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INTRODUCTION TO
PROCESS IMPROVEMENT AND LEAN SIX SIGMA
WHITE BELT TRAININGJANELLE SEENATH
UPDATED 2/6/18
1
OBJECTIVES
1. What is Process Improvement
2. Understand Common Improvement Methodologies
3. What is Lean and Why Lean
4. What is a Lean Project
5. Who is doing Lean
6. Common lean terms: muda, gemba, kaizen, yokoten
7. 8 Basic Improvement Tools
8. Understand the roles and responsibilities of the
members on a project team
9. Know how to select a project and identify your project
stakeholders
10.Understand the importance of teaming
2
12 BREAKTHROUGH PRIORITIES
Increase Access to Health Care
Veteran facing VA internal facing
Implement Care in the Community
Deliver a Unified Veterans Experience
Improve the Comp & Pension exam
Improve the Veteran Experience
Modernize our Contact Centers (to include Veterans Crisis Line)
Develop a simplified Appeals process
Continue to reduce Veteran
homelessness
Staff critical positions
Transform OIT
Improve Employee Experience(to include leadership development)
Transform Supply Chain
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WHAT IS PROCESS IMPROVEMENT (PI)?
Definition:
It is the proactive task of identifying, analyzing
and improving upon existing processes within
an organization for elimination of causes of
poor quality, process variation, and non-value-
adding activities for optimization and to meet
new metrics or standards of quality.
4
TYPES OF PROCESS IMPROVEMENT
Process Improvement Projects Come in Different Sizes:
• Process Reengineering involves wiping out the current
process and creating a brand new one from the ground up.
• Process Redesign projects are a little smaller in scope and
involve maintaining the basic framework of the process while
improving significant components. Sometimes, there is a fine
line between process redesign and reengineering projects.
Stellar results are possible in a process redesign project. This
basic methodology, with a few modifications, can be used to
improve processes of various sizes and scopes, from the
largest reengineering project to a small quick-hit fix.
5
• Healthcare/System Redesign involves
making systematic changes to practices
and health systems to improve the quality,
efficiency, and effectiveness of patient care
• Goal: To improve healthcare quality,
reliability and access to care for Veterans
SYSTEM REDESIGN
6
WHAT IS LEAN?What is Lean?
• Continued focus on providing customer value
• Drive continuous incremental improvement
• Provide the customer exactly what’s needed at the right time
• Daily focus to eliminate all forms of waste
• Long term vision out weighs short term gain
• Speeding up the operation by eliminating idle time created by paperwork and bureaucracy
• A way of thinking
“LEAN provides a way to specify value, line up value creating actions in the best sequence, conduct these activities without interruption whenever someone requests them, and perform them more and more effectively.”
by James Womack and Daniel Jones (1996)
7
Changing the Way We Do Business
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Why LEAN?
• There is an urgent need for business, process and cultural transformation. System
redesign and it’s LEAN components have been chosen to achieve this goal.
LEAN has proven to:
• Effectively reduce organizational costs
• Increase process efficiency
• Improve customer value
Lean is:
• Committing to not accepting defects, not creating defects, & not passing defects on
• Never forgetting why we are here
• Committing to making a positive difference!
CUSTOMER’S PERSPECTIVEEvery step in the process should be perceived as adding value (no waste): “It does what I require and expect it to do, when and where I want it done.”
The perfect process: • Creates value for the patient • Produces a good result every time• Does not cause delay• Is flexible• Is linked by continuous flow• Is satisfying
• for staff to perform• for managers to manage• for patients to experience
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The “lean” perspective is the
customer’s perspective.
Your project reflects your
understanding of the customer,
their circumstances, and their
perception of value.
LEAN PERSPECTIVE ABOUT PROCESSES
10
LEAN is a methodology that shortens the time between start and finish of
any given process by eliminating unnecessary and non-value adding
sources of waste.
11
HOW LEAN IS DONE?
Through:• Team work
• Critical thinking
• Transparency
• Courage
• Committing to having a roadmap for each project and using it
• Continuous learning
• Committing to not accepting defects, not creating defects &
passing defects on to other steps in the process
• Committing to making a positive difference!
