Lean for Lab Leaders - Chi Solutions, Inc€¦ · To develop an understanding of how the Six Sigma...

©2010 Chi Solutions, Inc. Proprietary and Confidential.

Executive War College 2010

Lean for Lab Leaders

Achieving Mastery with Concepts, Implementation, and Outcomes

April 29, 2010Presented byAnne Daley, Senior Consultant Nora Hess, Operations Managing Consultant Chi Solutions, Inc.

2 ©2010 Chi Solutions, Inc. Proprietary and Confidential.

Competition

Every morning in Africa, a gazelle wakes up; it knows it

must run faster than the fastest lion or it will not survive.

Every morning in Africa, a lion wakes up; it knows it must outrun the slowest gazelle or it will starve.

It doesn’t matter whether you are a lion or a gazelle: When the sun comes up,

you had better be running!

SeriousCompetition!


Welcome and What’s in This for Me?


Networking and Expectations

Networking

� What is your name (business card)?

� What keeps you busy during the day?

� What keeps you busy during the night?

Participant Expectations

� Learning from each other.

� For this program to be worth your time, what needs to happen before 4:30 this afternoon? (record on flipchart)


Learning Objectives� To learn the fundamental Lean concepts/tools and

develop an understanding of how those tools are bes t applied within an organization.

� To apply the basic Lean tools to a simulated, participant-driven, hands-on process flow exercise that will develop skills that can be immediately incorporated into daily work practices.

� To develop an understanding of how the Six Sigma DMAIC improvement methodology can be applied to Lean initiatives to achieve rapid improvement.

� To understand how Lean concepts and tools have been applied by leading healthcare institutions and facilities.


Program Overview

Just In Time Lean and Experiential Learning1. Define

2. Measure

3. Analyze

4. Improve

5. Control

9:00ish

AM 9:30ish (20 min)Lunch 12:00-1:00PM 2:45ish (15 min)

Breaks

Adjourn4:30 (no ish)

Next Steps3:45ish

Lean Lingo and Tidbits8:30ish

Welcome and What’s In This For Me?8:00


Geography of Bliss … aka Ground Rules

� Electronics in silent or off mode–if the sky is falling, please step outside of the room to talk.

� Be prompt to avoid missing important stuff.

� Challenge ideas/discussion topics, not people.

� Be responsible for everyone’s learning.

� Be present…if a mental side trip is taken, it’s OK; just let us know when you “departed” so we get you back on track.

� Spelling, math, penmanship counted in grade school–we are so past that!

� Have FUN and be creative. ☺☺☺☺


Lean Lingo and Tidbits


Philosophy: Quality vs. Value

Quality is “ a state in which the customer and provider realize value entitlement in every aspect of the business relationship.” Mikel Harry, PhD

CustomerNeed

ProviderService

ValueExchange

Cost

Defects

Time

Price

Quality

Delivery

Product

Service

Capacity

Capability

“We are not in the business of quality,we are focused on the quality of our business.”

Creation of VALUE is Key


Value =(Quality) (Service)(Financial Benefit)

X (People)

Clinical Quality andBusiness Excellence Customer Service

Work Culture

Value Proposition: Clinical Laboratory

Expense PerformanceRevenue PerformanceMargin ManagementCapital Generation


Value Proposition: Better Perspective

People ��Work Culture

Quality �� Clinical and Business Processes

Customer Service �� Customer Satisfaction

Financial Performance �� Margin & Capital

VALUE RIGHT SERVICE, RIGHT TIME, RIGHT PRICE

Qua

lity

Lead

ers

• FACIL

ITATE

• PARTI

CIPATE

Metrics


Four Keys to Lean Six Sigma

The Four Keys:

1. Delight Customers

2. Improve Processes

3. Teamwork

4. Data-based Decisions

Lean SixSigma

Variation &

D

efects

Process F

low

ImproveProcesses

Quality

Speed

DelightCustomers

Data and Facts

Team-Work

Source: What is Lean Six Sigma, George, Rowlands, and Kastle, McGraw-Hill, 2003.


Defining Lean Six Sigma

At a high level, Lean Six Sigma is a process improvement methodology.

Lean: The application of principles whose objective is to eliminate WASTE while improving process flow to achieve speed and agility at lower cost.

Six Sigma: The application of principles whose objective is to eliminate DEFECTS and VARIATION.

When combined and effectively applied, major improvements are achieved in business performance.


308,53769.1%2

66,80793.3%3

22,70097.7%3.5

621099.4%4

23399.98%5

3.499.9997%6

PPM/DPMOProcess YieldProcess Sigma

What is Six Sigma?

A Statistical Measure of a Process’s Ability to Meet Customer Requirements

A “Stretch” Goal6 Sigma � 3.4 DPMO

HealthcareToday?

Is considered “Virtual Perfection”


Five-Step Process Improvement Methodology

“Define”Introduced byMotorola to ensure projects are worth the effort ��PDCA = D+MAIC

DMAIC


What is Lean?Lean is the elimination of waste or anything not ab solutely required to deliver a quality product or service, o n time, to our customers.

What Does Lean Do?

� Increases productivity by producing or servicing MORE with the same or less resources.

� Improves quality.

� Reduces inventory.

� Reduces cycle time.

� Improves on-time performance.

� Increases capability by using freed-up resources.

� Increases capacity to increase volumes and expand products or services.


Combining Lean and Six Sigma Methodologies

Step 1 Step 2 Step 3 Step 4Inputs Outputs

Reduce variation within a process (Six Sigma )

Reduce waste within a process (Lean )


Cost of Poor Quality

Cost of Poor Quality (COPQ) is:

� A financial term that sums up all the costs associa ted with the prevention of problems, appraisal or inspe ction to obtain quality, internal failures, and failures at the customer.

� A form of waste that is not integral to the product or service your company provides.

� Waste that does not add value in the eyes of key stakeholders (customers, employees, investors).

COPQ is a symptom measured in loss of profit (finan cial quantification) that results from errors (defects) and other inefficiencies in our processes.


Difficult or impossible-to-measure costs from:

� Lost sales� Expediting� Redundancies� Late payment� Frustrated

employees

� People and equipment idle time

� Lost customer loyalty� Long cycle times� More facilities� Lost reimbursements

Intangible Quality Costs (20-35% of Sales)

Tangible Quality Costs (4-10% of Sales)Available or easy-to-measure costs from:

� Inspection� Rework� Warranty� Inventory

� Obsolescence� Scrap� Customer complaints � Legal

You have the ability to recapture many of these cos ts.

Cost of Poor Quality “Iceberg”


Traditional Thinking:

� Large batches

� Low unit costs

� Work at full capacity

� Tight schedules

� High WIP inventories

� High level of specialization

� Long cycle times

Lean Six Sigma Thinking:

� Single piece flow

� Value with less error

� Work at necessary capacity

� Flexible schedules

� Low WIP inventories

� Cross-training

� Short cycle times

Application to Clinical Laboratory


Just in Time Lean and Experiential Learning


You are either a customer or employee of the Art4U Company which produces custom artwork for healthcare facili ties.

You each have a job with assigned duties. Supplies are located in the Toolkit Box on each table. Save all scraps.

