Lean Six Sigma Overview Shana Dykema, MHA, CPPS

Lean Six Sigma Basics See a process as a sum of its parts and not as a whole. Process Step 1 Process Step 2 Process Step 6 Process Step 3 Process Step 5 Process Step 4

Lean and Six Sigma History James Womack & Daniel Jones “Lean Thinking” Henry Ford Continuous Flow Assembly Dr. W. Edwards Deming PDCA (Plan Do Check Act) “Lean” Coined by Jon Krafcik 1900 1920 1940 1960 1980 2000 World War II US Auto Industry Crisis 1910 1930 1950 1970 1990 2010 Dr. Walter Shewhart Statistical Process Control Bill Smith Father of Six Sigma Virginia Mason Medical Center First to use Lean in Healthcare Key points: -- In practice, lean has been around for a long time – always looking for ways to work faster, smarter, better -- Major players in developing lean and six sigma: Ford, Toyota and Motorola -- Health care began using lean in 2001 – Virginia Mason Medical Center -- MUSC began using lean in 2010 Henry Ford, 1920s Continuous Flow Assembly -- reduce wasted time Doubled production with no increase in workforce -- cycle time from 21 days to 2 days Taiichi Ohno (1912-1990) 1950’s: Toyota Production System; Continuous Flow Production; Just-in-Time (JIT); Eliminate “MUDA”; Top management commitment; Employee participation Dr. Walter Shewhart (1891-1967) Statistical Process Control Charts -- 3 sigma deviations from the mean required a process correction Dr. W. Edwards Deming (1900-1993) Father of modern quality management -- PDCA (Plan Do Check Act) Bill Smith (1929 – 1993) Father of Six Sigma -- introduced statistical approach while at Motorola in mid-80s Jon Krafcik – former Hyundai Motor America President & CEO Coined “lean manufacturing” -- describes Toyota’s system of getting by with half of everything (physical space, labor effort, capital investment, inventory – far fewer defects/safety incidents James Womack Founder of Lean Enterprise Institute Lean Thinking – “bible” of lean manufacturing Virginia Mason Medical Center Introduced continuous improvement concepts based on Toyota’s production system – 2001 -- Virginia Mason Production System MUSC Introduces lean principles through IMPROVE model in 2010 Taiicho Ohno Toyota Production System

Lean The relentless pursuit of the perfect process through waste elimination. We spend 75-95% of our time doing things that increase our costs and create no value for the customer! Patient Discharge Processes have halved their discharge times for patients in some units around MUSC In healthcare, Lean is about shortening the time between the patient entering and leaving a care facility by eliminating all non-value added time, motion, and steps.

Finding the Waste G R S T L N E Y F C D A O P U H J K M B I V X Q Z W Waiting - Idle time created when material, information, people, or equipment is not ready Overproduction - Doing too much, too soon or “just in case” Rework - Not doing things right the first time; work completed due to errors Motion - Movement of people, product, supplies that does not add value Processing (Over) - Unnecessary processing or procedures Inventory - More materials, parts, or products on hand than the customer needs right now Intellect - Underutilization of staff intellectual potential Transportation - Any excess movement of patient, materials or supplies to complete a task

Six Sigma Way of systematically improving processes by minimizing process variation by eliminating defects and errors.

What is Six Sigma? #91 #43 #99 68.26% 1 Sigma Ask someone in class to name their favorite college football team. Scenario: last few minutes of game – score is tied – within field goal range but not close enough to be a sure thing – have three kickers – click to show how each kicker kicks Ask class which kicker they want to send in. Click again – bell curve comes up. Explain Six Sigma. A statistically based process improvement methodology for reducing defects and variation Six Sigma seeks to reduce defects, errors, and variations in processes Don’t worry about the Algebra. Avert your eyes If you can add, subtract, multiply and divide, you’ll be fine! 3.4 defects per million opportunities (DPMO) #43 #99