12
We can’t solve problems by using the same kind of
thinking we used when we created them. - Albert Einstein
Can you solve:
https://www.youtube.com/watch?v=vKA4w2O61Xo
WHAT IS A LEAN PROJECTA Lean project is any effort that embraces Lean thinking and adheres to a methodology. There are six core VISN2 South Lean methodologies:
1. A3 Problem-Solving (9 steps or boxes) for process improvements where barriers or muda are evident.
2. 5S / 6S for disorganized work spaces (sort, set in order, safety, shine/simplify, standardized, and sustain.
3. Lean (pull systems, flow, 5S / 6S, value stream mapping) for cycle time and wait time issues
4. The scientific method for improving processes when causes of problems are simply not known.
5. Six Sigma DMAIC which mirrors the scientific method, and used where unacceptable variation or defects exist, or root causes of problems or issues are unknown or not well understood. Teams proceed through Define, Measure, Analyze, Improve, and Control phases.
6. Project Management for implementing and managing projects and changes.
7. Others
13
METHODOLOGY CROSS WALK
VA-TAMMCS
VISION
ANALYSIS
TEAM
AIM
MAP
MEASURE
CHANGE
SUSTAIN
SIX SIGMA
DMAIC
DEFINE
MEASURE
ANALYZE
IMPROVE
CONTROL
PDSA
PLAN
DO
STUDY
ACT
PROJECT
MANAGEMENT
INITIATE
PLAN
EXECUTE
MONITOR &
CONTROL
CLOSE
A3 9BOX
1. REASON FOR ACTION
2. INITIAL STATE
3. TARGET STATE
4. GAP ANALYSIS
5. SOLUTION APPROACH
6. RAPID EXPERIMENTS
7.IMPLEMENTATION/
COMPLETION PLANS
8. CONFIRMED STATE
9. INSIGHTS 14
Define Measure Analyze Improve Control
DMAIC
• Brainstorming
• VOC/Interviews
• Stakeholder
Analysis
• Pareto Analysis
• Cause and Effect
• Process
Documentation
• Process Map
• SIPOC
• FMEA/FMECA
• POA&M
• Define Project
statement
• VOC/Interviews
• Specifications
• Requirements
• Process/Product
Data Collection
• Process Maps
• Control Chart
• MSA
• FMEA/FMECA
• Defect and
Defective
Product/Process
• First past Yield
(FPY)
• Descriptive
Statistics
• Descriptive
Analysis
• SIPOC
• RASCI
• Pareto Chart
• Cause & Effect
Diagram
• Affinity Diagram
• Process Map
• FMEA/FMECA
• Capability
Analysis
• Process/Product
Analysis
• 5 Whys
• Process Map
• Brainstorming
• FMEA/FMECA
update
• PDSA
• Pareto Analysis
• Solution
selection matrix
• MSA
• Process
Capability
Analysis
• Implementation
Plan
• Final Process Map
• Final
FMEA/FMECA
• Implementation
Plan
• Control Plan
• SIPOC
• RASCI
• SPC Plan
• Audit Plan
• Training/transition
plan
• Project Notebook
Well Defined
Project Scope
& Metric
PDSA
of Improved
Process
List of Proposed
Improvements
to Process
Measure of
Process/Product
Effectiveness
More
Effective
Process
15
PLAN, DO, STUDY, ACT (PDSA)
16
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A3 9BOX METHODOLOGY
What is the A3 problem-solving process?
What are the 9 steps?
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CORE IDEAS OF LEANPull vs. Push: Let the patient pull the product or service
No delay versus delay (eliminate delays)
Parallel versus sequential process flow (do more things in parallel)
No action versus action (eliminate unnecessary processing)
No movement versus movement (eliminate unnecessary movement)
Determine value using the VOC (what does the veteran want?)