Employee performance is evaluated on:1. How fast work is completed.2. How many orders are completed.3. The level of quality produced.

Note: No talking or asking questions during produc tion.

Simulation #1:� Setup time - 3 minutes.� Production time - 10 minutes.� Debrief time - 5 minutes.

Art4U Simulation #1


Definitions to Key Terms� Production Lead Time (PLT): The time it takes one

piece to move all the way through a process, from start to finish. Sometimes referred to as throughp ut time.

� Cycle Time (CT): The time it takes one operator to go through all work elements before repeating them. Sometimes referred to as processing time.

� Work-in-Process (WIP): Items of work between processing steps.

� Defect: Item of work that does not meet customer expectations or defined specifications.

� Opportunity: Number of characteristics or features that if any one is bad would result in a defect.

Source: Lean Lexicon: A Graphical Glossary for Lean Thinkers, Lean Enterprise Institute, Fourth Edition, Version 4.0, March 2008.


1. Patient Name 2. SSN3. Address4. Age5. Insurance Number6. Provider7. Hospital Name8. Amount of Charges

8 Opportunities

An opportunity is the number of possibilities for defect creation in any unit of product.

Opportunities - Patient Statements

Name__________Name__________SSN__________SSN__________

Address_________Address_________Age__________Age__________

Insuran. #_________Insuran. #_________Provider__________Provider__________Hospital_________Hospital_________Charge $_________Charge $_________

Name__________Name__________SSN__________SSN__________



Name__________Name__________SSN__________SSN__________



Name__________Name__________SSN__________SSN__________



Name__________Name__________SSN__________SSN__________




Art4U Key Performance Indicators (KPIs)

Average Cycle Time (CT)

Number of Art4U Workers (FTEs)

Time to Complete All Orders

Quality Metric: Sigma Level

Productivity units produced/(time X # of people)

Number of Defect Opportunities/Unit

Number of Total Defects

Work in Progress (WIP)

Scrap

Units Produced

Time to Complete 1st Order (PLT)

Round 3Round 2Round 1


Calculating Opportunities for Error

Customer Order Form (COF) 20 Opportunities for Error

Canvas Sizing

Height (from 3 to 8 inches) 1 Basic Price

Width (from 3 to 11 inches) 2 Height x Width x $0.20= 3

Custom Features Unit Price Option Prices Land � Hills � Plains � Beach 4 Sky � Sunny � Cloudy � Snowy 5 Structures � Barn � House � Fence 6

Trees 7 Count $0.20 Ea 12 Bushes 8 Count $0.20 Ea 13 Animals Type 9 Count $0.20 Ea 14 Type 10 Count $0.20 Ea 15 Type 11 Count $0.20 Ea 16

Total Price (Basic Plus Options) $17 Customer Satisfaction Survey

1. Art4U service is fast, friendly, and helpful. 18

� Strongly Agree � Agree � Disagree � Strongly Disagree � Not Sure

2. Art4U landscapes are attractive and desirable pieces of art. 19


3. Art4U landscapes are good value. 20


(Scoring Guideline: SA = 4 pts, A = 3 pts, D = 2 pts, SD = 1 pt., NS = 0 pt)


Calculating Process Sigma

Process Sigma

6. Determine Sigma from conversion table

DPO x 1,000,000

5. Calculate Defects Per Million Opportunities (DPM O)

DPO = D/NxO4. Calculate Defects Per Opportunity (DPO)

D3. Enter total number of defects identified

N2. Enter number of total units produced

O1. Enter number of defect opportunities per unit

Sigma Calculator


Sigma Conversion Table

2.9870,00093.00%

3.0560,00094.00%

3.1450,00095.00%

3.2540,00096.00%

3.3830,00097.00%

3.5520,00098.00%

3.8310,00099.00%

3.879,00099.10%

3.918,00099.20%

3.967,00099.30%

4.016,00099.40%

4.085,00099.50%

4.154,00099.60%

4.253.00099.70%

4.382,00099.80%

4.591,00099.90%

5.2210099.99%

5.771099.9990%

6.04399.9997%

6.27199.9999%

Process SigmaDPMOYield

0.22900,00010.00%

0.36850,00015.00%

0.66800,00020.00%

0.83750,00025.00%

0.98700,00030.00%

1.11650,00035.00%

1.25600,00040.00%

1.37550,00045.00%

1.50500,00050.00%

1.63450,00055.00%

1.75400,00060.00%

1.89350,00065.00%

2.02300,00070.00%

2.17250,00075.00%

2.34200,00080.00%

2.54150,00085.00%

2.78100,00090.00%

2.8490,00091.00%

2.9180,00092.00%

Process SigmaDPMOYield


Sigma Score Performance Observations

IRS - Tax Advice

Sigma Score

1,000,000

100,000

10,000

1,000

100

10

1

DPMRestaurant Bills

Payroll Processing

Prescription Writing

Baggage Handling

AirlineSafety Rate

0 1 2 3 4 5 6 7

A Sigma score indicates the ability of a process to perform without defects.


Simplified DMAIC Approach

Step 5: Process Control

Monitor the Process and Celebrate Success(Control Methods, Keep it Alive!)

Step 3: Process Analysis

Understand Relationship of Input and Output Variables

(Cause and Effect Analysis, Fishbone Diagram)

Step 2: Process Measurement

Understand the Current Process Flow(Process Mapping, Value Analysis)

Step 4: Process Improvement

Step 1: Project Definition

Select and Define Opportunity for Improvement

(Balanced Scorecard, Project Charter, VOC, SIPOC)

KaizenEvent

Understand Waste and Variation within Process

(Waste Reduction, Spaghetti Diagram, Continuous Flow, Push vs. Pull, Kanban, Standard Work, Statistical Analysis )

Identify, Prioritize, and Implement Solutions for Improvement

(Visual Workplace, 5S, Water Spider, Poka-Yoke, XY Decision Matrix, Implementation Plan, Leading Change)


Step 1: Define MAIC

Key Concepts and Tools:Balanced Scorecard

Project CharterVoice of the Customer

SIPOC


If a man knows not what harbor he seeks, any wind is the right wind. -Seneca


Balanced Scorecard: Baseline Measurements

Quality Performance

� Improved flow through pre- and post-analytic processes

� Improved flow of information in tech/admin processes

� Improved performance via standardization of processes and implementation of best practices

Customer Service

� Improved process cycle time

� Reduction in overall turnaround time

� Improved customer satisfaction

Financial Performance� Reduction in cost associated

with non-value-added activities

� Improved capture of revenue via process improvement

� Improved operating margins

Work Culture� Improved employee satisfaction

� Reduction in turnover and improved retention

� Improved ability to attract new employees


Define: Project Charters

1. It increases the confidence of the leader and the supporting team.

2. There is more “buy-in” and support when people understand the problem (Problem Statement) and can sense the benefit (Objective Statement).

3. The problem becomes more manageable when it is transformed into a project.

4. There is a beginning and an end–you know when you’re finished–instead of an incomplete effort.

5. Most projects have hard financial benefit and/or they improve work conditions, predictability, and customer satisfaction.

The probability of success for an improvement proje ct is greatly improved when it is properly defined.

Why are we here?


