board of directors meeting - lab quality confab · value stream maps • value stream maps (vsms)...
TRANSCRIPT
Quality Confab
October 21, 2014
Essential Insights: Value Stream Mapping for Intermediate Practitioners, Prioritizing Projects and Selecting the Right Tools
COMPANY CONFIDENTIAL
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Value Stream Maps
• Value Stream Maps (VSMs) are the key to successful Lean projects.
• Their purpose is multifocal: – To expose opportunities for improvement.
– Level-set everyone on the process.
– Identify lack of standard work.
– Identify deviation from policy.
• Their value is to provide a roadmap for the future.
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Intermediate Level Value Stream Mapping
• Most everyone knows how to produce a VSM.
• What are the most efficient ways to produce VSMs? – Paper using cut-outs or just drawing on a large roll of butcher
block paper.
– Electronic using a common program such as Visio, Excel, or other common products.
– Highly sophisticated add-on programs such as EVSM which lays on top of Visio.
– Newer lower cost add ons such as Smartdraw which uses a more common platform (Excel) and is less costly to install and has a faster learning curve to use.
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Advantage/Disadvantage
• Paper advantages: – Cheap.
– Short learning curve to use.
– Flexible.
• Paper disadvantages: – Takes a lot of space to use it.
– Takes preparation work to have everything cut out.
– Hard to move (taping down required before moving).
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Advantage/Disadvantage (cont.) • Electronic Advantages:
– Fast to create.
– You can use a previous map as a template.
– Easier to transport a laptop than a large roll of paper.
– No problem with it coming unglued.
– You can easily make changes.
• Electronic Disadvantages: – Expensive.
– Learning curve, you can’t show and use.
– You have to have a projector for a large group to see it.
– You can’t always see the entire map in details at the same time.
– To print a readable copy you need a large paper roll plotter.
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Paper VSM
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EVSM
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Demand 10000.00
Work Time 24.00
Takt 416.7
Client
0.25 Hours
1.00 Hours
0.15 Hours
0.10 Hours
0.30 Hours
0.20 Hours
0.10 Hours
0.50 Hours
0.50 Hours
0.10 Hours
0.10 Hours
VA/T=1.90 Hours
NVA/T=1.40 Hours
PCE=57.58%
2500 1500 3000 1000 5000
LIS
HIS
1000
Hospitals, NursingHomes, Drs Offices
Data Entry
C/T(Hours) 1.00
Uptime 99%
Operators 10I
Accessioning
C/T(Hours) 0.10
Uptime 100%
Operators 14I
SpecimenProcessing
C/T(Hours) 0.20
Uptime 100%
Operators 6
I
Specimen Testing
C/T(Hours) 0.50
Uptime 95%
Operators 2I
Result Verificationand Release
C/T(Hours) 0.10
Uptime 99%
Operators 1
I I
SmartDraw
COMPANY CONFIDENTIAL
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Good Ol’ Visio!
10
5S Opportunity
5S Opportunity
FIFOSingle Piece Flow
Storage Time Aligned to Customer
Need
Utilization of GEL Technology
Enhanced Utilization of Tube System
Lean Implementation of Phlebotomy
Lean Implementation of
Processing
Standardization of Communication
Channels
Standardization of Product Flow
FIFOLean Product Flow
Batch Flow Reduction
Poka-yokeError Reduction
Standard Work
Lean Product Process Flow
Align to Customer
Requirements
Reduce Storage Space
Requirements
SOP Alignment to
Process
TAT Reduction in
Variation
Cost Reduction by Wasted Process
Reduction
Cellular Layout
Reduction in Required NVA
Activity
Selected Supply Inventory
Reduction
Visual Management Control
1,800sCT
1,800sLT
24/7AT1BX
100%FPY
Micro - Open Lab
1
Manual Body Fluids
1
428sCT
428sLT
24/7sAT1BX
100%FPY
Coag
1
Pneumatic Tube
1I
Sutter - Marin General HospitalCurrent State Value Stream Map
May 12th to May 16th 2003
Add-On Information
Routine Information
Add-On Electronic Information
Routine Electronic Information
