1. Lean Six Sigma Overview Shana Dykema, MHA, CPPS

2. 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

3. 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 ( )
1950’s: Toyota Production System; Continuous Flow Production; Just-in-Time (JIT); Eliminate “MUDA”; Top management commitment; Employee participation
Dr. Walter Shewhart ( )
Statistical Process Control Charts -- 3 sigma deviations from the mean required a process correction
Dr. W. Edwards Deming ( )
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 – Virginia Mason Production System
MUSC
Introduces lean principles through IMPROVE model in 2010
Taiicho Ohno
Toyota Production System

4. 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.

5. 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

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

7. 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

8. Is 99% Good Enough? Defects per Million Opportunities
(3.8 Sigma)
% 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 % 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

9. 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

10. 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.

11. 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

12. Define
Measure
Analyze
Improve
Control
Subway VS Jimmy John’s

13. 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

14. 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

15. 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

16. 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

17. 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

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

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

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

21. 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