Use the “pull” system to avoid overproduction (batching of lab tests)
One-piece flow make the process flow with out interruptions or wasted time
Level out the workload to the rate of customer demand
Stop and fix problems immediately when they appear
Standardize processes to support improvement
Use visual control so no problem remain hidden
Only use reliable technology that supports the people and the process
From Lean Six Sigma for Hospitals by. J Arthur
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WHO IS DOING LEAN
20Mayo Clinic CEO John Noseworthy:
https://www.youtube.com/watch?v=nO_7HyQ1X2k
WHAT IS “LEAN” THINKING?
• The Toyota Production System (TPS)
• The Toyota Way – Jeffrey Liker
Outlines 14 principles of the Toyota Way; i.e., “LEAN Thinking”
• Philosophy
• Process
• People and Partners
• Problem Solving
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PHILOSOPHY
Base your management decisions on a long-term
philosophy, even at the expense of short term goals.
Most difficult is
most important
Leaders must take responsibility
Start with goal of generating value for customers, society, and the economy – NOT
an endpoint
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PROCESS
Bring problems to the surface.
Use “pull” systems to avoid overproduction.
Level the workload (tortoise)
Culture of stopping to fix problems. Quality right 1st time.
Foundation of Standardized Tasks.
Visual controls, no hidden problems.
Use only reliable, tested technology.
24
PEOPLE AND PARTNERS
Grow leaders who thoroughly understand the work, live the philosophy, and teach it to others.
Develop exceptional people and teams who follow company philosophy.
Respect your extended network of partners and suppliers by challenging them and helping them
improve.
25
PROBLEM SOLVING
Go and see for yourself to thoroughly understand the
situation - GEMBA
Make decisions slowly by consensus, thoroughly considering all options; implement decisions
rapidly.
Become a learning organization through
relentless reflection and continuous improvement.
26
Kaizen – “continuous improvement”. Many use the term Kaizen to
mean short duration improvement projects, 1 to 2 days.
Sometimes, these are called, “kaizen events”. We in the VA tend to
use the term to mean Rapid Process Improvement Workshops
(RPIW) that may take from 3 to 5 days.
Gemba – “the scene”. We use the term Gemba to mean the area
under study; or the place where the process lives and where the
action takes place! “Gemba walk” or “walking the Gemba” refers to
walking around and observing a process for the purpose of
understanding, and documenting the current “as is” process.
Muda – an activity that is wasteful and doesn’t add value as defined
from the customer’s point of view
Yokoten - is copying and improving on proven solutions.
COMMON LEAN TERMS
27
LEAN = Eliminating the Muda or waste; i.e. unnecessary
burden of non-value added work, tasks, things
Typically 95% of Health Care Process Time is non-value added!!!
Eight Forms of Waste
1. Defects
2. Overproduction/Overprocessing
3. Waiting
4. Not Utilizing People/Resources
5. Transport
6. Inventory
7. Motion
8. Extra Processing
Non-value added
Value added
WHAT IS WASTE?
28
DEADLY WASTES: DOWNTIME
DefectsErrors or mistakes causing rework to correct
the problem
Wrong-site surgeries
Medication errors
Label on the wrong tube
Patient complaints/decreased satisfaction scores
Over-
Production/
Processing
Creating too much material or information
To many approval steps in the process
Batching, delivering set number of items at one
time
Pre-printing documents
WaitingWaiting for material or information, or material
or information waiting to be processed
Patients waiting to make appointments
Patients waiting to be seen for an appointment
Waiting for labs, ancillary tests
Not utilizing
People/
Resources
Not utilizing or underutilizing the talent (scope)
of employees or use of resources, staff not
involved in improvement projects
Top down improvement approach
No Voice of the Customer
Transport Moving material, information, patients
Moving patients from room to room
Charts not centrally located
Poor layouts, lab located a long distance from
the ED
InventoryHaving more material or information than you
need
Overstocked medications on units/floors
Overflowing supply bins, racks, shelves,
excessive stock
Motion Staff motion to get material or information
Excessive bending, reaching, walking to
get supplies
Heavy items on top shelf, light items on bottom
Extra-
Processing
Processing more than necessary to achieve
the desired output
Multiple copies (paper and electronic)
Multiple steps for approval, multiple signatures
Multiple blood specimen collections 29
8 BASIC PROCESS IMPROVEMENT TOOLSVoice Of the Customer Table capture the
customer needs and helps translate it into actionable measureable
performance steps
Control Charts to measure and monitor the
performance of any process.
