Session 8 - Introduction to Lean Six Sigma

Session 8: Continuous
Performance Improvement
Through Lean Six Sigma in the
Military Health System
COL Angela Koelsch, FACHE, MBB,
Process Improvement Specialist
Strategy & Innovation Knowledge Management Officer
angela.koelsch@us.army.mil

1

Agenda

• Military Health System (MHS) Decision

2

Agenda

• Lean Six Sigma (LSS) Basics

3

Agenda

• LSS “Fits” in Strategic Performance
Execution

4

Agenda

Execution
• Linking Strategy to Performance Improvement

5

Agenda

Execution

• Leveraging Learning Across the Organization

6

Agenda

Execution

• Leveraging Learning Across the Organization
• Early Lessons Learned

7

MHS QDR Mandate

• Select the CPI method most appropriate for
the MHS

9

MHS QDR Mandate

the MHS— common vocabulary, toolsets

10

MHS QDR Mandate

• Implement across all MHS components in a
consistent fashion

11

MHS QDR Mandate

consistent fashion— learn, grow together

12

MHS QDR Mandate

• Accelerate MHS’ CPI “journey” from current
stage

13

MHS QDR Mandate

• Accelerate MHS’ CPI “journey” from current
stage— improve sooner rather than later

14

Pathway to MHS Decision

15

• MHS QDR-9 PI Tiger Team Coordination
• Throughout Summer 06, teeing up for SMMAC
decision
• No implementation consensus; LSS fait-accompli by
Fall

16

• MHS QDR-9 PI Tiger Team Coordination
• Throughout Summer 06, teeing up for SMMAC
decision
• No implementation consensus; LSS fait-accompli by
Fall
• Execution in the Services:
• USA: Lean Six Sigma
• USAF: AFSO-21 (Air Force Smart Operations-21st
Century)
• USN/USMC: Lean Six Sigma
17

Lean Six Sigma Basics

18

LSS Basics
• Industry best practice management framework
combines “Lean” and “Six Sigma” strategies

19

LSS Basics
• “Lean” methods…

20

LSS Basics
• Remove non-value added waste from processes
• Thus, reduce process cycle time
• Happy customers—reduced cost!

21

LSS Basics
• “Six Sigma” methods…

22

LSS Basics
• “Six Sigma” methods…
• Analyze and reduce variability in processes
• Thus, improve quality
• More happy customers—more reduced cost!

23

What’s Different About LSS?

24

Craft Taylor –
Eli Whitney - Time/Motion
Production
Product Studies

… LSS Builds Upon a
Standards Gilbreth
Industrial Scientific
Shewhart – Production Management
Statistical

Foundation
Ford –
Methods Work
Statistical Analysis
Process Control
Juran – Assembly Simplified

of Continuous
Process Line Manufacturing
Manufacturing
Analysis
Quality Organized Sloan –
Control Tunner –
Labor – Modern
Taguchi – Berlin Airlift
Worker’s Management
Customer

Performance
Rights
Focus Mass Simplified
Quality Production Service/Process
Engineering
Zero

Improvement!
Deming – Toyoda,
Defects
Systems Ohno,
Thinking Shingo

TQM -
Toyota Simplified
Total Quality Production Product Line
Management
Smith System
Harry –
(Motorola) – DMAIC
Statistical Womack
Rigor Six & Jones
George & Wilson –
Sigma v1 Optimized
Welch/ Lean George, ITT
Enterprise Complexity
Bossidy – Industries,
Organizational CAT, Xerox
Infrastructure Six
Sigma v2
Lean Six
Sigma v1
Lean Six
Sigma v2

25

This is…

26

This is…

• Prescriptive framework
…vs descriptive framework

27

This is…

• Trained experts leading trained project teams
…vs reading a book and trying it on the fly

28

This is…

• Execution pervades the organization
…vs “that’s the QA Department’s job”

29

This is…

• Execution pervades the organization
…vs “that’s the QA Department’s job”
• Data-driven project selection and improvements
…vs guessing, windage, shooting from the hip