� Problem Statement

� Goal/Objective

� Scope

� Timeline

� Resources/Team Members

� Communication Strategy

� Signatures of Accountability

Basic Project Charter Elements(Name of Initiative) Project Charter

PROBLEM STATEMENT:

• A specific, quantifiable explanation of the effect or pain the problem is causing within the organization (what, when, where and to what extent). It should not imply a cause, attach blame or responsibility nor should it imply a solution. Include current key performance metric of process or “baseline performance”.

GOAL OR OBJECTIVE:

• Defines the expected outcome or level of performance in measureable terms and is stated in a positive manner (target metric reduction). Include financial performance or return-on-investment expectations (target savings).

SCOPE:

• In Scope: (define what is relevant and to be worked on, include process start and end point) • Out of Scope: (define what is not to be worked on) • Constraints: (possible limitations that will affect project outcomes)

TIMELINE:

• Includes start date, expected completion date and general overview of initiative schedule. RESOURCES / TEAM MEMBERS:

• Project Sponsor – Identifies management level key stakeholder who supports project and ensures resources are available. Eliminates complex or political barriers to ensure project moves forward

• Process Owner – Identifies individual accountable for process of concern, owns implementation and control plans

• Team Members – Identifies representatives from each primary group involved in the process to be included in the team. Caution to limit the number of management members, the most productive teams are comprised of those that work the process every day.

• Key Stakeholders – Identifies main individuals or groups impacted by the process. COMMUNICATION STRATEGY:

• Define what will be communicated (project progress) to whom (audience/stakeholders), when (frequency of communication) and how (tactics)

SIGNATURES OF ACCOUNTABILITY:

• Dated signatures indicate agreement with Project Charter content and shared accountability in meeting the project goals and timelines. Include Project Sponsor, Process Owner, Project Facilitator and Team Members


Charter: Problem StatementA specific, quantifiable explanation of the effect or pain the problem is causing within the organization (wha t, when, where, and to what extent). It should not im ply a cause, attach blame or responsibility, nor should i t imply a solution. Include current key performance metric of process or “baseline performance.”

Include the following: WHAT is wrong, WHERE and WHEN is it occurring, what is the BASELINE magnitude at which it is occurring, and what is it COSTING me?

Example: Average TAT (order to result) on STAT CBC s is 60 minutes for ER patients the past six months, 90 percent of the time. Delays greater than 30 minute s create a bottleneck within the ER and limit the abi lity to either transfer or discharge the patient.


Charter: Goal or Objective StatementDefines the expected outcome or level of performanc e in measureable terms and is stated in a positive manne r (target metric reduction). Include financial perfo rmance or return-on-investment expectations (target saving s).

Example: Reduce average TAT (order to report) on STAT CBCs from 60 minutes to 45 minutes, 95 percent of the time within 60 days. The benefit will be to im prove patient throughput in the ER that will result in a decrease in ER patient length of stay.

Include the following: Improve some METRIC from someBASELINE level to some GOAL, by some TIMEFRAME, to achieve some BENEFIT and improve upon some CORPORATE GOAL or OBJECTIVE .


Charter: Scope and Timeline

SCOPE:

� In Scope: Define what is relevant and to be worked on; include process start and end point.

� Out of Scope: Define what is not to be worked on.

� Constraints: Possible limitations that will affect project outcomes.

TIMELINE:

Includes start date, expected completion date, and general overview of initiative schedule.


Charter: Resources/Team Members� Project Sponsor - Identifies management-level key

stakeholder who supports project and ensures resour ces are available. Eliminates complex or political bar riers to ensure project moves forward.

� Process Owner - Identifies individual accountable for process of concern, owns implementation and control plans.

� Team Members - Identifies representatives from each primary group involved in the process to be include d in the team. Caution to limit the number of management members; the most productive teams are comprised of those that work the process every day.

� Key Stakeholders - Identifies main individuals or groups impacted by the process.


Charter: Identify Stakeholders

Coach

Other stakeholders

inside and outside the

organization

Sponsor(s)

Process Owner

Team Members

Lean Six SigmaTeam

Regular communication with stakeholders can help you:

� Understand what is important about your work.

� Identify better solutions to problems.

� Create more buy-in.

� Understand when and how to best involve others.

� Avoid pitfalls.


The Organizational Structure

Lean Six Sigma demands learning and accountability at all levels of the organization.

Leaders

Expert Coaches

Project Leaders

Team Members

All Employees

“Champion”

“Master Black Belt”

“Black/Green Belt”

“Yellow Belts”

“Foundation”


Charter: Communication, Change, AccountabilityCOMMUNICATION STRATEGY:

Define what will be communicated (project progress) to whom (audience/stakeholders), when (frequency of communication), and how (tactics).

SIGNATURES OF ACCOUNTABILITY:

Dated signatures indicate agreement with Project Charter content and shared accountability in meeting project goals and timelines. Include Project Sponsor, Process Owner, Project Facilitator , and Team Members.


Voice of the Customer (VOC)Critical to Quality (CTQ) Characteristics:

� Represents the “Voice of the Customer.”

� Measurement related to how the customer evaluates the quality of a product or service.

� Key performance indicator of the process output or outcome.

Examples of CTQ Indicators:

� Patient Service Center Wait Time.

� PAP Smear Result Turnaround Time.

� Patient Demographics Accuracy Rate.


Patient Experience: Warm or Cold?

Which environment do you prefer?

Adding color to an area provides instant “warmth.”

Breast Center

Hospital Outpatient Imaging Center


Define: SIPOC

High-level process diagram that helps teams define:

� Project boundaries (process start and end points)

� Who provides input to the process

� What the process produces (output)

� Who the customers are and what they require

� What key performance indicator(s) measure the proce ss

SUPPLIERS

CUSTOMERS

OutputsInputs Process


A high-level view is often captured as a top-level flowchart.

Invoice Received

Invoice Approved

Invoice Entered into

the Sub LedgerInvoice Paid

Common Process Inputs:

Material

Information

Ideas

Leads

Labor

Common Process Outputs:

Physical Products

Documents

Information

Services

Decisions

SIPOC: High-Level Process Snapshot

SUPPLIERS

CUSTOMERS

OutputsInputs Process


SIPOC: How to Diagram

1. Identify process boundaries (start and stop points) and key activities (in between steps).

2. Identify the key outputs and customers of those outputs.

3. Identify inputs and suppliers of those inputs.

4. Identify customer “critical-to-quality”requirements for the inputs, process steps, and outputs.

5. Identify the key performance indicator that measures the customer’s requirement.


Exercise: SIPOC

SIPOC plus Customer Requirements & Key Performance Metric

Process Outputs CustomersSuppliers Inputs Require Measure


Step 2: D Measure AIC

Key Concepts and Tools:Process MappingValue Analysis


Process HierarchySenior Management Owned

ProcessMember and

Process Owner Responsibilities

A core process is directly related to generating revenue, providing

services to the customer, or creating a strategic

advantage for the company.

Enabling Processes Core Processes Enabling processes do not directly

impact the customer. They must exist to enable and support the execution of the

core processes.

PM SummaryPM Summary PM SummaryPM Summary

Process A Process B Process C Process D Process E The many detailed activities, tasks, and decisions

involved in satisfying a process output.

