Lean Six Sigma Projects & Value Stream Mapping in Action! CPT Sylvia Beady Chief, Ancillary Services R.W. Bliss Army Health Center Ft.

Transcription

1 Lean Six Sigma Projects & Value Stream Mapping in Action! CPT Sylvia Beady Chief, Ancillary Services R.W. Bliss Army Health Center Ft. Huachuca, AZ

2 Objectives An introduction to the basic definition and steps of Lean Six Sigma (LSS) An overview of how the LSS tools works in other part of the healthcare services besides the laboratory (i.e. radiology & pharmacy A live demonstration of value stream mapping (VSM) simulation

3 Basic Definitions: The Keys to LSS

4 Example 1 5S Overview: Taking Action! Sort Set in Order (simplified) Shine (sweep) Standardize Sustain Anchoring Success in the Lab

5 Shipping Lean Six Sigma Improving Efficiencies Anchoring Success

6 PURPOSE: To create and maintain an organized, clean, safe, and high-performance workplace

7 Why Implement 5S? Enables anyone to distinguish between normal & abnormal It s s the foundation for continuous improvement, zero defects, cost reduction & safe work area It s s a systematic way to improve the workplace, processes, & products through employee involvement Minimize Non-Value Added: eliminate waste that does not add value to the process or product

8 What is Value Added Value Added: any activity that increases the form or function of the product. (These are things the customer is willing to pay for) Non-Value Added: any activity that does not add value to the form or function or is not necessary. Customer is not willing to pay for non-value added. Non-value added activities should be eliminated simplified, reduced or integrated into other activities

9 1S: SORT Goal: Remove all items from the workplace that are not needed for current production or tasks It does not mean that you remove only the items that you know you will never need It does not mean that you simply arrange things in a neater fashion When you sort, you leave only the bare essentials When in doubt, move it out

10 2S: SET IN ORDER: The goal is to Set in Order: Ensures what is needed for a job is in place and easy to find, use, and put back! Find ways to prevent the need for future cleaning!

11 Cleanliness: get the area looking clean and new 3S: SHINE Make it a habit: Assign responsibilities Make cleaning and organizing part of regular work duties Perform regular 5S audits and post results Prevention (take it to the next level): Make it difficult to NOT put things away

12 4S: STANDARDIZE Goal: Creating a consistent way of implementing the tasks performed daily, including Sort, Set in order, & Shine. It should be obvious at a glance when an item is not in its designated place Doing the right things the right way, every time

13 5S: SUSTAIN This takes discipline on everyone s part. Sustain, make it a habit to follow the procedures Practice, practice, practice! Teamwork! Personal accountability! Sustain ties Sort, Set in order and Shine together.

14 SUMMARY With 5S, ANYONE should be able to tell the difference between normal & abnormal Celebrate accomplishment & continue improving Make time each week to brainstorm & implement improvement suggestions

15 Example 2: DMAIC Define Measure Analyze Improve Control (DMAIC) A structured, data-based problem- solving process. That means Doing specific activities in a specific sequence (that s s the structured & process parts Gathering data in nearly every phase to help you make decisions (the data- based part) Making sure that the solutions your team decides to use will eliminate the cause of the problem you re trying to fix (the problem-solving part) Tracking TAT in Radiology

16 Radiology Unverified Reports Turn-around Time (TAT)

17 D M A I C Objective: Benefits: Unverified Reports TAT The purpose of this project is to improve the unverified reports TAT within SOP guidelines of 3 working days. Providers and Patients will receive timely reports and minimize delays in patient care. Project Team: Chief, Ancillary Services Assistant Chief, Ancillary Services NCOIC Radiology Radiologists Radiology Technician Schedule: Measurement: In progress Improvement: TBD Analyze: TBD Control: TBD

18 D M A I C Baseline Data Base line information 1434 unverified studies 140 unread 12 dictated status Data period: 11/1/02 9/30/06 FY07 unverified status are tracked separately