30

LSS Basics: Infrastructure
Needed to Succeed!
Executive Steering Committee

At each level of organizations: • Senior Leader
• Deployment Director
• Senior Financial Mgr
• Critical Process Owners
Organization’s • Master Black Belt (Advisor)
Senior Leader
Deployment
Director

Master Process Owner Process Process Owner
Black Belt Owner

Black Belt Green Belt Green Belt
Black Belt
Full-time Positions Project Team Member(s)
Green Belt(s) Financial Analyst
Project Team Member(s) Project Support …
Financial Analyst Mentor
…

Recommended LSS Infrastructure Based on Industry Best Practice

31

LSS Basics: Training/Certification
Multi-level/multi-phased training:
Training: Training & Certification
Executive Leader Green Belt
Project Sponsor Black Belt
Project ID/Selection Master Black Belt
Project Team/Yellow Belt
Organizational Awareness

32

LSS Basics: Training/Certification
Multi-level/multi-phased training:
Training: Training & Certification
Executive Leader Green Belt
Project Sponsor Black Belt
Project ID/Selection Master Black Belt
Project Team/Yellow Belt
Organizational Awareness
MBB Trng

Harvest Results and Share Knowledge
Contractor Mentoring & Consulting
Project Team Trng

BB/GB Trng

Project ID & Selection Wksp

Project Sponsor Trng

Organizational Awareness Trng

Executive Leader Trng

Assessment
Stand-up Program Perform Projects

Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 12 Month 18 Month 24+

33

LSS Basics: Project Execution

34

• Customer Issues/Opportunities
• Business Strategy
• Goals/Objectives
• Priorities
Project
Candidates

Structured Project Selection

35

• Priorities Prioritized by
Project Leader/Mgmt
Candidates Team

High
BENEFIT
Med
Low

EFFORT
Low Med High
36

Assign Project
to Sponsor
Project Leader/Mgmt
and Select
Candidates Team
Belt

High
BENEFIT
Med
Low

EFFORT
Low Med High
37

Assign Project
to Sponsor
Project Leader/Mgmt
and Select
Candidates Team
Belt

Structured Project Selection DMAIC Project Management Framework
High

Define Measure Analyze Improve Control

Sponsor Define project purpose and scope
BENEFIT

inspects Measure current performance
Med

deliverables Analyze causes & confirm with data
& checkpoints Improve by removing variation and
for each
non-value added activities
Low

phase
EFFORT
Control gains by standardizing
Low Med High
38

Assign Project
to Sponsor
Project Leader/Mgmt
and Select
Candidates Team
Belt

High


BENEFIT

Med

for each
Low

phase
EFFORT
Low Med High
39

Assign Project
to Sponsor
Project Leader/Mgmt
and Select
Candidates Team
Belt

High


BENEFIT

Med

for each
Low

phase
EFFORT
Low Med High
40

Assign Project
to Sponsor
Project Leader/Mgmt
and Select
Candidates Team
Belt

High


BENEFIT

Med

for each
Low

phase
EFFORT
Low Med High
41

Assign Project
to Sponsor
Project Leader/Mgmt
and Select
Candidates Team
Belt

High


BENEFIT

Med

for each
Low

phase
EFFORT
Low Med High
42

Assign Project
• Priorities Prioritized by Sponsor
to Sponsor
Project Leader/Mgmt Inspects
and Select
Candidates Team Progress
Belt

High


BENEFIT

Med

for each
Low

phase
EFFORT
Low Med High
43

Assign Project
• Priorities Prioritized by Sponsor Results are
to Sponsor
Project Leader/Mgmt Inspects Captured and
and Select
Candidates Team Progress Sustained
Belt

High


BENEFIT

Med

for each
Low

phase
EFFORT
Low Med High
44

Assign Project
• Priorities Prioritized by Sponsor Results are
to Sponsor
Project Leader/Mgmt Inspects Captured and
and Select
Candidates Team Progress Sustained
Belt

High


BENEFIT

Med

for each
Low

phase
EFFORT
Low Med High
45

How LSS Could “Fit” in Your
Business Innovation Toolkit

• BSC defines USAMEDCOM’s org strategy

46


• Yours may be defined by another strategy tool

47


• LSS fits as Performance Improvement
Engine…

48


Engine…
• Evaluate objective targets, performance gaps to
reach them

49


Engine…
reach them
• ID initiatives to close performance gaps

50


Engine…
reach them
• Those initiatives become LSS projects!