Middle Management Owned


SuppliersInternal/External

CustomersInternal/External

Process

Transformation(Creating Value)

Requirements and Feedback Requirements and Feedback

Outputs (Y’s)Process

ActivityTasks

Blending of Inputs

MethodsProcedures

Process RulesCustomer Requirement

Step AStart FinishStep B Step C Step D

Definition of a Process

Inputs (X’s)Materials InformationPeopleEnergyTools and Equipment

Inspect


Process Architecture

1. Obtain …2. Add …3. Move to …

Sub-process 2

Tasks

Activities

Sub-process 1

Major Processes

We all perform tasks at various levels and are therefore quite familiar with this concept.

Many people think of what they do as a set of activities that they do repeatedly. To create a more effective approach, their thoughts have to transform from activity thinking to process thinking.


Cost of Poor Quality and the Hidden Operation

Workarounds Quick Fixes

Inspections

Scrap

Rework

Extra Equipment

IncreasedInventory

Increased Cycle Time

FrustrationDefects

Customer Dissatisfaction

Cost Op i Op i + 1

Analysis ScrapOff-lineCorrection

Correctable?

Verified?

NoYes


There are usually three views of a process:

What it ACTUALLY is..

22 33What it SHOULD be..

Process Mapping

What you THINK it is..

11


Process Mapping Basic Components

ProcessStep

InspectFirst Step

Delay

ProcessStep

ProcessStep

ProcessStep

ProcessStep

ProcessStep Last Step

NO

YES


Exercise: Basic Process Mapping

Beginning steps to create a process map:

1. Label the process start point and end pointusing an oval shape .

2. Label each process step with a separate square shape .

3. Label each decision step with a separate diamond shape , adding sub-process steps and decisions.

4. Label each delay (queue) step with a separate triangle shape .

5. AVOID temptation to add arrows at this time. (It is the last step in developing the map; we will add more to the map later.)


Process Mapping Tips� Use self-stick notes.

(Precut shapes in process step color are pure joy)

� Tape multiple large sheets of paper on wall to hold work.(Flip chart paper and masking tape are best)

� If step is forgotten and needs to be added in, move the self-stick notes to accommodate.

� Walk the process after completing to validate work. (Expect to discover changes)

� Always label and date a process map.

� As ideas are generated, capture in a “Parking Lot.”(Improvement ideas, assumptions, questions, additional observations, and out-of-scope issues and ideas)

� Concentrate on the process, not the tools and symbo ls.

� Discuss what metrics could be used to measure proce ss effectiveness, efficiency, and customer satisfactio n; take notes.

Source: The Lean Six Sigma Pocket Toolbook, George, Rowlands, Price, and Maxey, McGraw-Hill, 2005, pg. 40-41.


Value Defined

Value: The worth of a product as judged by the patient (customer).

The key question of all Lean processes is:

Does the process add value to the delivery of the product or service?

Value-added defined:

1. Does this process step meet a customer need?

2. Does it change the product/service?

3. Is it rework?


Process activities are categorized in three value groups:

Value-added has three characteristics:1. The customer recognizes the value and is willing to

pay for it,2. It changes the product, and 3. It is done right the first time.

Value enabling means things that are:� Required by law, regulation, or contract.� Necessary for health, safety, environmental, or eth ical

considerations.

Non-value-added is: � Considered pure waste.� Everything not classified as value-added or enablin g.

Value Categories


What is a Value Stream? All the actions and activities required by the current state of the process to meet the consumer demand.

What is a Value Stream Map? A process map that visually documents how materials and information flow through the process.

When do you apply Value Stream Mapping?� Process cycle time is too high or long wait

times.� Need to communicate data and process flow.� Process crosses many functions and has

many handoffs.� Buildup of inventory or work in progress.

Value Stream Mapping


Lean Value Stream Map

I

Coils5 days

Person

C/T =Uptime =Run Hrs=Breaks=Hrs Avail=Sec. Avail=

Person


Person


Person


Person


Stamping

1 Person


I I I I I

500 Ft Rolls

Tue &Thurs

Pieces/Mo

Tray=

Shifts=

Delivery DPMO=

Quality DPMO=

BestMetal, Inc Dellex

.

A way of viewing the overall Value Stream, from supplier to the customer, on one sheet of

paper.

Enables you to “see what is actually happening.”

Mon & Wed


Customer Demand:100 pieces per Month

(Takt Time 5760 seconds)

Customer

Supplier

Information

Information

Information

Lead Time = 0 seconds

VA / T = 0 seconds

RM = 0 seconds

WIP = 0 seconds

FG = 0 seconds

Information

Management Control (2)

Customer (1)Supplier

(3) InformationFlow (8)

InformationFlow (8)

Activities/Measurements (4)

Transportation Line (6)

Summary Measures (7)

Defect Rate/Timeline (5)

Basic Structure of a Value Stream Map


Lab CorporationRM available?

Customer/Supplier

Decision

Centrifuge

Operation Delay

InformationFlow

Transportation

1x DailyInventory

TruckSchedule

SpecimenFlow

WithdrawalKanban

Pull/Withdrawal

ProductionKanban

Value Stream Map Symbols


Purpose: Practice using value stream mapping.

Materials: Yellow self-adhesive notes, black fine point magic marker, colored dots (red/yellow/green).

Exercise: Using available information, create a simple value stream map of your current process.

Use the summary information on the next two slides to guide you through the exercise.

Debrief: Be ready to present your maps.

Time: 20 minutes.

Exercise: Value Stream Mapping


Steps to Create a Value Stream MapStep 1: Create a basic process map.

Step 2: Add material flow (optional).

Step 3: Add information flow (optional).

Step 4: Add time for each process step and activity (record average time to perform without interruption).

Step 5: Add range of time for each process step or activity (record current knowledge of timing).

Step 6: Analyze the “value” of each activity or process using green/yellow/red markings.

Step 7: Validate the map.


The key question to ask of each Lean process step:

Does the task at hand add value to the delivery of the product or service?

Green Dot : Value-Added

Yellow Dot: Value Enabling

Red Dot: Non-Value-Added or Waste

To answer YES, it must meet the following three val ue-added characteristics:

1. The customer recognizes the value and is willing to pay for it, and

2. It changes the product, and

3. It is done right the first time.

Identifying Value-Added Process Steps


Production Lead Time (PLT)The time it takes a specimen to move all the way th rough the process or value stream from start to finish.

Cycle Time (CT)The time it takes a technician/assistant to go thro ugh all work elements before repeating them.

Value-Added Time (VAT)The time of those elements that actually transform the product in a way that the customer is willing to pay for.

Value-Added Cycle Time (VCT)Value-Added Time/Production Lead Time � Value-Added Time = 5 Minutes� Production Lead Time = 180 Minutes� % Value-Added Time = 5/180 Minutes = 3.6%

Typically: VAT < CT < PLT

Types of Time Measured


Takt Time

Takt time is the speed at which an area needs to op erate during normal working hours in order to meet demand . It is independent of process capability and cycle time.

