• Screening Experiments

• Response Surface Optimization

Control Phase

• Detecting Out-of-Control Conditions

• Implement Statistical Process Control

• Determine Process Capability

• Calculate Process Sigma

• Variable and Attribute Control Charts

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Appendix 2: Team Healthcare Projects

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Operational Effectiveness & Efficiency… Process Improvement Projects

• Scheduling to Improve Patient Flow at IUMG Outpatient Clinic– Simulation Design of Experiments: Scattered

Appointments, Overflow Call Routing to PSA’s, Batching of Patient Records, Pooled Registration Queues

• Call Center Volume Management– Time Series Forecasting, Staffing

28

Operational Effectiveness & Efficiency… Process Improvement Projects

• Modeling & Optimizing Multitasking Administrative Operations– Check-in and Phone Calls

• Modeling Patient Attendance at Outpatient Clinics– Logistic Regression, Machine Learning Algorithms

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Operational Effectiveness & Efficiency… Process Improvement Projects

• Modeling Patient Flow in a Centralized Registration Process– Simulation

• Evaluating Scheduling Policies in a Colorectal Cancer Care Center– Agent-based Simulation

30

Additional Projects

• Medical Diagnosis– Computational Intelligence / Machine Learning

Algorithms for Diagnosing Breast Cancer

• Information Technology– Electronic Medical Records

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