51


Engine…
reach them
• Those initiatives become LSS projects
• Aligns commitment, resources, and effort
against strategically-focused projects

52

……
• Aligns commitment, resources, and effort
against strategically-focused projects
• The MHS is ahead of the rest of the DoD!
• Strategy and objectives defined…MHS BSC, other
tools
• Data-driven decision-making is routine
• Data-mining already part of our infrastructure

53

Challenge: Leveraging
Learning Across the
Organization

54

Knowledge
Management
(its Best Practice Transfer component)

our next big challenge…

55

Think about it…

56

“Cave dwellers froze to
death on beds of coal…

- Adapted from Carla O’Dell, If Only We Knew What We Know, p. ix.
57

Coal was right under them!

but they couldn’t see it…
mine it…
or use it…
58

What you don’t know
really can hurt you!

59

But it’s happening all over
again in the 21st Century!

60

Now it’s not beds of coal…

…it’s beds of knowledge

61

they exist in all organizations!
relatively untapped…
relatively unmined…
relatively unused…

62

Unwarranted variation...

Unpredictability for patients…
Sub-optimized
transactional outcomes…

Poor Knowledge Management
can hurt us…here’s how…
Sub-optimized
Best Practice Transfer clinical outcomes…
measured in years vs months…

Misdirected (wasted) resources…
Incremental improvement vs
enterprise-wide improvement…
63

Why Best Practices Don’t
Get…from If Only We Knew What We Know: The Transfer of Internal Knowledge and Best Practice, Carla O’Dell, author
Transferred

Why Don’t
Why Don’t
Best Practices
Best Practices
Get
Get Transferred?
Transferred?

64

Transferred

• Reason #1: Ignorance…

65

Transferred

• People with knowledge don’t realize others may find it useful
• People who could benefit from knowledge don’t know others have it

66

Transferred

• People with knowledge don’t realize others may find it useful
• People who could benefit from knowledge don’t know others have it

• Reason #2: No absorptive capacity…

67

Transferred

– People with knowledge don’t realize others may find it useful
– People who could benefit from knowledge don’t know others have it

– People lack the money, time, and to make it useful to their work

68

Transferred


– People lack the money, time, and resources to make it useful to their work

• Reason #3: The lack of preexisting relationships…

69

Transferred



– People absorb knowledge & practice from people they know, respect, trust

70

Transferred




• Reason #4: Lack of motivation…

71

Transferred




– People may not perceive a clear reason for pursuing the transfer

72

Transferred



– People may not perceive a clear reason for pursuing the transfer
– People must have a sense of urgency!

73

An Army Medicine example:

at a high level…
linking Organizational Strategy
to Performance Improvement
using
Lean Six Sigma
and
Best Practice Transfer!

74

We align all MEDCOM
LSS projects to our
organization’s
strategy…our
Balanced Scorecard…

76

We recognize we have
a performance gap in
Access to Care…

77

Value Stream #9: Improve Access & Continuity of Care
PVC #1: Maximize Value in Health Services

Suppliers Inputs Process Outputs Customer
• Patients • Need for Care • Customer Service • Satisfied beneficiary • DOD Title 10 patients
(preventive, acute) • Accessible (e.g., Soldiers,
• Telephone Services
• DOD appointments retirees, families)
• Healthcare staff
Healthcare • Provider Support Staff Utilization • Standardized, utilized
• Non-Title 10 patients
Professionals • Facilities and support staff
• Primary Care Exam Room (e.g., civilian
infrastructure • Optimized provider
Utilization emergencies,
• IMCOM productivity
contractors, foreign
• Patient Appointing, Referral Mgt. • Optimized referral
officers and families,
execution, delivery
• TRICARE Online Appointment etc.)
• Increased utilization of
on-line appointment
system