Takt Time = Regular Available Time/Period (Shift)

Units Produced/Period (Shift)

Example:

� Resources: 3 FTEs per shift = 1,260 minutes (exclu des 1 hour ofbreak)

� Production Demand: 120 tests per shift

� Takt Time: 1,260 minutes/120 tests = 10 minutes 30 seconds

Conclusion: To meet customer demand, one test has to be completed every 10 minutes and 30 seconds.


Value Stream AnalysisQuestions to Ask when Analyzing the Value Stream Ma ps (VSM):

1. What is the total value-added time?

2. What is the total non-value-added time?

3. Where does the specimen/customer/product spend th e most non-value-added time?

4. Where is the waste?

� Where does excessive movement or travel distance oc cur? What could be improved?

� Is the level of inventory balanced to demand? What would you do differently?

� What might you do to improve customer satisfaction? Where would you focus your efforts first?

� Which internal process would you target for improve ment first, second, third? What criteria would you use to decide?

� What resources/skills/methods would you use to solv e some of the problems?


Applying Lean: Functional Deployment Mapping

Improvement to focus on

reducing process delay times

(red hour glass), transportation

times (green car), and rework or

additional work (red boxes)


The key question to ask of each Lean process step:

Does the task at hand add value to the delivery of the product or service?

Green Dot : Value-Added

Yellow Dot: Value Enabling

Red Dot: Non-Value-Added or Waste

To answer YES, it must meet the following three val ue-added characteristics:

1. The customer recognizes the value and is willing to pay for it, and

2. It changes the product, and

3. It is done right the first time.

Identifying Value-Added Process Steps


Case Study:Current State Patient Process Flow


Case Study:Common Observations - Strengths and ChallengesStrengths:� Scheduling centralized for patient appointments.

� Significant available capacity at all sites.

Challenges:� Scheduling unable to easily determine first available appointment within

system locations.

� Lack of standardized physician ordering requisition ; information received rarely complete (lack ICD-9 code, pre-cert number, procedure type unclear).

� Inconsistent handling of physician orders–informati on obtained is variable and generally not received until the patient presen ts for a procedure. Occasional faxing.

� Registration follows hospital inpatient protocol; e xcessive patient questions.

� Billing practices and pricing follows hospital inpa tient protocol; not competitive with local competition.

� Patient time spent in obtaining scan is significant compared to freestanding imaging center; one person stated, it is an “afternoon event”vs. “over the lunch hour.”


Will it BlowUp In

Your Hands?You’re Toast!

Can You Blame Someone

Else?

NO PROBLEM!

Is It Working?

Source: Unknown Internet.

Flowchart for Problem Resolution

NO

Did You Mess

With It?

YES

YOU IDIOT!NO

NO

Look The Other Way

Don’t Mess With It!

YES

NO

Hide It

DoesAnyone Else

Know?

YES

YESYES

NO


Benefits of Mapping the Value Stream

� Visualize flow

� Identify sources of waste

� Get to a common language

� Make decisions about flow obvious

� Establish the foundation for improvement activities

� Links material flow to information flow

� walk the process� write it down…and most importantly…

Understand the process through facts and data!



Challenge: Customers are not fully satisfied with the artwork being produced or the level of service provided. A rt4U has the opportunity to incorporate THREE IMPROVEMENT CHANGES in its production process.


Simulation #2:� Set up time - 10 minutes.� Production time - 10 minutes.� Debrief time - 5 minutes.

Art4U Simulation #2


Step 3: DM Analyze IC

Key Concepts and Tools:Cause and Effect Analysis

Fishbone DiagramsWaste Reduction

Spaghetti DiagramsContinuous Flow

Push vs. Pull/KanbanStandard Work

Statistical Analysis


Cause and Effect Analysis

XXXXXXXXXXXX

X X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X X

X X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X X

X X X X X XX X X X X X XX X X X X X XX X X X X X XX

The quantity of X’s remaining after

DMAIC

The many X’s when we first start

(the trivial many)

The quantity of X’s keep reducing as you work the

project


� X1 . . . Xn� Independent� A Process Input� The Cause of a

Problem� What Needs to

be Controlled

(X)(X)YYFundamental Relationship of Cause and Effect

� Y

� Dependent

� A Process Output

� The Effect

� It is a Symptom

� Can Only be Monitored

is equal to a function ofis equal to a function of

This is the “Blending” or the way in which the process combines the inputs together with various process activities.

The performance of an output or a characteristic we are interested in is a function of the process inputs, called X’s, and the manner in which the process combines them to provide the resu ltant output (Y). Written as Y = f(X).


Cause and Effect Diagram (Fishbone)

EFFECT

Primary Cause

Secondary Cause

Equipment Process People

Materials Environment Management

Provides “pain point” discovery.


Case Study:Fishing for Patient Satisfaction

Findings: Primary “pain points” were process-related.

UnsatisfactoryPatient Experience

Management Process

Materials & Equipment Environment

People

Clinician orders unclear

Staff shortage,especially

during break times

Pre-registration information excessive

Registration not always located or

performed in Imaging

Requisition not standardizedamong system sites

Bills confusing

Procedure roomunavailable

Multiple bills

Patient prep not acceptable

ER patient delaysOutpatient

Supervisor not on-site

<10% orders faxedto dept before appt

Signage from parking to department unclear

Parking limited

Follow hospitalinpatient process

Billing requirements

Equipment down

Heavy workload

Difficult to determinefirst available appointment

RIS limited functionality, Site schedules not consolidated


Over-processing

Motion Waiting

Defects Over-production

Transporting

Inventory

6. Unnecessary Motion

Extra steps and data entry Analyzers spread out in work area

7. Overprocessing

Handling paperwork not required Process steps that do not add value Data collection for information not used

8. Human Potential

Failure to engage people Skill not matched to task

1. Defects

Time doing something incorrectly Correcting errors, rework Inspecting for errors Miscommunication

2. Overproduction/Making Too Much

Unnecessary testing Doing more than needed Doing something sooner than needed

3. Transporting/Moving Things

Extra steps in the process Hand-offs, sign-offs

4. Inventory/Unnecessary Stock

Excess supplies on hand Supplies not used before expiration date Instrumentation spare parts that are not critical

5. Waiting

For other functions or disciplines Running batch jobs (i.e., blood draws) Unnecessary STATs, hand-offs

Types of Waste (MUDA)

Types ofWaste

Human Potential


Correcting errors or defects adds unnecessary costs because of additional supplies and labor expenses.

An example is rescheduling a patient draw because of a missed test during order entry.

Waste #1: Defects


Waste #2: Overproduction/Making Too Much

� Producing more tests than necessary.

� Producing tests at a rate faster than required.

� Doing this requires more raw product inventory than necessary, overuses machines and people, and requires more storage area.


Conveyance is an incidental, required action that does not directly contribute value to the product.

It’s vital to avoid moving material unless it is supplying items when and where they are needed (i.e., just-in-time delivery).

Waste #3: Transporting/Moving Things


Waste #4: Inventory/Unnecessary Stock

Inventory is a drain on an organization’s use of capital. The greater the inventory, the higher the carrying costs.

To remain flexible to customer requirements and to control product variation, we must minimize inventory.


� Idle time between process steps.

� Examples are patients waiting to have blood drawn or an instrument waiting for the operator to load specimens or accept quality control to report results.

