How Do We Know Where,
What & How to Improve?
Jennifer Hooks MBA
Manager, Performance Improvement
Six Sigma Master Black Belt
Lean Sensei
Chris Rees, MHSA, MBA
Director of Quality and Safety
Six Sigma Master Black Belt
Objectives
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Overview of Performance Improvement
Introduction to LEAN thinking
Learn How to Pick a Successful Project
Define What Makes a Good Problem
Statement
• Illustrate the Importance of Measurement
• Group Work - Define a Project to Address
Your Business Problem
How To Improve?
There is no magic answer
Despite What the Book Sellers will Tell you
How to Improve?
No Magic Answer, but some basic
must haves:
• Use a Standard, Disciplined
Approach.
• Focus on:
– Reducing Waste and Inefficiencies,
– Reducing Variation and Eliminating
defects.
Basics of All Approaches
• Use a team – Trust the Group
• Clearly identify what it is you are trying to
improve – Define your process & metrics
• Measure and analyze data, both
Quantitative and Qualitative
• Focus only on the important issues
• Validate that the results met your
objectives
• Have a plan to sustain results
Going Lean
Can it work for the
Medical University?
What is 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!
In healthcare, Lean is about shortening the time between the
patient entering and leaving a care facility by eliminating all nonvalue added time, motion, and steps.
What Lean is not
• Layoffs
• Customers = widgets
• Making people work faster
• Short term cost reduction program
Origins of Lean
• Henry Ford, 1920s
• Continuous Flow
Assembly
• Reduce wasted time
– 1913-1914: doubled
production with no
increase in workforce
– 1920-1926: Cycle time
from 21 days to 2 days
Origins of Lean
• Taiichi Ohno (1912-1990)
• 1950’s: Toyota Production
System
– Continuous Flow
Production
– Just-in-Time (JIT)
– Eliminate defects
– Eliminate “MUDA”
– Top management
commitment
– Employee participation
Lean Thinking Process
The 5 steps to Lean Thinking …
Specify value from the customer’s
perspective and express value in
terms of a specific product
1
Specify Value
The complete elimination of
waste so all activities create
value for the customer
2
Map the
Value Stream
3
Establish
Flow
5
Work to
Perfection
Nothing is done by the upstream process until the
downstream customer signals the need
Map all of the steps…value added,
non-value added and…non-value
added required that bring a product
of service to the customer
4
Implement
Pull
The continuous movement of
products, services and information
from end to end through the process
What are your customers willing to pay for?
Who Is the Customer?
VA NVA-R NVA
1 Specify Value
• Value is determined by the
customer
– The customer must be willing to pay for
the activity
– The activity must change the form, fit or
function of the service or product
– The activity must be done right the first
time
2 Map the Value Stream
3 Implement Pull
• Produce work when initiated by
customer demand
• Smooth communication between
process steps
• http://www.youtube.com/watch?v=0
YGF5R9i53A&feature=related
4 Establish Flow
• Remove non-value-added activities
(wastes) from the process
• Keep work moving at all times
• Eliminate congestion
Identifying Wastes
Transportation
Inventory
Motion
Waiting
Overproduction
Over
Processing
Defects
Non-utilized
Talent
Moving
equipment to
different meeting
rooms.
Overfilled
stationery
cupboards.
Medical students
walking from
wards to lecture
theatres.
Students queuing
to register at start
of term.
Printing out
multiple copies of
meeting minutes
already sent
electronically.
Too many
meetings and
committees
Students being
given incorrect
exam marks
Underutilizing
people’s
knowledge and
creativity
Moving forms
between HR and
other
departments.
Stockpiling
headed
notepaper
Forms moving
around internal
mail
Waiting for exam
results.
Printing
unnecessary
documents
Several
colleagues
checking the
same paperwork.
Incorrect
expenses being
paid to staff
Uneven work
flow resulting
with some
team members
overburdened
while other
underutilized
Retrieving or
storing files
Excessive books
in the library.
Poor office layout
and design located far from
printer etc.
Sitting in a
meeting room,
waiting for
meetings to start
because people
are late.
Offering courses
that nobody
applies for
Repeated manual
data entry
Data entry
errors.
Moving
documents to
and from shared
equipment
Out of date
equipment that is
still stored.
Searching for files.
Waiting for
signatures.
Students
graduating in
subjects in which
there are no jobs.
Keeping local
databases which
replicate
University
databases
Incomplete
forms.