Routine Material Flow
Add-On Material Flow
Pn Tube
Phlebotomy Delivery to Lab
Storage(1 week)
1I
1I
1I
1I
1I
1I
1I
LIS (FlexiLab)
Misys
Customer
Scope = Laboratory Material is A Specimen Container
Demand = 447 Specimens/DayTakt Time = 3.22 Minutes
Hospital
H
Emergency Room Hospital InpatientHospital Outpatient Outreach Courier
Financial(Lab Client)
Misys
Interface Engine
Misys
Storage(~8 hours)
Temp Storage(Instrument = 4
Hrs))
Orders Hospital Information System's
6I
Labels
Temp Storage
(Bench = 24 Hrs) Alphabetized
2x Beckman Coulter LH 750
3I
Supplier
Emergency Room = 13% Hospital Outpatient = 13%Hospital Inpatient = 70.5% Outreach = 3.5%
Hospital
M
Results
Add on Orders
Paper Bill Clients
1I
Panic Values
2x MLA 1400C
Demand does not include Histology
0I
0I
Special Hem/Path Review2
I
Manual Body Fluids Verify
1
Total Lead Time0.054 Days 1.30 hours
77.8 minutes
Total Process Time2,707 Seconds45.1 Minutes
500sCT
500sLT
24/7A/T1BX
100%%FPY
Urinalysis
1
240sCT
240sLT
24/7sAT3BX
100%FPY
Immunochem
1
120sCT
120sLT
24/7AT2BX
100%FPY
Blood Gas
1
Hematology
133sCT
133sLT
24/7sAT1BX
100%FPY
2
916sCT
916sLT
24/7AT1BX
100%FPY
Manual DIFF2
300sCT
Chemistry
300sLT
100%FPY
24/7AT
1BX
1
- Manual Reading
- CELL-DYNE 3500R- CELL DYNE 1700
ABL 700 x 2
1I1
I Storage(Store for 14 days)
15sCT
15sLT
24/7AT1BX
100%FPY
Hematology Verify
1
Phlebotomy4
15sCT
15sLT
24/7AT1BX
100%FPY
Manual DIFF Verify
1
15sCT
15sLT
24/7AT1BX
100%FPY
Chemistry Verify
1
15sCT
15sLT
24/7AT1BX
100%FPY
Coag Verify
1
15sCT
15sLT
24/7AT1BX
100%FPY
Blood Gas Verify
1
15sCT
15sLT
24/7AT
1BX
100%FPY
Urinalysis Verification
1
15sCT
15sLT
24/7AT1BX
100%FPY
Immunoassay Verify
1
- Manual Entry- Verify
15sCT
15sLT
24/7AT1BX
100%FPY
Manual Verify
1
1,785sCT
1,785sLT
AT1BX
100%%FPY
1
- Plasma Hgb- Osmo/ESR/Ketone- Mono/Strep/Infl- Pregnancy Test- BNP
Manual/Kits
Receiving 1
Receive Ord/Recd40sCT 90s40sLT 90s
AT 16/7 24/7 100%FPY 100%1BX 1
1I
Delivery to Dispatch
Urinalysis Verification
- Add-ons- Test ordering- Pre Label Tubes- Phlebotomy Mgmt.
- Test ordering- Label Tubes- Phlebotomy Mgmt.
Long Term Storage(5 Days)
Temp Storage
(Bench=8 Hrs)
Long Term Storage(5 Days)
Discard (After Verification)
Storage(1 week)
Temp Storage
(Bench=8 Hrs)
Sendouts
Quest
Sendouts-Novato - Lipids-Quest-Mills
Extra Tubes
Blood In Lab
Axysm
Reflex Testing(Culture if Indicated)
Add on Orders
Patient ID & Register
Courier Delivery & Pickup
Chem HemeCoag
Chem
Heme
Total Lead Time0.035 Days 0.84 Hours
50.4 Minutes
Total Process Time1,410 Seconds23.5 Minutes
Total Lead Time0.061 Days 1.46 Hours
87.8 Minutes
Total Process Time2,291 Seconds38.2 Minutes
Quest
HBOC
1
3I
93sCT
93sLT
12/7sAT1BX
100%FPY
Micro
1
Plant Culture Only
Micro - Wounds & Misc. Refered to Mills
1
?sCT
?sLT
12/7AT6BX
?FPY
Micro- Blood Cultures
1
4I
6I
505sCT
505sLT
12/7sAT2BX
100%FPY
Micro-Vitek Set-up
1
317sCT
371sLT
12/7sAT1BX
100%FPY
Respiratory & Blood Culture - Special Testing/
Subculture
1
1I
8I
218sCT
218sLT
12/7sAT1BX
100%FPY
Misc.- Final Report
1
8I
510sCT
510sLT
100%FPY
1BX
24/7AT
- Draw in Patients- Test ordering
EKG's2
- Performs on * Inpatinets *Outpatients
4I
270sCT
270sLT
12/7sAT8BX
100%FPY
Micro- Vitek Read
1
218sCT
218sLT
12/7sAT1BX
100%FPY
Respiratroy- Final Report
1
3I
1I
- Open Lab- Take Temps- Open
98sCT
98sLT
12/7sAT1BX
100%FPY
Micro- Urines
1
6I
10I
2I
439sCT
439sLT
12/7sAT1BX
100%FPY
Urines - Special Testing/
Subculture
1
146sCT
146sLT
12/7sAT1BX
100%FPY
Micro- Gram Stain Prep
1
3I
168sCT
168sLT
12/7sAT1BX
100%FPY
Gram Stain- Read
1
218sCT
128sLT
12/7sAT1BX
100%FPY
Urines- Final Report
1
3I
300sCT
300sLT
12/7sAT1BX
100%FPY
Micro - Respiratory & Blood Culture
Inital Read
1
4I
8I
218sCT
218sLT
12/7sAT1BX
100%FPY
Stools - Final Report
1
1I
3I
3I
Micro- O & Ps, Stools
Refered to Mills
1
10I
510sCT 780s510sLT 780s
AT 24/7 24/7 20%FPY 100%1BX 4
Inpatient Outpatient
3I
1I
24/7
0.002 days 0.005 days 0.020 days
90 sec 510 sec
0.007 days
1,101 sec
0.002 days
916 sec
0.013 days
90 sec
0.005days
0.002 days 0.005days 0.020 days
90 sec 510 sec 240 sec