Waste #5: Waiting


Any movement of people, products, or technology that does not contribute added value to the product; i.e., programming delay times and excessive walking distance between process steps/ workstations.

Waste #6: Unnecessary Motion


Processing work that has no connection to improving the quality of the product.

Examples include excessive documentation of quality control or typing memos that could be handwritten.

Waste #7: Overprocessing


A basic Lean philosophy is the person closest to the work is the best source of information on how to improve it.

It is important to match the employee skill level with the level of knowledge required to perform the task.

Waste #8: Human Potential


Specimen Processing: Identification of Waste1. Defects: Fixing mislabeled/improperly labeled tubes.2. Overproduction: Process/sort several items before

passing on.3. Transportation: Unnecessary walking to deliver

specimens. Waiting: Specimens in receiving area awaiting sorting.

4. Inventory: Buildup of specimens due to batching.5. Waiting: Specimens in receiving area awaiting

sorting. Holding a specimen until nursing clarifies order.

6. Unnecessary Motion: Back/forth physical movement due to poor workstation layout.

7. Overprocessing: Taking requisitions in/out of bags.8. Human Potential: Technologists picking up

specimens.


Spaghetti DiagramsIllustrates the physical flow of a person, product, or information as it moves through multiple steps in a process.

Benefit: Identifies workflow inefficiencies and provides a method of modeling out potential improvements before making major (or minor) process changes.

Basic Cooking Steps:

1. Gather the tools.

2. Draw the basic work area or workstations.

3. Diagram the workflow.

4. Analyze the diagram.

5. Design and test an improved workflow.

6. Communicate and pilot the changes.

7. Evaluate effectiveness.


Spaghetti Diagram: Day Shift Workflow

Findings: Heavy traffic and bottleneck in specimen processing area. Technical workbenches spaced far apart when techs n eed to cover multiple

areas with overall excessive movement by staff.


Increasing Efficiency with Minimal Change

Improvement Opportunity: Removal of one panel in each work row redistributes workflow of support and technical sta ff and improves

overall workflow efficiency for all shifts.


Producing and moving one item at a time (or a small and consistent batch of items) through a process in a c ontinuous manner, with each step producing just what is neede d by the next step. Also known as single-piece flow or make one, move one.

Benefits:

� Builds in quality.

� Increases productivity.

� Reduces inventory.

� Frees flow and space.

� Improves safety.

� Improves morale.

Continuous Flow

Examples: Morning phlebotomy blood draws - After every three patients specimens are sent to Specimen Processing (small batch) or automated analyzer lines (single-piece flow).


Push System:

Work production is scheduled based upon anticipated demand with no consideration of the actual need.

Pull System:

Work production is scheduled based upon actual need . (The status of downstream operations dictate the product ion requirements for upstream operations.)

Upstreaminventory

Assembly

Upstreaminventory

Assembly

Push

Pull/Kanban

Kanban signals Full containers

Push vs. Pull


What is a Kanban?Kanban - A signaling system to manage and control themovement, production, or supply of material within aprocess. Kanbans have two primary functions:

� Instruct processes to make products.

� Instruct material handlers to move products.

Benefits:

� Promotes visual management.

� Provides pickup or transport information.

� Prevents overproduction and excessive transportatio n.

� Controls the amount of WIP in the system.

� Serves as a visual work order.

� Exposes waste and forces a root cause solution.


Kanban Signaling System


Visual Management: Kanban Supply System


“One Point Lesson” on Visual Controls

Situation Before: Solution:The paperwork for various work batches was unorganized and the system at times created unnecessary delays in handling.

Through an organizational system that was color coded by date of collection, specimens were handled in order; overall TATs decreased.


Standard WorkPurpose: To create a consistent, safe, efficient, high quali ty, and low cost product or service that:

� Breaks work down into elements.

� Defines the amount of work performed by each operat or to achieve balanced flow.

� Maximizes throughput capacity and productivity.

� Reduces process variation.

� Used to balance workloads with customer demand.

� Developed through a team approach and owned by them.

“One must standardize, and thus stabilize the proce ss before continuous improvement can be made.”

-Masaaki Imai (father of Kaizen)


Spaghetti Diagram of Patient Waiting Room

Findings:Patient moved multiple times

during the registration

process, while Imaging

personnel had minimal

movement.

Solution:Cross-train

Imaging receptionists to

do patient registration.


Statistical Analysis: Seven Basic Quality ToolsHow many are you familiar with?

1. Histogram

2. Control Chart

3. Pareto Analysis

4. Check Sheets

5. Scatter Plots

6. Stratification

7. Cause and Effect Diagram (Fishbone)

Rooney, Kubiak, Westcott, Reid, Wagoner, Phylipow, Plsek, Building From The Basics, 7 Essential Quality Tools, Quality Progress, pgs. 18-29, Vol 42, No 1,

January 2009. www.qualityprogress.com


Step 4: DMA Improve C

Key Concepts and Tools:Visual Workplace

5SXY Decision Matrix

Implementation Plan


Principle: As you clean up a workplace, you make the problems of that workplace visual!

Visual Control: Any communication device in the work environment that informs:

� How work should be done.

� Whether work is deviating from the standard.

Examples:

� Magnetic room/patient scheduling board.

� Graphs that show daily performance.

� Supply storage shelf labeling.

Visual Workplace


Visual Communication: Information Empowers

The distinctive aspect of Visual Communication is i t provides a group of workers timely information on process performance.

Visual Communication can be:� A sign� A label� A photograph� A display� A trend chart� A color scheme� Whatever serves the purpose

A Visual Message is observed by everyone working in a given area, everyone who passes throug h the area, and everyone who comes into range of visibili ty.


Visual Management: Communication Boards

Communicating the Five Pillars of Performance:People, Quality, Service, Growth, and Finance

Breast Center

Hospital Imaging Department


Quality DeliveryCost Safety

5-s

Cell Team Name

Defect Pareto

Hours/Unit

% Implementation Rate

DPU Chart

Month By The Day Chart

5-s Rating

5-S Rating

1S ______2 S ______3 S ______4 S ______5 S ______Tot _____

1S

2S

3S4S

5S

0

5

10

15

20

100

0

5-S Rating0 - Start

20 - Poor40 - Fair60 - Good80 - Excellent

100 - Outstanding

Activity Who When

Action Plans

Paynter Chart

Customer

0

10

20

30

40

50

60

70

80

1 2 3 4

0

5

10

15

20

25

30

Mat’l $/Unit

0

5

10

15

20

25

30

Overtime% Sched Time

0

5

10

15

20

25

30

Process Map

Quality Control Plan

TAKT TIME

00.050.1

0.150.2

0.250.3

0.350.4

0.450.5

J F M A M J J A S O N D

00.050.1

0.150.2

0.250.3

0.350.4

0.450.5

J F M A M J J A S O N D

Lost Workdays

Total Incidents

Team Leader

Team Members

Continuous Improvement Suggestions

Activity Who When Activity Who When Activity Who When Activity Who When

Voc Scorecard

Customer A

0

5

10

15

20

25

30

Throughput TimeVoc

Scorecard Customer B

Voc Scorecard

Customer C

The Visual Workplace (cont.)


