What it's like to be in a3 class

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What’s it like to be inA3 Class?

www.akronchildrens.org/givingMark A. Watson Center for Operations ExcellenceProcess Improvement Through People Development

Organizational Commitment

• Very Powerful tool

• Supported by Administration

• Important initiative for the organization

• Our Commitment• Efficiencies gained as the result of a Lean Six Sigma

project will not result in layoffs


A3 is for Anyone!

• Highly engaged and committed• Use the Lean tools to analyze and make changes• “Those who do the work change the work”

Mark A. Watson Center for Operations ExcellenceProcess Improvement Through People Development


Process Improvement Through

People Development


A3 and DMAIC

Define

Measure

Analyze

Improve

Control

• Define and Scope your project• Background Information, Problem Statement, SMART

Goal• Process Mapping• Data Collection• DOWNTIME

• Fishbone Diagrams• 5 Whys• Spaghetti Diagrams

• Lean Toolkit• Standard Work, 5S

• Control Planning and Sustaining Your Gain!

WEEK 1

WEEK 2

WEEK 3

WEEKS 4

-7

WEEKS 7

-8



What you can expect in this course?

• You can solve an opportunity for improvement in your work area (or perhaps even outside of it)

• Knowing how to work with your Process Owner to solve opportunities

• You’ll have a new method to approach problems and solve them

• Empower you to tackle long standing issues

• Your trainer/coach will be available to help you with your project

• You’ll learn how to move through speed bumps that pop up in your project



What is expected of you in the course?

• Show up at each class session or at least notify the trainer when you can not

• Be a part of the discussion and activities

• Continually be working on your project throughout the program

• Report out at the end of your project



The Essence of Lean• Lean is a culture of continuous improvement aimed at

identifying and eliminating waste• All work processes must be controlled, constantly modified,

and improved by the people who do the work• Lean is about PEOPLE!


• By eliminating waste, our processes can take:• Less time• Less effort• Less space• Less equipment• Less material• Less money

What is Lean?



Value• Value is always defined by the customer. It is any item, activity or service

for which the customer would be willing to pay for.

Waste• Any activity that consumes resources but creates no value and they are

activities that the customer would not gladly want to pay for if they knew they were happening.

The Essence of Lean

Gemba• Japanese term meaning the place where all

activities are actually taking place.



• The term “A3” refers to the paper size (11 x 17) used for problem-solving, proposals, plans, and project reviews

• The A3 document is used by the A3 candidate as s/he goes through the A3 program

• However, more than just a paper size, it…• Fosters dialog• Provides a standard way of communicating• Gives insight into stakeholder alignment• Aides in project management• Tells the story of the project

What is the A3?



A3 Project Selection

• Ideally, it addresses an issue identified in huddle• Has to be a process that touches your department• Has to be a process you are involved with • Has to occur multiple times per week or day, not seasonal• Must be measurable• Should not focus on technology or staffing solutions• Keep the strategic plan in the background of your project



Working on your project• You’ll have approximately 4 weeks after the end of class to finish the

project and graduate with your class mates

• Keeping your stakeholders up to date and involved in the project will be important


• Meeting with your coach weekly helps to keep the project going

• Be willing to try new ideas out even though at first you may not think they will work


Project Report Out. . .What to Expect?• Who attends? Hospital Administration, Board Members, previous A3 Graduates, COE Members, etc. . .they all love to see the work and improvements you’ve done!

• You will be given four minutes to present your project

• Come and practice. It will be a great help!

• Recruit your co-workers and those who helped and supported you! Or anyone who wants to see what this is all about



A couple A3 examples


Inaccurate Dressing CardsBurn Center

Maryke Bard BSN, RN, CEN

Process Owner: Christine Sadie BSN, RN

August 10, 2009

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Center for Operations Excellence

A3 Project Report Out

17

• Problem Statement:• When dressing cards are inaccurate, Burn dressings are

opened for dressing changes and not used which causes excessive waste of supplies and cost to the Burn Unit.

• Goal Statement:• Reduce the amount of inaccurate dressing cards from

48% to 30% by August 10th, 2009.

