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• A comprehensive set of tools and a general, systematic approach for: – Identifying & enhancing value – Eliminating waste – Reducing errors – Minimizing variation – Increasing employee and customer satisfaction Copyright 2011 JonPadfield.com

• General approach to process improvement – Graphically map your process – Identify all value adding activities – Use Lean to the greatest degree PRACTICAL to eliminate all non-value adding activities (waste) – Use Six Sigma to reduce variation in what remains (improve repeatability of outcomes) Copyright 2011 JonPadfield.com

“Nothing is less productive than making more efficient what you shouldn’t be doing at all.”

• • • • • • • • • • 3 rd Party reimbursement Admittance & discharge Food & laundry service Emergency response Medication Therapy Hiring & termination Purchasing authorization Staff training & scheduling Internal & external reporting Infection control & prevention Copyright 2011 JonPadfield.com

“Fully automated” processes are a myth

Customer Value Process

“to make something better.”

http://en.wikipedia.org/wiki/Improvement

“any permanent structure on real property, or any work on the property which increases its value.”

http://legal-dictionary.thefreedictionary.com/Improvement

Business process improvement (BPI) is a systematic approach to help an organization optimize its underlying processes to achieve more

efficient

results.

http://en.wikipedia.org/wiki/Business_Process_Improvement

Effectiveness = The degree to which an offering fulfills a customer need Value = Effectiveness * Importance of the need

Efficiency



value

produced resources

consumed

• • • Value Added – Does something the customer cares about.

Non-Value Added (NVA) – Activities that consume resources but that the customer doesn’t care about (would not be willing to pay for if they had the choice).

“Conflicts between importance and urgency often arise… Becoming conscious of such conflicts is usually all we need to do to resolve them.

When we are pressed for time, however, we can lose sight of the importance and urgency of the individual problems in our bundle, and then we revert to "muddling through,"

focusing on urgent but often unimportant problems and ignoring the truly important ones.” (Dorner, 1997)

3) 4) 5) 1) 2) The Original “7 Wastes” by Taiichi Ohno (1948)

Unnecessary Transportation : Movement of materials (or data) is a waste.

Excess Inventory : Ties up cash, requires space, risk of obsolescence, etc.

6) 7)

Motion : Put frequently used equipment near users (printers, copiers) Waiting : Minimize waiting time by creating continuous flow.

Overproduction : Making more than is needed or making sooner than is needed. Strive for “Just in Time” for your customers. Over Processing : Doing more than is required (or valued) by your customer. Do they really need color copies? Do they care if the bottom of the dining table is sanded? stained? Sealed with urethane?

Defects : Defects cause rework which is a waste of resources.

The “New Wastes”

Takt Time = Demand / Available Time

• • If you have to clean 32 rooms per day and have 8 hours to do it in, your Takt Time is 15 minutes – In reality, you don’t have 8 hrs/day due to meetings & interruptions so your Takt time is actually shorter Systems should be flexible to accommodate changes in demand – End of Year / Flu season – Long term demographic shifts – Short term economic trends Copyright 2011 JonPadfield.com

• • • • • Define Measure Analyze Improve Control

DMAIC

• Used for improving an existing process • • • • •

DMADV



(

1 

2  ...

x n

)

Emergency response time (Y) is a function of

– – – – – – – – – Clarity and accuracy of information given by caller (x 1 ) Readiness level of responders (x 2 ) Readiness level of vehicle (x 3 ) Rural or urban route(x 4 ) Distance to caller (x 5 ) Road conditions (x 6 ) Time of day (x 7 ) Traffic (x 8 ) ??? (x n ) Copyright 2011 JonPadfield.com

• In Six Sigma the answer to everything is “it depends” – the bonus points are awarded for knowing what it depends on.

– How accurate / reliable does the data need to be?

– How long do you have to collect the data?

– What is your budget for data collection?

– How are you going to use the data?

“It is better to have unanswered questions than unquestioned answers”

- Dr. Kenneth Kahn

• According to the Center for Disease Control ( http://www.cdc.gov/Motorvehiclesafety/ ) there were approximately 2,300,000 motor vehicle injuries requiring emergency room visits in the United States in 2009 – 2/3 of those were caused by sober drivers – Equates to ~4.5 injuries every minute of every day Copyright 2011 JonPadfield.com

200 180 160 140 120 100 80 60 40 20 0 25

Motor Vehicle Injuries Occurring During a 24 Mile Drive

35 45

Your odds of being injured in a wreck while driving home are lower if you speed.

55 65 75 85 95

Speed Driven in MPH

105 115 125 135

• A problem exists when there is a gap between desired (or at least historic) performance and current measured performance – Customer satisfaction survey rating is below target – Joint Commission audit score drops – Number of website hits suddenly drop – Readmission rate increases – Employee turnover increases Copyright 2011 JonPadfield.com

1. Guess at a possible cause 2. Take action to correct it 3. See if problem goes away 4. Repeat if necessary until you run out of time, money, patience This is great way to create superstitions Copyright 2011 JonPadfield.com

• • • • • • Who owns the problem?

What exactly is the problem?

How bad is it?

What is causing the problem?

How can the cause be fixed?

Did the fix work?

Who owns the problem?

What exactly is the problem?

What is causing the problem?

Did the fix work?

Define Measure Analyze Improve Control

How bad is it?

How can the problem be fixed?

1. Define the performance problem 2. Measure the problem by collecting data 3. Analyze data to determine likely causes 4. Improve the performance by testing causes and solutions 5. Control the problem by implementing the best fix and putting a control plan in place Copyright 2011 JonPadfield.com

“In the 1960s, erroneous actions of one kind or another were estimated as contributing to around 20% of the causal contributions to major accidents. By the 1990s, this figure had increased four fold.”

Barry Strauch “Investigating Human Error”

Slide 1

Transcript Slide 1

“Nothing is less productive than making more efficient what you shouldn’t be doing at all.”

Customer Value Process

Efficiency

value

produced resources

consumed

Takt Time = Demand / Available Time

DMAIC

DMADV

“It is better to have unanswered questions than unquestioned answers”

- Dr. Kenneth Kahn

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