SORT STRAIGHTEN STANDARDIZE SUSTAINSHINE

� Exposes Problems

� Safe Working Areas

� Space Reduction

� One-piece Flow

� Discipline to Follow Standard Work

Foundation and Building Blocks

for All Other Activities

DrivesProductivity!

Workplace Organization: 5S

Sort Straighten

Shine Standardize

Sustain


5S Translation - Workplace Organization

Step Japanese Literal Translation Eng lish

Step 1: Seiri Clearing Up Sorting

Step 2: Seiton Organizing Straightening

Step 3: Seiso Cleaning Shining

Step 4: Seketsu Standardizing Standardizing

Step 5: Shitsuke Training and Discipline Sustaining

Focus on using the English words, much easier to remember.


SORT - Decide What is NeededDefinition:

� To sort out necessary and unnecessary items.

� To store often used items at the work area, store infrequently used items away from the work area, and dispose of items that are not needed.

Why:

� Removes waste.

� Safer work area.

� Gains space.

� Easier to visualize the process.

Things to remember� Start in one area, then sort

through everything.� Discuss removal of items with all

persons involved.� Use appropriate decontamination,

environmental, and safety procedures.

� Items that cannot be removed immediately should be tagged for later removal.


A Method for Sorting

Dispose

Useless

Keep and Monitor

Unknown Useless

Keep and Store

Useful

Useful

ABC Storage

Sorting

Item


A Method for Sorting (cont.)

AB

CFre

quen

cy o

f Use

Distance

Use this graph as a general guide for deciding where to store items along with the table below.

YESNONOCMonthly or Quarterly

NOYESMAYBEBWeekly

NOMAYBEYESADaily or Several Times a Day

Keep in Remote Location

Keep in LocalLocation

Keep Within Arm’s ReachClassFrequency of Utilization


STRAIGHTEN - Arranging Necessary ItemsDefinition:

� To arrange all necessary items.

� To have a designated place for everything and everything in its place.

� Easily visible and accessible.

Why:

� Visually shows what is required or is out of place.

� More efficient to find items and documents (silhouettes/labels).

� Saves time by not having to search for items.

� Shorter travel distances.

Things to remember� Things used together

should be kept together.� Use labels, tape, floor

markings, signs, and shadow outlines.

� Sharable items should be kept at a central location (eliminated excess).


SHINE - Cleaning the WorkplaceDefinition:

� Clean everything and find ways to keep it clean.

� Make cleaning a part of your everyday work.

Why:

� A clean workplace indicates a quality product and process.

� Dust and dirt cause product contamination and potential health hazards.

� A clean workplace helps identify abnormal conditions.

Things to remember� “Everything in its place” frees

up time for cleaning.� Use an office or facility layout

as a visual aid to identify individual responsibilities for cleaning. This eliminates “no man’s land.”

� Cleaning the work area is like bathing. It relieves stress and strain, removes sweat and dirt, and prepares the body for the next day.


STANDARDIZE - Creating ConsistencyDefinition:

� To maintain the workplace at a level that uncovers problems and makes them obvious.

� To continuously improve your office or facility by continuous assessment and action.

Why:

� To sustain sorting, storage, and shining activities every day.

Things to remember� We must keep the workplace neat

enough for visual identifiers to be effective in uncovering hidden problems.

� Develop a system that enables everyone in the workplace to see problems when they occur.

� Assign duties for performing 5S.


SUSTAIN - Maintaining the 5SDefinition:

� To maintain the improvement, it needs to be practiced and repeated until it becomes a way of life.

Why:

� To build 5S into our everyday process.

� To maintain efficiency gains, there needs to be a plan for continually improving.

Things to remember� Train workers on new

systems; obtain “buy-in.”� Develop schedules and

checklists.� Good habits are hard to

establish.� Commitment and discipline

toward housekeeping are essential first steps toward being world class.


Implemented bar code-based software system for specimen storage and retrieval.

Before

After

Applying 5S: Specimen Processing


Applying 5S: Supply Room

Before

Sorted through supplies (discarding those expired a nd not used), set to order, and standardized remaining ite ms.

After


Before

After

Improving patient first impression: Remove clutter from registration area–added benefit is it provides more workspace.

Applying 5S to Increase Work Space


5S Assessment Deployment

Assessing the level of 5S in a work space:

� SortOnly items currently used remain in work space

� StraightenEverything has a place and everything is in its pla ce

� ShineItems are maintained, marked off, areas clean

� StandardizeProcesses identified, documented, and consistent

� SustainSelf-triggered activities on a daily basis to maint ain


Purpose: Practice using 5S concepts and tools.

Materials: Colored dots (red/yellow/green), large carry bag (purse, tote bag).

Exercise:

1. Place the contents of the bag on the table.

2. Attach colored dot to each item using the following description:

Green - Use daily or multiple times per week.

Yellow - Use weekly, or critical when needed.

Red - Rarely or never used, able to obtain.

Debrief: Be ready to discuss your findings.

Time: 5 minutes.

Applying Lean: 5S Dot Exercise


The term Water Spider refers to an employee who delivers parts to the various workstations. This is done so that others do not have to get up to obtain replenishment mater ials/ specimens, minimizing interruption in workflow.

Benefits of having Water Spiders?

� Value-added personnel do not have to leave their workstations.

� Waiting time becomes visible.

� The water spider becomes the pace maker for the wor k area.

� The water spider can fill in for absent workers.

The term Milk Runs refers to the path given to a water spider in his/her parts delivery or pickup. This path sho uld be optimized for maximum efficiency.

Water Spiders


Poka-Yoke DefinitionPronounced POH-kah YOH-kay.

� It is a translation of a shortened Japanese phrase meaning “to make mistakes impossible.”

� Plain English: “Mistake-proofing.”

Developed by S. Shingo of Toyota.

� Shingo calls it “Zero Quality Control” (ZQC).

Why is Poka-Yoke important?

� It is one of the simplest tools to learn.

� It has extremely high impact, usually at little cos t.

Poka-Yoke has two parts:

� Making mistakes impossible (prevention and solution ).

� Making mistakes immediately obvious (detection).


Fact-Based Decision Making (XY Matrix)

The XY Decision Matrix is a statistical-based tool used to make criteria-based decisions.

Benefit: Used to facilitate complex decisions, assuring focus remains on desired outcomes, minimizing personal bias. Also used to prioritize multiple choices or options.

Basic Steps:

1. Define decision to be made and desired outcome.

2. Select evaluation criteria.

3. Establish weighting for each criteria in level of importance (1=low, 3=medium, 9=high).

4. Analyze the diagram.

5. Evaluate choices or options.

6. Review results and make decision.


XY Decision Matrix Example

Interpretation: Which candidate would you select?

Desired Criteria/Expectations:

TO

TA

L

Criteria Weight (Low=1, Med=3, High=9)

ScoreWtd.

ScoreScore

Wtd.Score

ScoreWtd.

ScoreScore

Wtd.Score

ScoreWtd.