Define

18

Define

19

Measure

20

Analyze

21

Improve

1.Pre 5S in the Burn Dressing Room

22

Improve

1.Post 5S in the Burn Dressing Room

23

Improve

1.Completed a 5S in the Burn Dressing Room.2.Minimized amount of burn dressings being

opened prior to dressing changes.3.Developed new process for keeping dressing

card and charge sheet with dressings and prompting immediate updating of card.

4.Developed and educated all staff on standard work instructions for setting up dressings, updating card, and 5S of Burn Dressing Room.

24

Results

1.Direct savings of $18,673 from reduction of Burn dressings wasted.

2.Reduction of 168 items from Burn Dressing Room inventory resulting in a savings of $197 to the unit

3.Reduction of Burn dressing card inaccuracies of 8%

25

Control

Follow Up Plan1. Collect data on wasted Burn dressings for 3 days twice a

quarter for 6 months.2. Maintain visual management of 5S area at the end of each

shift by Burn Center staff.

Next A3 Project: Standardizing Burn dressing card, Maintaining bandage scissors, Updating dressing change white board…

Filling Holes in Provider Clinic

EndocrinologyParticipant: Donna Green

Process Owner: Milva Holley

Coach: Chris Weisbrod

26



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• Problem Statement:• Cancelled appointments are leaving holes in clinic

Schedule creating longer wait time to be seen

• Goal Statement:• Reduce number of unfilled appointment slots due to

cancels from 10 a week to 5 by August 5 2011

Define

28

Measure

29

Analyze

30

Improve

1.Developed standard work instructions for filling slots

2.Updated Wait list3.All PSRs attended Excel training for wait list4.Developed flow that allows continuous focus

on filling appointment slots

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Improve

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Results

The Improvement

PreMetric

Post Metric

FinancialImpact

Potential Revenue

%Improved

To fill cancelled appt slots

3/week 11/week Hard

$2,530

$29,900 266%

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Control

Next A3 Project: New Patient Scheduling

Process Improvement Through People Development TM

Accessibility to Critical Airway Supplies in the ED

Department of Pediatric Emergency Medicine

Participant: Nirali Patel MD, James Lee MD & Osama El-Assal MD

Process Owner: ED

34



Process Improvement Through People Development TM 35

• Problem Statement:• Delayed airway resuscitation can lead to significant

morbidity and mortality in critically- ill or injured patients.• Critical airway supplies are in various locations, away

from the patient’s airway causing delay in care.

• Goal Statement:• Reduce the time and steps to obtaining critical airway

supplies from 3 minutes to 1.5 minutes, or 50% time reduction.

• Improve accuracy and consistency of obtaining supplies among PEM physicians.

Define


• Trained ED personnel consumed on average 150.6 seconds to locate critical airway supplies and equipments.

• No one was able to obtain all the supplies needed at various stages of resuscitation correctly.

• There was significant motion to locate various supplies between different treatment rooms.

Measure


Analyze

ManMethodMaterialWho stacksall equipments?

No protocolNo defined space

Not enoughEquipments

Measurement Machine Environment

Treatment roomLayout

Delay in timeLots of steps

Not enough equipment


Improve

List of Improvement Activities:

1. Created a cart containing all critical airway equipments and supplies in one mobile unit.

2. Decreased time to obtaining critical airway supplies from 150.6 seconds to 55.2 seconds, with 63% time reduction.

3. Increased accuracy of obtaining correct equipments from 0 to 100%.


Critical Airway Cart & Pathway.


Time Reduction After Creating Mobile Airway Unit

S1 S2 S3 S4 S50

50

100

150

200

250

300

350

After

Before

Tim

e in

Sec

on

ds

Subjects


Results

The Improvement

PreMetric

Post Metric

NVAT in Hours

Savings Potential Revenue

%Improved

Time

Accuracy

150.6 S.

0%

55.2 S.

100%

NA Hard

Soft

NA

NA

63%

100%


Control

Follow Up Plan

Next A3 Project: Maintenance of skills with PEM faculty through Simulation

Metric Frequency Who What to do if not in control

Time, and accuracy

Monthly ED Fellows Re evaluate


Next Steps



Next Steps

• If you are interested in signing up, please contact Jennifer Hoge in the COE!

Jennifer [email protected]


What it's like to be in a3 class

Healthcare

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