High level process maps
Customer (SIPOCs) help us better focus
Input Metrics Process Metrics Output Metrics

• DOD Title 10
onCall Volume
• the problem/s in our work…
• Call Hold and Handle Times,
• Patient Satisfaction

patients • # of Appts. Requested Call Abandon Rate • Access to Care Standards (e.g.,
achieve acute care appt. within
• Non-Title 10 • Type of Care Requested • Care Appointment Availability 24 hours)
patients
• Schedule Availability • Support Staff to Primary Care
• Staff Availability Provider Utilization ratio
• Facility Scheduling • Facility Availability

78

Value Stream #9: Improve Access & Continuity of Care
PVC #1: Maximize Value in Health Services

Suppliers Inputs Process Outputs Customer
• Patients • Need for Care • Customer Service • Satisfied beneficiary • DOD Title 10 patients
(preventive, acute) • Accessible (e.g., Soldiers,
• Telephone Services
• DOD appointments retirees, families)
• Healthcare staff
Healthcare • Provider Support Staff Utilization • Standardized, utilized
• Non-Title 10 patients
Professionals • Facilities and support staff
• Primary Care Exam Room (e.g., civilian
infrastructure • Optimized provider
Utilization emergencies,
• IMCOM productivity
contractors, foreign
• Patient Appointing, Referral Mgt. • Optimized referral
…and we decided to start by
• TRICARE Online Appointment
execution, delivery
officers and families,
etc.)
• Increased utilization of
improving the Telephone on-line appointment
system
Appointing Process

Customer Input Metrics Process Metrics Output Metrics
• Call Volume • Patient Satisfaction
• DOD Title 10 • Call Hold and Handle Times,
patients • # of Appts. Requested Call Abandon Rate • Access to Care Standards (e.g.,
achieve acute care appt. within
• Non-Title 10 • Type of Care Requested • Care Appointment Availability 24 hours)
patients
• Schedule Availability • Support Staff to Primary Care
• Staff Availability Provider Utilization ratio
• Facility Scheduling • Facility Availability

79

LSS Project LD00373:
Access to Care— Improve Telephone
Appointing Process at Darnall Army Medical Center

Documented in PowerSteering!

80

Project Summary: Carl R. Darnall AMC
Telephone Appointing Mark Hernandez – Black Belt Candidate

• PROBLEM / BASELINE / GOAL • IMPROVEMENTS
PROBLEM STATEMENT
The telephone appointing process at CRDAMC has observed low patient  Agent scheduling changes to handle peak times
satisfaction scores and long process hold times. Over the last six months,
 Agent training, area setup, shift change by SOP
it takes an average of 3:14 minutes to answer customer calls to make an
appointment. This has led to numerous customer complaints which have  Phone menu tree and call handling improved
led to lower patient satisfaction scores for telephone appointing services.
BASELINE  Future ACD design requirements specified
 Army’s largest call center: 10,000+ calls a week
 Low customer satisfaction: 68% BEFORE AFTER

Hold Time
 Average wait time: 3:14 minutes
 Calls answered under 90 seconds: 65%
GOAL
 Overall call abandon rate: 26%; Peak time: 49%
 Decrease process hold time to less than 90 seconds per call
 Decrease overall abandoned call rate to less than 10%
 Decrease peak time call abandon rate to less than 25%
• RESULTS / BENEFITS • REPLICATION / WAY-AHEAD
 Overall average hold time reduced to 33 seconds  Performance Action Plan Completed; Access to Care
 Overall call abandon rate reduced: 3% Initiative 17.2
 Adjust MEDCOM BSC telephone appting standards NLT 20
 Peak time call abandon rate reduced: 22%
Apr 07
 Call volume reduced 20% due to less call backs
 Establish CMS metric for telephone appting NLT 1 May 07
 Calls handled increased from 4700 to 7300 / week
 Publish MEDCOM Telephone Appting Policy NLT 1 May 07
 Agent training time reduced from 6 weeks to 4 weeks
 Replicate LSS projects across MEDCOM MTFs NLT Dec 08
 Agent turnover reduced

