Lean Six Sigma - A Prescription For Healthcare

Lean & Six Sigma; A Prescription for Healthcare April 7, 2009

WELCOME TO…

Lean & Six Sigma;
A Prescription for Healthcare

PRESENTED BY E-ZSIGMA (CANADA) INC.
CANADA’S LEADER IN LEAN, SIX SIGMA AND INNOVATIVE PRACTICES

CHALLENGES FOR CANADIAN HEALTHCARE
Primary Care Reform
the way in which primary care and primary health care services
can be organized to best serve population health needs
Health Human Resource Planning
the way in which a variety of health professions should be
deployed to provide health care services to the population
Cost and Sustainability
the way in which health care services are funded and the costs for
the future
Role of the Private Sector
the way in which health care is delivered and funded privately
Quality of Care and Measurement
the way in which decisions about healthcare interventions are
based on evidence of effectiveness to improve quality.
Source: Canadian Policy Research Networks, January, 2004

2 Lean & Six Sigma: A Prescription for Healthcare Tuesday April 7, 2009

Presented by e-Zsigma (Canada) Inc. I www.e-zsigma.com I 416.593.8026 1


THE DEMAND CURVE WE ARE FEELING

Source: Understanding Canada’s Health Care Costs, Health Canada, 2000


DEMAND ACCELERATORS & RESPONSES
ACCELERATORS
Emerging and New Technologies
major joint surgery, neonatal and fetal technologies, dialysis, organ
transplantation, genetic testing and therapy
Increased Incidence and earlier onset of Chronic and New Diseases
heart disease, diabetes, tuberculosis, Hepatitis C, HIV, and AIDS
Increased demand from an aging population
New Pharmaceuticals
Declining Productivity Gains & Changing Expectations
RESPONSES
Improved management of health care systems and delivery modes
Increased process and treatment efficiency and effectiveness
A public that is capable of making informed & appropriate choices




ORGANIZATIONS TURNING TO LEAN
Royal Victoria Hospital, Barrie
St. Michael’s Hospital, Toronto
Ministry of Health & Long-Term Care
University Health Network
Mount Sinai Hospital
Alberta Medical Association
Sykes Assistance Services
Health Canada
Hamilton Health Sciences
Joseph Brant Memorial Hospital
Eagle Ridge Hospital, Vancouver


LEAN & SIX SIGMA
LEAN
Patient/Customer Focused
A Paradigm Shift in the Way Value is Defined
5 Key Principles & Eight Associated Sources of Waste
A Value-Stream Based Approach: The “Flow” of Value (velocity)
Tools & Techniques to Improve Value Creation
Turn everyone’s “waste radar” on
Reduce or Eliminate the Inhibitors to Value Creation
Extremely Participative Problem-Solving , Event Driven, & Culturally Transforming

SIX SIGMA
Focus on process “problems”: Errors, Quality, Robust Process Design
Key to Success: Focus on Understanding Process Variation
Emphasis on data and analysis: Profound Knowledge!
Project-Centric: Well Defined Goals & Measurable Results
Rich & Diverse “Tool Box” for Analysis and Problem-Solving

“At e-Zsigma, we teach people to do Six Sigma and we CHANGE people to do Lean”



LEAN 101: THE EIGHT SOURCES OF WASTE
Inventory: Staff “squirreling away” personal supplies & equipment
Waiting or Delays: Physicians waiting for test results
Over-producing: Processing extra lab samples than necessary
Transportation: Moving patient across/outside hospital to receive
treatment
Motion: Retrieving patient file (hard copy) from central filing system
Errors/Mistakes: Misdiagnosis of type of infection in patient
Over-processing: Patient receives X-ray, then ultra-sound, followed later
by CT scan… X-ray redundant?
Underutilized human capability: Automated processes that need to be
“watched” as they complete. Inspecting quality versus producing quality.


LEAN 101: MAKING WASTE MORE VISIBLE
Process Flow Maps
Spaghetti Diagrams
Value Stream Maps
Cause and Effect Diagrams
Five “Whys?”
Pareto Charts
Workplace Organization
5S (Sort, Set, Shine, Standardize, Sustain)
Visual Workplace
Process Reports, Audits and Assessments




LEAN 101: VALUE STREAM MAPPING

• Current state?
• Future State?

Observing the process, Capturing data & Looking for waste….


LEAN 101: THE 5S EVENT
1. Sort: Separate what is needed in the work area from what is not. Then…
get rid of what isn’t needed!
2. Set in order: Organize what remains – in the order that it is required for
the process or task
3. Shine: Clean and inspect the work area/workplace
4. Standardize: Standardize the cleaning, inspection,
and safety practices – make it part of the job
5. Sustain: Establish an environment, including audits and visual cues, that
ensure the culture of 5S “sticks”
Note: Lean organizations have a standard that any “tool” must be able to be found within X
seconds (example: 60 seconds). A tool can be a piece of equipment, a document, a file, etc.
necessary for the work to proceed and value to be created.