0.002 days
540 sec
0.005days
30 sec
0.002 days 0.011 days 0.020 days
90 sec 510 sec 240 sec
0.013 days
372 sec
0.002 days 0.001 days
133 sec
0.002 days
916 sec
0.005 days
30 sec
0.005 days
5S Opportunity
5S Opportunity
5S Opportunity
5S Opportunity
Single Piece Flow
Examine ER Rainbow for Necessity
950
Thaw FFP
1
30sCT
30sLT
24/7AT1BX
100%FPY
Blood Bank Verify
1
Add On Crossmatch
2,220sCT
2,220sLT
24/7AT1BX
50%FPY
Type & Screen
1
2,220sCT
2,220sLT
AT 24/71BX
50%FPY
Type, Screen, & Crossmatch
1
Pre-LaboratoryProcess Variation
Reduction EMERGENCY DEPARTMENT
PJM 5/24/2004
Storage(1 week)
Temp Storage
(Bench=8 Hrs)
Utilize Pneumatic Tube to Deliver Blood Products
Pn Tube
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So.. What’s The Right Thing To DO?
• Like everything else with Lean, let the data drive the decision.
• Do you have money for the software?
• Do you have technical expertise to learn to use it?
• Do you have access to projectors where you will be using it to develop the Value Stream Maps?
• How often are you going to be using it?
• Do you need/want to share the maps with others who are not able to come to the exercise (virtual VSMs).
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EVSM
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EVSM
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Smart Draw
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Samples Of Each
• Exercise #1 – The paper VSM.
• Exercise #2 – EVSM.
• Exercise #3 – Smartdraw.
• Exercise #4 – Visio.
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Selecting The Right Tool For The Job
– Value Stream Map.
– 5S.
– RACI Chart.
– Spaghetti Diagram.
– Primary Visual Display.
– Huddle Meetings.
– Metrics.
– Voice of the Customer. 16
– Brown Paper.
– Standard Work.
– Poke Yoke (error proof).
– Single Piece Flow.
– Kaizen/Blitz.
– 20 Keys.
– Hot Button List.
• Lean uses tools much like a carpenter, plumber, doctor, nurse, or laboratory tech does.
• The tools are common to all Lean projects, their application might vary somewhat with the use of each.
• The common Lean tools include:
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Grouping Tools for Use
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• The tools can be grouped into: – Discovery/initiation of CI projects.
– Implementation of change.
– Monitoring to sustain change.
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Discovery/initiation of CI projects
– Value Stream Map (Identifies potential opportunities)
– Spaghetti Diagram (Identifies waste)
– Huddle Meetings (Idea generation for change)
– Metrics (Quantifies potential project benefits)
– Voice of the Customer (Identifies opportunities)
– 20 Keys (quantifies and identifies opportunities)
– Hot Button List (Allows employees to speak up)
– Brown Paper (Identifies Opportunities)
– Primary Visual Display Board (Dashboard of activities, metrics, and success)
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Implementation of change
– Value Stream Map (Future State shows how it could work)
– 5S (Removes waste/clutter)
– RACI Chart (Allows change to occur)
– Standard Work (Directs the new work)
– Poke Yoke (Error proof drives the change)
– Single Piece Flow (Directs the new work)
– Kaizen/Blitz (Provides the vehicle for change)
– 20 Keys (Provides the process for change)
– Huddle Meetings (Directs and educates change)
– Metrics (Quantifies what the change will be)
– Voice of the Customer (Allows employees to speak up concerning change)
– Primary Visual Display Board (Dashboard of activities, metrics, and success)
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Monitoring to Sustain Change
– RACI Chart (Maintains the control of authority).
– Primary Visual Display (Dashboard of metrics and success/shortfalls).
– Huddle Meetings (Communication with the employees which keeps momentum going).
– Metrics (measures success and degree of success).
– Voice of the Customer (Allows employees/customers to speak up).