ScoreScore

Wtd.Score

Candidate Background HighlightsCandidate A MBA/HCM, 15 years supervisory

experience plus 5 technical, external applicant. 9 81 1 9 1 3 9 27 9 9 9 9 138

Candidate B BS, no supervisory experience,10 years technical experience, internal applicant 9 81 3 27 9 27 1 3 1 1 3 3 142

Candidate C BS, 2 yrs supervisory experience plus 2 technical, currently at major competitor 3 27 9 81 3 9 9 27 3 3 9 9 156

Candidate D AS, recent graduate, 4 years supervisory experience at local coffee shop 1 9 9 81 9 27 1 3 3 3 1 1 124

XY Decision Matrix - Selecting Technical Supervisor

Technical Knowledge

Personality fit with Team

Internal Candidate

Lean Workflow Experience

Supervisor Experience

Regulatory Knowledge

9 9 3 3 1 1


Implementation Plan

Basic project management components:

� Action steps to be taken

� Assigned accountabilities

� Timeline tracked

� ROI tracked

� Progress report

Ref. No Action Steps Task Leader(s) Comments

Wk of 4/7 4/14 4/21 4/28 5/5 5/12 5/19 Later

Planned ActivityOn Schedule / Activity CompletedOff Schedule - Should Not Impact TimelineOff Schedule, Will Impact Overall Project Timeline

List Category #1 List Action Step List Leader Name Add notes or provide update on progress Done

List Action Step List Leader Name Add notes or provide update on progressList Action Step List Leader Name Add notes or provide update on progress Delay


Leading Change

Effective Approach to Leading Change

1. Establish a Sense of Urgency

2. Create a Support Network

3. Develop and Communicate the Vision

4. Address Resistance

5. Empower Employees

6. Communicate the Wins



Challenge: Customers are not fully satisfied with the artwork being produced or the level of service provided. A rt4U has the opportunity to incorporate as many changes need ed to improve the production process.


Simulation #3:� Setup time - 10 minutes.� Production time - 10 minutes.� Debrief time - 5 minutes.

Art4U Simulation #3


Step 5: DMAI Control

Key Concepts and Tools:Control Methods


Sample

Proportion

1361211069176614631161

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

_P=0.2438

UCL=0.3519

LCL=0.1357

Before 1st Intervention 2nd Intervention Night shift focus

0.15

1

1

11

1

1

1

1

111

111

1

1

1

11

1

1

1

1

11

1

1

1

111

1

P Chart of R/V by InterventionT roponins Excluded

Tests performed w ith unequal sample sizes Reduced Turnaround Time

Control Methods: Run Charts

Monitoring performance will increase the ability to sustain or continue to improve over time.


Outcome: Reduced Outreach Imaging Center Patient W ait Time

Maintain the Gains

Most improvement initiatives involve multiple solutions - goal is to reduce process variation

OP Imaging Center Average Wait Time (min)

UCL 45.982

CL 33.082

LCL 20.182

10.700

20.700

30.700

40.700

50.700

60.700

70.700

80.700

1-Sep

3-Sep

5-Sep

7-Sep

9-Sep

11-S

ep13

-Sep

15-S

ep17

-Sep

19-S

ep21

-Sep

23-S

ep25

-Sep

27-S

ep29

-Sep

1-Oct

3-Oct

5-Oct

7-Oct

9-Oct

11-O

ct13

-Oct

15-O

ct17

-Oct

19-O

ct21

-Oct

23-O

ct25

-Oct

27-O

ct29

-Oct

31-O

ct

Date

Ave

rage

Wai

t Tim

e (m

in)

“Leaned” Patient Registration Process

Major Patient Dissatisfaction

“Leaned” Physician Order Process


Keep it Alive!

� Communicate success:

� Storyboards/bulletin boards

� Showcase of excellence event

� Article in organizational newsletter

� Monitor ongoing performance:

� Balanced scorecard

� Quality metrics–establish limits of performance that trigger review

� Integrate into individual performance expectations


Next Steps


Project Selection CriteriaProjects will likely have greater success if…

� The problem is related to a key business issue–lead ership support is critical.

� The problem is linked to a clearly defined process (i.e., you can identify the starting and ending points).

� You can identify the customers who use or receive t he output from this process.

� You can clearly identify what a defect is and count it.

� You can demonstrate how improvements will enhance financial performance.

� There is appropriate organizational support.

� They have SMART goals: specific, measurable, attai nable, realistic, and timely.


Moving to the Future: Kaizen Events

“Kaizen Blitz” events move the organization from its current state to the future state

using Lean Six Sigma principles in a rapid manner.

Kaizen


Overview of Kaizen Approach

1. Construct project charter to clarify scope, goal, key stakeholders, timeline, and deliverables (Define )

2. Collect performance data on process to be improved ( Measure )

3. Facilitate team meetings:

� First: Define and Measure

� Second: Analyze and Improve

� Third: Analyze and Improve

� Fourth: Analyze and Improve (if needed)

� Fifth: Control and Celebrate


Summary of Process Improvement Process

Step 5: Process Control

Monitor the Process and Celebrate Success(Control Methods, Keep it Alive!)

Step 3: Process Analysis

Understand Relationship of Input and Output Variables

(Cause and Effect Analysis, Fishbone Diagram)

Step 2: Process Measurement

Understand the Current Process Flow(Process Mapping, Value Analysis)

Step 4: Process Improvement

Step 1: Project Definition

Select and Define Opportunity for Improvement

(Balanced Scorecard, Project Charter, VOC, SIPOC)

KaizenEvent

Understand Waste and Variation within Process

(Waste Reduction, Spaghetti Diagram, Continuous Flow, Push vs. Pull, Kanban, Standard Work, Statistical Analysis )

Identify, Prioritize and Implement Solutions for Improvement

(Visual Workplace, 5S, Water Spider, Poka-Yoke, XY Decision Matrix, Implementation Plan, Leading Change)


Application Examples

� Specimen Processing: A frequent opportunity target in many laboratories.

� Staffing vs. Workload: Helps to break away from “historical staffing patterns” to “workload-based staffing.”

� Billing Process Improvement: The majority of outreach programs do not effectively manage revenue.

� Laboratory Design: Application of Lean thinking regarding process improvement before design is finalized leads to effective use of space and reduced construction cost.


Why Use Lean Six Sigma? Speed Variation

Improve Patient Safety

Improve Physician Satisfaction

Enhance Customer Value

Increase Company Value

Improve Employee Satisfaction

60% Process Time Improvement

50% Improvement in Turnaround Time

30% Improvement in Quality Levels

40% Cost Reduction

20% Floor Space Reduction

Speed

Customer's Perception of Value and Safety

Operational Excellence Top Quality Service

Lean Six Sigma

Business Processes


For additional information and Lean tool templates visit: www.chisolutionsinc.com

To navigate the website:

Knowledge Center / Presentations / Executive War College / Lean for Lab Leaders


Anne T. DaleySenior ConsultantChi Solutions, Inc.

(800) 860-5454 [email protected]

Nora HessOperations Managing Consultant

Chi Solutions, Inc.(800) 860-5454 x505

[email protected]

Lean for Lab Leaders - Chi Solutions, Inc€¦ · To develop an understanding of how the Six Sigma...

Documents

Transcript of Lean for Lab Leaders - Chi Solutions, Inc€¦ · To develop an understanding of how the Six Sigma...