LEAN 101: VISUAL WORKPLACE
The Challenge: People not having access to the knowledge they need to do
their jobs effectively and efficiently. What tasks? What priority? What
target? The “correct” way? Which tools and where can I find them?
Waste: Searching, asking, waiting, retrieving, reworking!
Visual workplace: Providing vital information when and where it is needed.
Easily understood & unambiguous work instructions on what to do,
when, and how.
Tools and methods to easily and reliably identify process errors ad
omissions as quickly as possible - at the source.
Real-time performance feedback so employees know where they stand in
terms of meeting goals or targets.
Encourage alignment of activities across and up and down the
organization so that they congruent with strategic goals and objectives.
Promote and communicate cultural change in the organization,
specifically the lean evolution.


SIX SIGMA 101: “Y IS A FUNCTION OF X”

The heart of “Six Sigma” thinking
The phrase “Y is a function of X" means that the value of Y (process
outcome) depends upon the value of x (process inputs), so Y can be
written in terms of X.
This philosophy has evolved into a robust, powerful problem-solving and
process improvement methodology used by hundreds of thousands of
organizations world-wide
Automotive, aerospace and manufacturing
Banking, insurance and financial services
Hospitality and service industries
Government and public sector
Healthcare



SIX SIGMA 101: THE IMPORTANT QUESTIONS
1. Do I fully understand the customer requirements? 1
(Target and Tolerance)
2. How much variation is in the process I use to meet 2
my customer’s needs?
3. How well does my process meet my customer’s
needs? How often? What is the impact on Cycle 3
time? Safety? Customer Satisfaction?

4. What are the root cause(s) of the process variation? 4 Y = F(X1..Xi)

5. Can I reduce variation within the process to reduce
5
the defects? (If not, get a new process.)

6. Can I center the current process on target? 6


SIX SIGMA 101: DMAIC APPROACH
Define… process improvement goals that are consistent with customer
demands and the enterprise strategy.
Measure… key aspects of the current process and collect relevant data.
Analyze… the data to verify cause-and-effect relationships. Determine
what the relationships are, and attempt to ensure that all factors have
been considered.
Improve… or optimize the process based upon data analysis using
techniques like Design of Experiments.
Control… to ensure that any deviations from target are corrected before
they result in defects. Set up pilot runs to establish process capability,
move on to production, set up control mechanisms and continuously
monitor the process.
Source: www.isixsigma.com




LEAN SIX SIGMA 101: ROBUST “TOOL BOX”
Define Phase – Key Tools
•VOC (Voice Of the Customer) •Cost of poor quality •“Critical To” Tree (CT Tree)
Define •Project scoping and problem statement •Change management •High level process map
•Team identification •Project contract
Measure Phase – Key Tools
•Process Mapping (including SIPOC) •Control Charts Basics •Binomial Distribution Statistics
•Rolled Throughput Yield (RTY) •Measurement System Analysis •Graphical Analysis and Techniques
•Basic Statistics (MSA) •Data Collection Plan
Measure •Central Limit Theorem (CLT) •Process Capability •Failure Mode & Effects Analysis (FMEA)
•Cause and Effect (C&E) Matrix •Cause and Effect (C&E) Diagram

Analyze Phase - Key Tools
•Advanced Graphical Analysis •Statistical Analysis •Confidence Intervals
oMulti-Vari Studies oHypothesis Testing •Power and Sample Size
oMain Effects Plots Means
Analyze oInteraction Plots Variation
Chi Square
Non-normal data
oCorrelation Proportion Analysis of Variance
oRegression Counts Analysis of Means
Improve Phase - Key Tools
•Modeling Designs of Experiments •Robust Design of Experiments •Screening Design of Experiments
Improve •Response Surface Design of •Survey Design of Experiments •Multiple Regression
Experiments

Control Phase – Key Tools
• Process Control Plans • Mistake Proofing • Statistical Process Control
Control • Gage Control Plans • 5S • Business Case Simulation Exercise
• Preventative Maintenance Control Plans • Standard Operating Procedure


SIX SIGMA 101: PROCESS EXCELLENCE




APPLICATION: LEAN SIX SIGMA IN E.D.


