Lean and Six Sigma Healthcare Fad or Reality. Vince D Mello President

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1 Lean and Six Sigma Healthcare Fad or Reality Vince D Mello President

2 TODAY S DISCUSSION About Lean Methodologies Application benefits and outcomes About Six Sigma Key learning's

3 QUALITY FUNDAMENTALS Function of leadership Journey not a destination Opportunity to learn and improve Select the appropriate tool for the situation Involve front line staff Integrate clinical, operational, financial, and patient safety criteria for best ROI TQM, world class = Baldridge award

4 SUCCESSFUL CHANGE REQUIRES: Vision Skills Incentive Resources Action plans ( A & B)

5 SIX SIGMA THEME: Genuine Focus on the customer Data and Fact Driven Management Proactive management Collaboration Drive for excellence

6 WHAT IS SIX SIGMA? A sophisticated, comprehensive and flexible program for achieving, sustaining and maximizing organizational improvements, using a structured approach.

7 WHY SIX SIGMA? Structured problem solving approach Healthcare complex, challenging with many fragmented processes Eliminate non value added activities Flavour of the year meeting success Improve patient safety and satisfaction Enhance operational efficiencies, reduce variations

8 WHAT DOES SIX SIGMA MEAN? σ PPM 2 308, , , Sigma Level Defects per Million Opportunities

9 ANOTHER WAY TO LOOK AT IT σ % Non-Defective % % % % %

10 DEFECTS AND ERRORS: # of Specimens # of Specimens with QA Incidents % Incident Rate Defects per 10 6 (DPM) Sigma Metric** 50,

11 What is LEAN? Strategy to eliminate waste and non value added activities

12 LEAN Principles Specifies value as defined by the client Value stream mapping to compare current vs future state Workflow (continuous vs batch) Customer wants vs unwanted Perfection = LEAN culture (reduced errors, costs, effort, space, time, inventory)

13 What is 5 S? Sort Simplify Systematic cleaning Standardizing Sustaining

14 Why LEAN? Optimize: Workflow Service delivery Supply chain and inventory levels Space (floor, bench, storage) Cleanliness, functional layout, efficiencies

15 SIX SIGMA vs LEAN Six sigma helps reduce process variations and errors Lean reduces waste (not people) Biggest challenge with either is human aspects of change management Six Sigma takes months (start-finish) Lean takes weeks

16 THE SIX SIGMA DIFFERENCE Traditional Programs Driven internally Focuses on outcomes Fixes defects Improves quality Looks backwards High on theory and people Six Six Sigma Driven by the customer Focuses on processes Prevents defects Improves bottom line Looks Forward High on methodology and data Disciplined decision making

17 DMAIC METHODOLOGY

18 SIX SIGMA FOCUS Y = f (x) Y Dependant Output Effect Symptom Monitor X1 Xn Independent Input & Process Causes Problems Control

19 Six Sigma Phase DEFINE MEASURE ANALYZE IMPROVE CONTROL Tool Charter Initial Capability: Control Chart Process Map Cause & Effect Matrix Failure Mode & Effects Analysis Multi-Vari Statistical Indices Business Process Redesign Pilot Final Capability Control Plan Objective Initiate Project Define Measurable Objective Identify Defects Determine Scope Understand actual performance of the process to be improved (baseline data) Depict Process Flow with Steps, Inputs (influences) and Outputs (result variables) Select the most important Input X s from the Process map based on the strength of the effect that X s are thought to have on project Y Possibilities for errors in the Input X s which would create a process breakdown on the Process Y s are identified and evaluated Importance of Input X s is supported with data Correlations between Xs and project Y are investigated using statistical tests Cross functional process map is created for improved process showing who does the work and in what relative timeframe Input X improvements are implemented in a trial mode to verify effect on project Y Process improvement is demonstrated in measurable Y data Controls for critical Input X s are clearly identified and affected in order to maintain the improvement gained in the project

20 TYPICAL SIX SIGMA PROJECTS IN A HOSPITAL Medical error reduction Increase in capacity and throughput Reduction in cycle times any department Reduction in waiting times Length of Stay reductions Reduction in bloodstream infections

21 TYPICAL EXPENSES Construction costs Staff Training Backfills for staff Consultant fees

22 TYPICAL OUTCOMES Productivity improvements 30-40% Throughput increased 30-50% Space reduced 20-25% 25% Reduction in unit costs 25-35% Inventory reduced 40-50% ROI = less than 12 months

23 PROJECT SELECTION CRITERIA Strategic alignment with corporate priorities example reduction in wait times Champions available Staff available Positive history of teamwork Meaningful availability of data Improvement opportunity, high probability of success Timelines

24 LAB PROJECT EXAMPLES Improve TAT s Increase productivity / FTE Reduce costs/reportable test Workstation consolidations Improve operational efficiencies by reducing non-value added tasks

25 LEAN & SIX SIGMA BENEFITS Sets a performance goal for staff Enhances value to customers Promotes learning and interdepartmental- collaboration Enables strategic change

26 TIPS TO SUCCEED Strong Strong leadership formal and situational Senior Senior management champions Establish Establish upfront key principles and non negotiables Address Address barriers to progress Select Select a Just Do It implementation team Skilfully Skilfully manage change, setbacks and staff concerns Communicate, Communicate, Communicate

27 TIPS TO SUSTAIN GAINS Nurture a culture of improvement Value Value client feedback Focus Focus on patient care benefits Use Use meaningful Benchmarks Sell Sell as growth and development opportunity for staff Think Think added value Measure, Measure, Measure, Measure Recognize and celebrate accomplishments

28 EXPECT TO LEARN Co-operation operation is critical for success Takes Takes focus, time and effort to get positive outcomes and sustain improvements Sceptics Sceptics will be pleasantly surprised with Lean and Six Sigma framework and outcomes Challenge perceptions/opinions with supporting data Use Use relevant data to drive decisions and plan improvements Process Process heightens awareness of realities and constraints between departments and identifies system wide challenges

29 SUMMARY Lean & Six Sigma are.. A measure of quality A process to improve An enabler for structural change DMAIC methodology can be used to improve any existing product or process One of many quality improvement tools Step towards achieving operational excellence!

30 CONCLUSION Adoption of quality tools and systems lead to best practices Emerging trend here to stay, impressive outcomes continue to be reported globally Important for improving patient safety and reducing process variation through elimination of problems

31 TAKE AWAY MESSAGE L = Leadership S = Strategic E = Excellence I = Influence A = Actions N = Never ends G = Goals M = Measure performance A = Acknowledge success

32 Thank You

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