19 D M A I C High Level Map Project Output

20 D M A I C Low Level Process Map (1 of 2)

21 Radiology Study Process (With Severity Scores) Start HCP orders a study HCP send Pt to Rad Pt shows Rad Rad staff check-in Pt Rad staff checks validity of order No Return to HCP via telephone What % problem? 1-2% ~30/month on average (4) Pt may not show (1) Pt may show w/o order (2) non-valid order (3) Yes 98-99% ~10% found invalid by Radiologist Process Images Images Taken only 2 cassette readers (5) Tech or Clerk takes Pt to exam Rm Pt examined Yes Rad staff determines if exam is done T or sched No Pt rec d prep info & scheduled TAT(7) non-responsive facilities delay in treatment/diagnosis 1 down- slows down process QC Check O.k. Images sent to Radiologist Radiologist checks validity O.k. Radiologist Evaluate Film Priors Needed (this is standard) Yes Tech request prior images from originating facility Prior images received Yes A Not O.k. Not O.k. No No Retake Return to step 1 Proceed to Radiologist read films Sub Process for later A Radiologist reads & dictate films/ reviews priors Fwd to transcription for editing of texts (dictation) Radiologist receives, reviews, corrects, & electronically signs Power-scribe sends completed rpt to CHCS & AHLTA Power-scribe sends alert to ordering HCP HCP reviews report Stop occasional problem w/ upload (5) HCP notification DINPACS, CHCS, AHLTA checks & balance in place (7) outside script BB: CPT Beady

22 D M A I C Low Level Process Map (2 of 2)

23 D M A I C Measure Phase Data Collection (1 of 2)

24 D M A I C Measure Phase Data Collection Note: FY07 Tracking data; no decrease in baseline data report between Nov 2002 Sep 2006

25 D M A I C Analyze Phase - Status

26 Example 3: Lean + Six Sigma Process Flow DMAIC Fishing for Success in Pharmacy

27 Purpose: Improve efficiency in pharmacy, wait time and patient satisfaction report card Project Goal: 90% improvement in wait time within 30 minutes 90% patient satisfaction survey report card Project Y s Baseline GOAL units Wait Time % Satisfaction Survey Report %

28 Define Phase: Fishbone

29 Improving Pharmacy Efficiency Producing Results with Little Waste Measurement (???) Service after P2K Q-Matic estimated Wait Time vs. transaction time Staff shortage per day Patient complaints Materials [Define Phase: 5M s & 1P] Grey Cart (Lisa) Mail boxes Flammable Storage Key Box Red Bins Sign in board posted Shred it: Move to new side (Tom) Cork board (break room) TV (Tom) Men (personnel) Lack of/limited Information to patients Increased patient Wait time Macessan software more steps & more training Exemption from duty (golf cart) Help w/ Office Supply Stop Pick-point Support Increased Staff workflow Efficiency Safety (ECC) System failure (audio care, computer) Prepackaging (volunteers) Prepacks (fast mover) Key Control Interview Rm LCD Screen Schedules (2wk/4wk/6wk) Staff office (mbr teams: 58,59,60,61 Copy Rm Faxed orders not rec d or incomplete Data South Printer location Zebra Printers Mother Nature (environment) Method Machine

30 Lean Tool Box: Current Process Flow

31 Process Observation:

32 Process Flow chart:

33 Admin Area Staff Work Stations Sterile Room Supply Office Window #1 Window #2 Window #3 Window #4 Window #5 Window #6 Door Rx Shelf Rx Shelf Rx Shelf Rx Shelf Fill Station 3 2 Rx Shelf Fill Station 7 5 Rx Shelf Rx Shelf Fax 5 3 Refill Bins 2 Refill Bins 4 6 Rx Shelf 2 Rx Shelf Baker Cell Refill 6

34 Analyze Phase: Note: Measure Phase used C&E Matrix similar to Radiology Box Plot Chart & FMEA

35 Analyze: Wait Time vs. Week Day Sept 2006 Wait Time vs Week Day Week Day Mon Tues Wed Thur Fri Mon Tues Wed Thur Fri 0:00:00 0:30:00 1:00:00 1:30:00 0:00:00 0:30:00 1:00:00 1:30:00 7:00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 Mon Tues Wed Thur Fri 15:00 16:00 17:00 0:00:00 0:30:00 1:00:00 1:30:00 0:00:00 0:30:00 1:00:00 1:30:00 Panel variable: Hour Wait Time

36 Pharmacy Wait Time August 2006 Pharmacy Wait Time by Time of Day August Morning Afternoon Frequency Area to improve Frequency Longest wait time Wait Time Wait Time Q-Matic Daily Category Q-Matic Daily Category CHCS-Volume Summary Report Total # Rx Mon Tue Wed Jul Thur Fri Mon Tue Wed Aug Thur Fri Main

37 Failure Mode & Effects Analysis

38 Improve Phase: Key Points

39 Processes Under Improvement: Communication Organization Staff involvement/awareness Overall wait times

40 Example 4 VSM Simulation

41 QUESTIONS.

42 References: George, M., Rowlands, D., Kastle B. What is Lean Six Sigma? 2004 George Group Phillips Corporation presentation