Pareto Charts identify the most frequent types of
defects, mistakes and errors.
5 Why’s or Ishikawa (fishbone) diagrams identify
the potential root causes of the problem.
Check sheets to quantify & understand the magnitude
or frequency of the problem
Flow Charts identify current process steps
Run Charts shows data process over time
Box Plots display differences between populations without
making any assumptions
30
31
Control chart
Pareto chart
Check Sheet
32
ROLES AND RESPONSIBILITIES
33
ROLES & RESPONSIBILITIESTeam:
Share the workload and support the team lead in the
successful execution of the project. Should possess
the following skills and abilities, data gathering, data
analysis, focus, commitment to the project and team,
ability to use MS word, MS. Excel, MS. PowerPoint.
Project Leader:The individual who is responsible for keeping the
project team on task and on schedule towards
achieving the project teams goal. Key: Courageous,
leader, follower, focused on results, & timely
completion.
LEAN Coach/Facilitator:Not the project leader, but advisor and coach
regarding appropriate methodology, tools, and
application, investigator, team builder, communicator,
problem solver. Must demonstrate competencies,
learning, & growth. Must facilitate curriculums. Key:
knowledge transfer
Financial Rep:Validator of cost and revenue calculations, evaluator of
benefit categories and translation into financial/budget
terms as avoided costs and actual project savings and
new revenues.
Process Owner/Champion:Co-owner of projects, roadblock remover, strategist,
communicator, alliance builder, reality checker,
identifies/assists in getting resources, identifies and
ensures alignment of projects to strategic objectives;
focuses on meaningful, measureable, scalable,
sustainable results. Responsible for progress. Key:
Authority & availability.
Project Sponsor: Provide guidance relative to the selection and
application of the project benefits, effort and risk
evaluation criteria. Recommend project candidates.
Approve and fund the project.
Supervisor:Assess the resourcing (funding, man-hours, facilities,
equipment) that will be required to execute the project.
Concur in the approval of the project.
VISN Network Office Coach:Consultant, technical advisor, mentor, strategist
focused on facility and team support, high reliability,
sustainability, and transformation; continuous learner,
change agent, curriculum design, improvement
practices, and standards. Coach the coaches and
sometimes teams and team leads.
34
35
PROJECT SELECTION PROCESS (SCOPE)
Initial Project:
• Local-level project (i.e., usually within individual’s office/team).
• Must have an impact on the operation of a specific unit
(process/team/office/department) of the organization, in terms of one or more
of the following areas: Quality, Cost, Schedule and/or Risk
• The scope of the project should be narrow as it affects a single process or unit
of the organization
Advance Project:
• Strategic-level project (i.e., cross-departmental, leverage-able/replicable,
multi-command or cross-agency type).
• Must have an impact on the operation of more than one organizational unit
(multiple teams/offices/departments) in terms of one or more of the following
areas: Quality, Cost, Schedule and/or Risk
35
36
BENEFITS – EFFORT/RISK EVALUATION
MATRIX EXAMPLE
Potential Projects
(Priority (9) x Criteria Score (9) = 81)
Pri
ori
ty
(we
igh
t)
Reduce LOS
Inventory
Process
Maintenance
Process
Be
ne
fits
Support Organization Strategy 9 81 27 9
Attract New Business 3 3 3 9
Reduce Operating Cost 9 81 27 81
Improve Ease of Use 3 27 3 3
Total Benefits Ranking 192 60 102
Eff
ort
/R
isk Project Cost 3 9 9
Project Resources 0 3 9
Internal Resistance 1 9 9
Total Effort/Risk Ranking 4 21 27
36
STAKEHOLDER ANALYSIS
What is a Stakeholder Analysis?
• A disciplined project risk management method for identifying the
stakeholders, assessing potential stakeholder impact and planning for
stakeholder involvement
Why perform a Stakeholder Analysis?