81


PROBLEM STATEMENT
 Low customer satisfaction: 68%
…the initialBEFORE
project was
AFTER

Hold Time
 Calls answered under 90 seconds: 65% conducted at Fort Hood’s Carl
GOAL
R. Darnall Army Medical Center
 Decrease overall abandoned call rate to less than 10% (CRDAMC)…
Apr 07

82


PROBLEM STATEMENT

Hold Time
 Average wait time: 3:14 minutes …high call volume, low patient
GOAL
satisfaction, long process cycle
time, high variation…
Apr 07

83


PROBLEM STATEMENT

Hold Time
 Average wait time: 3:14 minutes …the project sought to
GOAL
decrease process cycle time
and call abandon rate to
 Decrease peak time call abandon rate to less than 25% improve patient satisfaction…
Apr 07

84


PROBLEM STATEMENT
 Army’s largest call center: 10,000+ calls a week WOW

Hold Time
GOAL
Apr 07

85


PROBLEM STATEMENT

Hold Time
 Average wait time: 3:14 minutes 7-Fold
GOAL Improvement
Apr 07

86


PROBLEM STATEMENT

Hold Time
GOAL
10-Fold
 Decrease process hold time to less than 90 seconds per call Improvement
Apr 07

87


PROBLEM STATEMENT

Hold Time
GOAL
>2-Fold
 Decrease overall abandoned call rate to less than 10% Improvement
Apr 07

88


PROBLEM STATEMENT
BASELINE Disciplined, Corporate  Future ACD design requirements specified

Action to Harvest and
Replicate Across

Hold Time
MEDCOM
GOAL
 Adjust MEDCOM BSC telephone appting standards
 Establish CMS metric for telephone
 Replicate LSS projects across MEDCOM MTFs NLT Jun 09

89


PROBLEM STATEMENT
A project result not anticipated… and call handling improved
 Phone menu tree
appointment. This has led to numerous customer complaints which have

Hold Time
GOAL
Apr 07

90


PROBLEM STATEMENT
 Phone menu tree
Although patient satisfaction with
 Low customer satisfaction: 68% telephone appointing improved, BEFORE AFTER

Hold Time
 Average wait time: 3:14 minutes overall patient satisfaction at
GOAL Darnall decreased!
Apr 07

91


PROBLEM STATEMENT
 Phone menu tree
Although patient satisfaction with
 Low customer satisfaction: 68% telephone appointing improved, BEFORE AFTER

Hold Time
 Average wait time: 3:14 minutes overall patient satisfaction at
GOAL Darnall decreased!
Patients’ phone calls were now
being answered quicker, only to be
told Darnall had no appointment
available!
Apr 07

92


PROBLEM STATEMENT
Teaching Point:
 Phone menu tree and call handling improved

Ofttimes you must consider the
 Low customer satisfaction: 68% project dependencies along the BEFORE AFTER

Hold Time
 Average wait time: 3:14 minutes value stream…
GOAL
 Overall call abandon rate: 26%; Peak time: solution
The 49% set from Project B
 Decrease overall abandoned call rate to less than 10% be realized before the
may best
solution set from Project A!
Apr 07

93


PROBLEM STATEMENT

Hold Time

And Today?
GOAL
Apr 07

94


PROBLEM STATEMENT

Mean Hold Time at BEFORE
 Low customer satisfaction: 68% AFTER
CRDAMC =

Hold Time
GOAL
3 seconds!
Apr 07

95

Session 8 - Introduction to Lean Six Sigma

Session 8 - Introduction to Lean Six Sigma

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (17)

Andere mochten auch

Andere mochten auch (20)

Ähnlich wie Session 8 - Introduction to Lean Six Sigma

Ähnlich wie Session 8 - Introduction to Lean Six Sigma (20)

Mehr von MedXellence

Mehr von MedXellence (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Session 8 - Introduction to Lean Six Sigma

Hinweis der Redaktion