INITIAL TRIAL RESULTS
Metric Current Performance Trial Results

Time to PIA
CTAS 3 >2 Hours 30 Mins. Ave: 45 Mins.
CTAS 4 >2 Hours
70% Reduction

Length of Stay
CTAS 3 >4 Hours 30 Mins. Ave: 3 Hrs. 23 Mins
25% Reduction
CTAS 4 >3 Hours
%LWBS 6-7% Zero
(Expected to be <1%
ongoing)




LEAN SIX SIGMA BENEFITS
Reduced Patient Length of Stay D.I. – less batching, better flow
Increased Patient satisfaction Inside Clerk
Patient sees physician much quicker Less batching of patients/work
LWBS drastically reduced Simpler process
Faster patient flow Less phone calls and interruptions
Improved patient safety Less stress and greater job satisfaction
Physicians see patients sooner The Lab
RN Fewer unnecessary tests
More time for patient care Fewer add-ons
Greater % of time on VA activities Less batching of ER tests
Peace of mind (Pt. seen by Dr. first) Less need to phone ER
Better waiting room attitude Phlebotomist
Fewer interruptions at Triage One visit per patient
Less stress and Greater job No Hallway draws
satisfaction Less batching
Housekeeping – less batching Less frustration and greater satisfaction
For RVH C.I.T. has earlier intervention
improved reputation and image R.T. sees patient sooner
Potential future funding Barrie Community has a better ER
opportunities

E-ZSIGMA (CANADA) INC.
Canada’s leader in Lean, Six Sigma & Innovation strategy, consulting and
training
Canada’s only Certificate in Lean Six Sigma for Health Care
Schulich School of Business Lean Six Sigma Centre of Excellence
Some of our Health Care clients;
St. Michael’s Hospital
Mt. Sinai Hospital • Lean Six Sigma Strategic Deployment
Ontario Ministry of Health • On-site Lean Six Sigma Training
LHIN, FHITs, Strategy, etc. • Lean Six Sigma Project Management
Health Canada
• Open Enrollment (Public) Training
Royal Victoria Hospital
• Process Design, Modeling & Simulation
Hamilton Health Sciences
• Master Black Belt Project Coaching
London Health Sciences
Canadian Blood Services
& Mentoring
Centre for Addiction & Mental Health • Lean Six Sigma Certification
Alberta Medical Association • Comprehensive e-Learning Program
Joseph Brant Memorial Hospital




RAPID START: GREEN BELT FOR HEALTHCARE
Lean Six Sigma for Healthcare focuses first on the processes,
tasks and activities that define world-class healthcare
service and patient care. It enables the delivery of
consistently high levels of quality & value while banishing
waste & non value-added activities. The result is lower
costs and more desirable outcomes for patients and
caregivers alike.
8 Day Program
GBH096 (Toronto) GBH098 (Toronto)
Session 1: April 14 – 17, 2009 Session 1: Sept 28 – October 1, 2009
Session 2: May 11 – 14, 2009 Session 2: October 26 – 29, 2009


COURSE OVERVIEW
Six Sigma fundamentals and methodology
Lean fundamentals and methodology
Differences and synergies of Lean and Six Sigma
Six Sigma measures and statistics
The eight step Six Sigma strategy
Managing Lean Six Sigma projects using DMAIC approach
Opportunities for defects
Customer focus -The CT tree and Quality Function Deployment
Sigma level and Cost of Quality
The importance of the people side of managing improvement
projects




E-ZSIGMA SERVICES
HEALTH CARE SPECIFIC TRAINING PROGRAMS
E-Zsigma has designed an 8-day Lean Six Sigma Healthcare program
tailored specifically for the Canadian Healthcare industry. This program is
the first of its kind in Canada.
CUSTOMIZED SOLUTIONS
Our training programs can be customized to suit your needs and be
delivered at your location.
PROJECT MANAGEMENT & LEADERSHIP
Allowing our senior Master Black Belts to help you lead rapid and highly
successful lean six sigma improvement projects
Patient flow and wait times
Information technology implementations
Process improvement projects where they are needs and when they are needed
E-LEARNING SOLUTIONS
We understand the hectic schedule of the healthcare professional.
Therefore we offer a comprehensive e-Learning program designed to meet
your needs on your schedule.


YOUR EXPECTATIONS FOR LEAN SIX SIGMA
Improved patient experience and satisfaction
Faster response to patient needs
Increased job satisfaction & reduced stress for caregivers
Improved, standardized & repeatable processes that are more predictable
Between 20% and 60% reduction in Process Cycle Time
Ability to focus resources on more value-added activities
Greater than 50% Improvement in resource utilization
Improved asset utilization: people, equipment & technology
Reduced unit costs through increased capability
Improved flow through elimination of bottlenecks (delays) and constraints (limiters)
Greater than 30% gain in process capability
Dramatic improvement in scheduling predictability – better process management
Participative problem-solving
Engaging the people who know and do the work… the team
Recognition of the “human” side of lean and the need to manage change




CONTACT INFORMATION

E-Zsigma (Canada) Inc.
One Dundas St W, suite 2500
Toronto, ON
www.e-zsigma.com
sales@e-zsigma.com
O: 416.593.8026
F: 416.204.1939

Thank you for joining us today!



Lean Six Sigma - A Prescription For Healthcare

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Lean Six Sigma - A Prescription For Healthcare