– 20 Keys (used to monitor success, continue improvements, discover next initiatives).
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How to Engage Employees • Engage ALL employees by knowing all employees.
• Assign employees to the tools. – Employees get scared easily.
– Employees feel left out.
– Employees fear their job will be eliminated.
• Make it interesting. – Golf Tee Game to teach Standard Work.
– Single piece flow exercise to prove the value before asking them to believe.
– Have them cut out the icons for the VSM, or at least have them at least review the work once it is done in an interview/presentation fashion.
– Be creative! E.G. contests to decorate PVD Dashboard.
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How to Engage… (cont.)
• Get everyone involved: – Make sure everyone has a “job” on a team.
– Make it part of their job/evaluation/review.
• Reward good behavior: – Know your staff and what motivates them.
– Provide a reward if metrics are met; pizza, ice cream, special parking place, special lab coat…
• Make the reward easy at first, harder as time goes on: – Reward good behavior even if failure has occurred!
– Avoid money!!!!! It only makes it harder to motivate them later!
– Make them feel like a team.
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How to Engage… (cont.)
• High organizational visibility is a big plus. – Make sure administration/leadership recognizes the team’s
activities and is present at award/reward meetings.
– Have Administration attend huddle meetings periodically.
– Try not to make a big deal out of their attending; make it part of the plan.
– Encourage them to speak BRIEFLY on any organizational global initiatives that the staff might be interested in.
– Possibly the hardest behavior to change is the Administration!
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Use All of the Tools
• There is always a tendency to use your favorite tools and avoid some other tools.
• Understand when to use what tools and use them! Even the most difficult tools become easy when you are comfortable using them.
• Don’t use the tools just to use them. – Once you have used a tool make sure that you show the results
and discuss the outcome with the staff at huddle meetings or special meetings of time is needed to show, discuss, plan.
• It helps if you have a reference that discusses the use of the tools.
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Try Some Games…
• Exercise #4 – Standard Work (Golf Tee Game).
• Exercise #5 – Single Piece Flow (Sort the Tubes Game), Golf Ball Game.
• Exercise #6 – Draw The Pig!
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C f
Standard Work Game
• Standard work is necessary to make any process work efficiently.
• To prove this, we have a game for you to play.
• Play the game without standard instructions.
• The goal is to have only one golf tee left.
• The game plays like “Checkers”.
- As you jump a tee with another tee, remove the tee jumped.
• You have 3 minutes, good luck!
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C f
Try it again!
• This time follow the instructions on the next slide.
• You should end up with only one tee left.
• You should always end up with the tee in the same hole (#13).
• You may keep the game as a reminder of the importance of Standard Work, and to remind you to think of BD when you think of Lean-Sigma!
• You have 3 minutes, good luck!
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C f
1
3 2
6 5 4
10 9 8 7
15 14 13 12 11
Standard Work Practice#6 to #4remove #5
#1 to #6remove #3and so on
#7 to #2
#13 to #4
#10 to #8
#2 to #7
#7 to #9
#15 to #13
#12 to #14
#6 to #13
#14 to # 12
#11 to #13
Set up Triangle with hole #1 emptyBegin with #4 jumping #2 landing in empty
hole #1
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Standard Work
• Hand out two pieces of blank paper.
• Place a grid on the paper as depicted in the next slide. – First use the attached Standard Work for making a Pig.
• The second piece of paper is to make a second version for the “customer” after improving the standard work.
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Standard Work
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Standard Work Instructions
• Draw the letter M at the top left intersection. Bottom center of M touches the intersection.
• Draw the letter W at the bottom left intersection. Top center of W touches the intersection.
• Draw the letter W at the bottom right intersection. Top center of W touches the intersection.
• Draw an arc from the letter M to the top right intersection.
• Draw another arc from the top right intersection to the bottom right W.
• Draw an arc between the bottom W’s.
• Draw the letter O in the center left box.
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Standard Work… (cont.)
• Draw an arc from the letter M to the tangent of the circle.
• Draw an arc from the left W to the tangent of the circle.
• Draw an arc for the eye. Halfway between M and circle.
• Draw an arc for the mouth. Halfway between W and circle. Must be a happy pig!!
• Draw the cursive letter e near the top arc on the right.
• And finally draw two dots in the middle of the circle for the pigs nose.
• This is the exact the sequence which we must draw our pigs. This is the Standard Work for drawing a pig
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The Approach is to Provide Long-Term Sustainable Results
VSM Current
Brown Paper, Root cause, Spaghetti Diag, 20Keys, VOC
Charter, VSM Future State, Kaizen, 20Keys, PDCA
Blitz, RACI, Std Work
Metrics, PVD, Error Proof
VSM, Huddle/ LDMS, Metrics
Std Work, 5S, Kaizen - Pilots
Coaching, Change Mgt, Huddle/LDMS/PVD