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AgileLean Six SigmaFor Healthcare

Jay Arthur

Learning Outcomes

• Learning outcome 1

• Learning outcome 2

• Learning outcome 3

• Learn the difference between Lean Six Sigma and Agile LSS.

• Discover tools and techniques to get your organization on

board quickly.

• Learn to identify problem areas and root causes.

• Discover the 12 principles of Agile Lean Six Sigma.

• Learn to "hack" Lean Six Sigma to make it agile.

20th

Century Quality Improvement

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The Long Tail of

LSS Tools

Master the Top 4%

21th

Century Quality Improvement

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3

Data

+

7 Key

Tools

Uncomplicated

Problems

Simple Problems

Complicated Problems

ToolsComplex

None

Problems

Focus

Improve

Sustain

Honor

MethodsDMAIC, DOE

Trial & Error

© MMXVI KnowWare

Hacking Lean Six Sigma

The spirit of hacking can be adapted and

applied to general business management,

not just technical innovation.Scott Brinker – Hacking Marketing

9© MMIX KnowWare www.qimacros.com

Hacking Lean

WHERE DO I START?

SHRINK THE ARROWS

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Value Stream Mapping

10 © MMIX KnowWare www.qimacros.com

Spaghetti Diagramming

11 © MMIX KnowWare www.qimacros.com

Nursing Unit Spaghetti Diagram

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Hacking Six Sigma

Action

Countermeasures

MatrixControl Chart with

Process Change

Make Sure Your Story Uses the Magnificent Seven Tools

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IS THAT GOOD OR BAD?

I DON’T KNOW

IS THAT GOOD OR BAD?

I DON’T KNOW

STABLE AND CAPABLE!

Most Data Is Overcooked

(C) MMXVI Knowware www.turningdataintodollars.com 18

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Go on a Raw Diet!

Why Raw Data?

(C) MMXVI Knowware www.turningdataintodollars.com 20

Because Summarized Data Has Little Nutritional Value

If You Have Data Like This…

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If You Have Data Like This…

Data Mining Wizardry

Raw Data

Insights

For Action

Pivot Tables

Select the

Right Charts

Counted &

Categorized

Data

Focus on Performance

Start with a control chart of defects, mistakes, errors or costs:Charges Coded as Denials

$2,552,122UCL

CL $1,071,509

LCL $(409,103)

$(1,000,000)

$(500,000)

$-

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

10/02 11/02 12/02 01/03 02/03 03/03 04/03 05/03 06/03 07/03 08/03 09/03

2002-2003

Ch

arg

es

Denials (E)

UCL

+2 Sigma

+1 Sigma

Average

-1 Sigma

-2 Sigma

LCL

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Go Deeper –

Apply the 4-50 Rule

4% of the Process Results in over 50% of the Errors

Use Paretos to Find What to Fix

Denial-No Appeal Charges

$150$109,813$336,270

$750,766$1,295,032

$2,516,508

$7,849,569

100%99%97%

91%

81%

61%

$-

$1,607,264

$3,214,527

$4,821,791

$6,429,054

$8,036,318

$9,643,582

$11,250,845

$12,858,109

Timely Filing Medical

Necessity

No Auth Partial Auth Invalid Auth ET ES

Memo Code

Am

ou

nt

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

n=12858108.93

Denials for Timely Filing by Insurer

1114471114151824242745

81

501

100%100%100%99%99%98%96%94%

93%90%

87%84%

81%

75%

64%

0

97.25

194.5

291.75

389

486.25

583.5

680.75

778

Ins 1 Ins 2 Ins 3 Ins 4 Ins 5 Ins 6 Ins 7 Ins 8 Ins 9 Ins 10 Ins 11 Ins 12 Ins 13 Ins 14 Ins 15 Ins 16

Payer

Nu

mb

er o

f D

enia

ls

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

n=778

64% of Denied Due to

Timely Filing Claims Due

to one Insurer

Use Paretos to Find What to Fix

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Identify Root Causes

Use the fishbone diagram to perform root cause analysis:

Medical Necessity

Payor Psych

ER

One Payor accounted for 64% Reauthorization

No Auth

In Patient

Timely

Filing

64% of

Denials

Problem

Statement

Countermeasures

(Mistake Proofing)

• Countermeasure

– Work with insurance company to resolve

excessive denials

– Reduce delays that contribute to timely filling

denials

Verify Results

Reduced denials by 35% starting the

following Monday ($380,000/month)

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Kick-Butt Improvement Posters

85% of C-suite executives say their company struggles with problem

diagnosis, not problem solving, and that this comes with a significant cost.

January-February 2017 HBR

Six Sigma is too complex and time-consuming to fit into a regular workday.

We need tools that don’t require the entire organization to undergo weeks-long training programs.

Thomas Wedell-Wedellsborg

January-February 2017 HBR

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What a waste of

time!

Hacking Six Sigma Training

You Don’t Need to Learn Formulas

You Don’t Need to Learn Decision Trees

Attribute

(counted)

Defects People Events

Type of Data

Variable(measured)

XmRIndividuals

XbarR

XandS

Sample Size

1

time/project

2-10

diameters, lengths

11-25

diameters, lengths

Time

Length

Weight

Money Averages

Individual

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Learn the Patterns – Reduce Variation

Errors

Per

Million

UCL

LCL

CL

Good

Time

Move Center Line Down or Up

Errors

Per

Million

UCL

LCL

CL

Good

Time

Move Center

Line

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Why Pivot Now?WHY DO WE NEED TO CHANGE SIX SIGMA?

TO AVOID EXTINCTION

Agile Lean Six Sigma

Traditional

•

•

•

•

•

•

Agile

•

•

•

•

•

•

YOU CAN BE HERE

STEP 1GUT FEEL

COMMON SENSE

TRIAL AND ERROR

PROBLEM

SOLVING

ABILITY

STEP 2COLLECTING

DATA

STEP 3ANALYZING

DATA

STEP 4IMPROVE

STEP 5HASSLE-FREEHEALTHCAREDenial-No Appeal Charges

$150$109,813$336,270

$750,766$1,295,032

$2,516,508

$7,849,569

100%99%97%

91%

81%

61%

$-

$1,607,264

$3,214,527

$4,821,791

$6,429,054

$8,036,318

$9,643,582

$11,250,845

$12,858,109

Timely Filing Medical

Necessity

No Auth Partial Auth Invalid Auth ET ES

Memo Code

Am

ou

nt

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

n=12858108.93

MONEYBELT

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Key Takeaways

Lean Six Sigma Can Be Fast and Fun!

Hack Lean By Eliminating the Arrows

Hack Six Sigma By Using Softwareand the Magnificent Seven Tools

Questions

QI Macros – Affordable Toolsfor the Statistically Challenged

KnowWare International Inc.

2696 S Colorado Blvd. Suite 555

Denver, CO 80222

303-756-9144 888-468-1537

www.qimacros.com

jay@qimacros.com

qimacros.com/pdf/Agile-Lean-Six-Sigma.pdf

www.lssyb.com

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References & Resources