Is 99% Good Enough? Defects per Million Opportunities (3.8 Sigma) 99.99966% Good (6 Sigma) 200,000 wrong drug prescriptions per year 68 wrong drug prescriptions per year 5000 incorrect surgical operations each week 1.7 incorrect surgical operations each week 99% sounds pretty good? Six Sigma = 3.4 defects per million opportunities Working to perfection 99% of the time vs. 99.99966% of the time. Tie to hand hygiene compliance and infection rates Defects per Million Opportunities “The number of errors per unit observed divided by the number of opportunities to make a error for the process being studied normalized to one million.” Benefits: Greater predictability Less waste & rework = lower cost Products & services perform better & last longer Happier customers who value you as a supplier 770 coding errors per day 10 coding errors per year 14.4 minutes of unsafe drinking water per day 0.3 seconds of unsafe drinking water per day

Roadmap D M A I C Identify the Problem Identify Critical Measures Problem Analysis Develop Potential Solutions Monitor & Adjust Solutions Voice of the Customer Collect Data Look for Root Causes Select Best Solutions Capture and Sustain Gains Define Scope Determine Process Performance Prioritize Root Causes Build Implementation Plan Standardize Work Tollgate Tollgate Tollgate Tollgate Tollgate

With teamwork, the ultimate goal is the success of the project With teamwork, the ultimate goal is the success of the project. To attain that success you want to have the right people on your team – choose them for their expertise, knowledge, experience. Encourage everyone to participate – strength in numbers – everyone is working toward a common goal.

Team Roles Champion Process Owner Team Members Lean/Six Sigma Belt Senior leader Identifies ideas Commits resources Removes roadblocks Owns project success Knows process Owns solution Assembles team Documents process Manages process improvement cycle Ensures project gains are sustained Subject matter experts Change agents Selected by Champion or Process Owner Represent various functional areas 5 to 7 members Informal leader Lean/Six Sigma expert Guides team Keeps meetings on track Promotes interaction Not a team member

Define Measure Analyze Improve Control Subway VS Jimmy John’s

Define D Key Activities: Identify the Problem Gather the Voice of the Customer (VOC) Define the Scope Identify the Problem Voice of the Customer Key tools: project charter, SIPOC diagram Discuss problem and goal statements Define Scope Tollgate

Identify Critical Measures Determine Process Performance Key Activities: Identify Critical Measures & Collect Data Determine Process Performance Collect Data Determine Process Performance Key tools: data collection plan, process/value stream maps, fishbone diagram, process capability analysis Tollgate

Prioritize Root Causes Analyze A Key Activities: Conduct Root Cause Analysis & Prioritize Root Causes Problem Analysis Look for Root Causes Prioritize Root Causes Key tools: results of data analysis (from Measure phase), pareto chart, fishbone diagram, cost analysis, FMEA, regression analysis, control charts Tollgate

Develop Potential Solutions Build Implementation Plan Improve I Key Activities: Develop Potential Solutions Select Best Solution(s) Optimize Solution(s) Develop Potential Solutions Select Best Solutions Build Implementation Plan Key tools: design of experiments (DOE), implementation plan, Gantt chart, decision matrix or impact/ease matrix, 5S & visual management, poka yoke Tollgate

Monitor & Adjust Solutions Capture and Sustain Gains Control Key Activities: Monitor & Adjust Solution(s) Capture and Sustain Your Gains Standardize the Work C Monitor & Adjust Solutions Capture and Sustain Gains Standardize Work Key tools: control charts, control plan, optimized solution(s) Tollgate

Ensures project message is delivered to the right audience at the right time using the most effective medium of exchange

Documentation Good documentation is crucial Provides information about data Suitable for future use Contains best practices

“It is not enough to do your best; you must know what to do, and then do your best.” -W. Edwards Deming

Lean Six Sigma 101: An Overview for Beginners Tell Us What You Thought! Lean Six Sigma 101: An Overview for Beginners New to Lean/Six Sigma? This workshop is for you! This workshop will introduce participants to basic Lean and Six Sigma concepts and how they can be used to drive performance improvement at your organization. Participants will use a hands-on simulation activity to walk through the DMAIC methodology. Presenter: Shana Dykema, MUSC Health