Same document
going back and
forth from one
office to another
to review
Listing courses in
UCAS that are set
to 0.
Meetings instead
of telephone calls
Waiting for faxes.
Producing reports
that nobody reads
Sending Reply all
e-mail
Out of date
mailing lists
etc.
Waiting for a
printer to be
repaired
Overly scrutinising
work when key
stakeholder has
approved it
Unused records
in the database.
Inaccurate
advice given to
staff and
students.
5S Philosophy: Organize the Workplace
Sort, Set, Shine, Standardize, Sustain
• A visually-oriented system
for organizing the workplace
to minimize the waste of
time.
• Clears the clouds
– Eliminates the waste of
motion/ looking for things
• Makes the abnormal visually
obvious
Step 1: Sort
Before
After
Separate the needed from the not needed
Step 2: Set
BEFORE
AFTER
A place for everything & everything in its place!
Step 3: Shine
“Shine” and inspect
equipment to ensure it is in
perfect working condition...
Add inspecting equipment
into your work routine.
Daily housekeeping is
important.
Regularly “shine” to ensure everything is in
perfect working condition and clean
Step 4: Standardize
Note: Blue taped outlines and
labels ensure equipment is quickly
found and returned to the same
spot every time.
Standard Work requires determining the best
method then following that method every time.
Step 5: Sustain
Develop a method for sustaining your gains
5 Work to Perfection
• A continual, never-ending journey
• Constantly work on shortening work
cycle
• Quality and Quantity
• Focus on what the customer values
Lean Goals
• Build trust by removing fear
• Initiate long-term cultural change
• Communicate the vision to all staff
• Active commitment of leadership is a must, in
both words and action
How to Pick a Project
Criticality
Critical to the Customer
*Customer Satisfaction*
Voice of the Customer
• Identify the customer. Who is the recipient
of the output?
• Is the customer internal or external?
Understand that internal customer
satisfaction impacts external customer
satisfaction.
• Identify customer decision criteria. CQFA
– cost, quality, features, availability.
Is anybody listening?
Criticality
Critical to the Business
*Revenue Growth, Economic and Market Value*
Voice of the Business
• Strategic
• Identify and prioritize improvement initiatives to achieve
strategic goals and objectives
• Operations
• Risk management internal enabling processes that can affect
overall performance
• Reporting
• Corporate dashboards/balanced scorecards measure efficiency
and effectiveness
• Compliance
• Regulatory compliance
Listen to
Mission, Vision, Goals
Mission
Improve health and maximize quality of
life through education, research and
patient care
GOALS
•
•
•
•
Interprofessional/Interdisciplinary Practices
Technology/Innovation
Entrepreneurialism
Globalization
Root Cause Solution Unknown
Pick a problem that does not already have a known root cause or solution
Well Managed Scope
Large enough to significantly improve the process, but still small
enough to be manageable
Project should be within your control to make the recommended
changes in order to improve the process
Select a project that can be completed in a reasonable period of
time (3 months to 6 months max)
Chronic Issue
Select a problem that happens often
It is not worth the time and effort to develop a solution for a problem if
it is unlikely to happen again
Difficult to collect past data to analyze the causes because the problem
occurred only once in the past
Good Leadership Support
Essential support from MUSC leadership goes beyond providing
teams with the needed resources (time, money, people, etc.)
Ensures ongoing comprehensive communication throughout the
entire organization for the life of the project—beginning to end
Execute the IMPROVE Methodology
IMPROVE Roadmap
Important to YOU!!
Passionate, Interesting and Exciting
Exercise
Group Work - Define a
Project to Address Your
Business Problem
Define the Problem
• Initial Questions to Ask:
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–
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–
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What is the problem?
What is the benefit of reducing the impact of this problem?
What is the Measurement?
Who is my customer?
What matters to them?
• How do they define quality
– What is the scope?
• You can’t solve World Hunger!
– What is a reasonable goal, a definition of success?
• Remember your goal should be S.M.A.R.T.
– Specific, Measurable, Achievable, Relevant, and Time
bound
Exercise
• Work at your tables to answer the
questions from the last slide and
create a problem statement for this
case study
– A problem statement has the form:
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•
•
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WHAT is wrong
WHERE it happened
WHEN it occurred
Why is this a problem
– A problem statement:
• Does not include causes of the problem.
• Does not include likely actions or solutions.
• Is clear, concise, and specific.