• To assure that all of the stakeholders are identified
• To identify the stakeholders’ interest in and expectations of the project
• To assess the stakeholders’ attitude toward the project
• To plan for the stakeholders’ involvement in the project
• To plan for the communication of the core project team with the
stakeholders
37
STAKEHOLDER ANALYSISWho are your Stakeholders?
• Any individual who can have an effect on a improvement project or
will be affected by the improvement project team recommendation
• All of the stakeholders are to be included as a project team member
(either full time or ad-hoc)
When to perform a Stakeholder Analysis?
• Early in the initial phase of the project
Who performs a Stakeholder Analysis?
• The core project team members perform the analysis and
coordinate the results with the project sponsor, process owner and
coach/mentor
38
STAKEHOLDER ANALYSIS WORKSHEET
39
SUCCESSFUL TEAM INGREDIENTS
• Clearly defined goals
• Clearly defined roles
• Interpersonal and Team Skills
• Cooperative
• Balanced Participation
• Ground Rules
• Team Tools
• Face-to-Face Interaction
• Trust
• Communication
40
TEAM DEVELOPMENT MODEL
41
• Expert knowledge & Experience
• Improvement Advisors, lead teams and advise coaches, facilitate trainingsBlack
• Knowledge & experience in advanced tools & leading projects
• May lead projects and coach and facilitate for improvement teams
Green
• Knowledge of basic tools & some experience applying them
• Active participant on improvement teams
Yellow Belt
• Basic understanding of Lean Principles, define value, Identify Waste
• All Staff
White Belt
4 Levels of Lean Mastery
See your lean coach
about training &
certification opportunities
You are here
42
REVIEW
1) What is Process Improvement?
2) What is Lean?
3) What are the Lean methodologies?
4) What are the common lean terms?
5) What are the 8 basic process improvement tools?
6) What are 8 forms of waste?
7) Why is project selection important?
8) Why is stakeholder analysis important?
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44
QUESTIONS
Janelle Seenath, System Redesign Coordinator/Supervisor x4755
Barbara Carralero, System Redesign Health System Specialist X3087
LOCAL PROCESS IMPROVEMENT EXPERTS
AND GOOD PEOPLE TO KNOW…
45
Project Title:
Project Start Date:
Project Origin/Alignment breakthrough priorities:
Process Owner:
Team Lead:
Team Coach:
Project Champion:
Team Members:
Key Metric or Deliverable:
Aim - 1. Reason For Improvement
Problem Statement:
Scope:
Trigger:
▪ Process Start –
▪ Process Stop –
Limitations:
Box 1 – Reason for Action
Map - 2. Current State
List of Current State Attributes:
Box 2 – Current State
Baseline Data
Metric Current (Dates)
Box 2 – Current State
Map - 3. Target State Box 3 – Target State
List of Target State Attributes:
Measure - 4. Gap Analysis
Note: Show the gap between the Current State versus Target State, for example:
• Waste difference (i.e. comparison of Value-Added, Non Value-Added But Necessary, and Non Value-Added and Unnecessary process steps)
• Metrics comparison
• Process step comparison (i.e. difference in the total number of process steps)
• Gap Analysis Tools Used (i.e. 5 Whys, Fishbone Diagram, etc…)
• Identified Problems and corresponding Root Cause(s)
Box 4 – Gap Analysis
Measure - 5. Solution Approach
If we do this… …then we will achieve this….
Box 5 – Solution Approach
Change - 6. Rapid Experiments
Plan Do Study Act
Box 6 – Rapid Experiments
Change - 7. Completion Plan
What Who When Status
Box 7 – Completion Plan
Sustain - 8. Confirmed State
Metric Baseline Goal ActualCountermeasures [Please describe control/sustain tools, like dashboards, control charts, visual controls, etc.]
Baseline or below
Above Baseline, trending to goal
Goal or better
Box 8 – Confirmed State
Sustain - 9. Insights
What went well?
•
What did not go well?
•
Lessons Learned
•
Box 9 – Insights