green belt for healthcare

Presented by e-Zsigma (Canada) Inc.

Canada’s Leader in Lean, Six Sigma and Innovative Practices

Lean Six Sigma, Leaders for Today, Innovators for Tomorrow

CHALLENGES FOR CANADIAN PROFESSIONALS� 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

Lean & Six Sigma: A Prescription for Healthcare2

� 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

September 9, 2010

THE DEMAND CURVE WE ARE FEELING


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

September 9, 2010

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

September 9, 2010

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


� Mount Sinai Hospital

� Alberta Medical Association

� Sykes Assistance Services

� Health Canada

� Hamilton Health Sciences

� Joseph Brant Memorial Hospital

� Eagle Ridge Hospital, Vancouver

September 9, 2010

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


� 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”

September 9, 2010

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.

September 9, 2010

LEAN 101: MAKING WASTE MORE VISIBLE

� Process Flow Maps

� Spaghetti Diagrams

� Value Stream Maps

� Cause and Effect Diagrams

� Five “Whys?”


� Five “Whys?”

� Pareto Charts

� Workplace Organization

� 5S (Sort, Set, Shine, Standardize, Sustain)

� Visual Workplace

� Process Reports, Audits and Assessments

September 9, 2010

LEAN 101: VALUE STREAM MAPPING

• Current state?

• Future State?


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

September 9, 2010

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

Standardize: Standardize the cleaning, inspection,


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.

September 9, 2010

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.


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.

September 9, 2010

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


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

� HealthcareSeptember 9, 2010

SIX SIGMA 101: THE IMPORTANT QUESTIONS

1. Do I fully understand the customer requirements?

(Target and Tolerance)

2. How much variation is in the process I use to meet

my customer’s needs?

3. How well does my process meet my customer’s

needs? How often? What is the impact on Cycle

1

2

3


needs? How often? What is the impact on Cycle

time? Safety? Customer Satisfaction?

4. What are the root cause(s) of the process variation?

5. Can I reduce variation within the process to reduce

the defects? (If not, get a new process.)

6. Can I center the current process on target?

Y = F(X1..Xi)

3

4

5

6

September 9, 2010

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.


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

September 9, 2010

LEAN SIX SIGMA 101: ROBUST “TOOL BOX”

Define

Measure

•VOC (Voice Of the Customer)

•Project scoping and problem statement

•Team identification

•Cost of poor quality

•Change management

•Project contract

Define Phase – Key Tools

•“Critical To” Tree (CT Tree)

•High level process map

•Process Mapping (including SIPOC)

•Rolled Throughput Yield (RTY)

•Basic Statistics

•Central Limit Theorem (CLT)

•Cause and Effect (C&E) Matrix

•Control Charts Basics

•Measurement System Analysis

(MSA)

•Process Capability

•Cause and Effect (C&E) Diagram

Measure Phase – Key Tools

•Binomial Distribution Statistics

•Graphical Analysis and Techniques

•Data Collection Plan

•Failure Mode & Effects Analysis (FMEA)

Analyze Phase - Key Tools


Analyze

Improve

Control

•Advanced Graphical Analysis

oMulti-Vari Studies

oMain Effects Plots

oInteraction Plots

oCorrelation

oRegression

•Statistical Analysis

oHypothesis Testing

�Means

�Variation

�Proportion

�Counts

•Confidence Intervals

•Power and Sample Size

�Chi Square

�Non-normal data

�Analysis of Variance

�Analysis of Means

•Modeling Designs of Experiments

•Response Surface Design of

Experiments

•Robust Design of Experiments

•Survey Design of Experiments

Improve Phase - Key Tools

•Screening Design of Experiments

•Multiple Regression

• Process Control Plans

• Gage Control Plans

• Preventative Maintenance Control Plans

Control Phase – Key Tools

• Mistake Proofing

• 5S

• Standard Operating Procedure

• Statistical Process Control

• Business Case Simulation Exercise

September 9, 2010

SIX SIGMA 101: PROCESS EXCELLENCE

Lean & Six Sigma: A Prescription for Healthcare16 September 9, 2010

APPLICATION: LEAN SIX SIGMA IN E.D.

Lean & Six Sigma: A Prescription for Healthcare17 September 9, 2010

INITIAL TRIAL RESULTS

Metric Current Performance Trial Results

Time to PIA

CTAS 3

CTAS 4

>2 Hours 30 Mins.

>2 Hours

Ave: 45 Mins.

70% Reduction


70% Reduction

Length of Stay

CTAS 3

CTAS 4

>4 Hours 30 Mins.

>3 Hours

Ave: 3 Hrs. 23 Mins25% Reduction

%LWBS 6-7% Zero (Expected to be <1%

ongoing)

September 9, 2010

LEAN SIX SIGMA BENEFITS

� Reduced Patient Length of Stay

� Increased Patient satisfaction

� Patient sees physician much quicker

� LWBS drastically reduced

� Faster patient flow

� Improved patient safety

� Physicians see patients sooner

� RN

� More time for patient care

� D.I. – less batching, better flow

� Inside Clerk

� Less batching of patients/work� Simpler process� Less phone calls and interruptions� Less stress and greater job satisfaction

� The Lab

� Fewer unnecessary tests� Fewer add-ons� More time for patient care

� Greater % of time on VA activities� Peace of mind (Pt. seen by Dr. first)� Better waiting room attitude� Fewer interruptions at Triage� Less stress and Greater job

satisfaction

� Housekeeping – less batching

� For RVH

� improved reputation and image� Potential future funding

opportunities

� Fewer add-ons� Less batching of ER tests� Less need to phone ER

� Phlebotomist

� One visit per patient� No Hallway draws� Less batching� Less frustration and greater satisfaction

� C.I.T. has earlier intervention

� R.T. sees patient sooner

� Barrie Community has a better ER

� September 9, 2010

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

� Master’s Certificate in Healthcare Management

� Some of our Health Care clients;� St. Michael’s Hospital

� Mt. Sinai Hospital

• Lean Six Sigma Strategic Deployment

• On-site Lean Six Sigma Training


� Mt. Sinai Hospital

� Ontario Ministry of Health

� LHIN, FHITs, Strategy, etc.

� Health Canada

� Royal Victoria Hospital

� Hamilton Health Sciences

� London Health Sciences

� Canadian Blood Services

� Centre for Addiction & Mental Health

� Alberta Medical Association

� Joseph Brant Memorial Hospital

• On-site Lean Six Sigma Training

• Lean Six Sigma Project Management

• Open Enrollment (Public) Training

• Process Design, Modeling & Simulation

• Master Black Belt Project Coaching

& Mentoring

• Lean Six Sigma Certification

• Comprehensive e-Learning Program

September 9, 2010

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


costs and more desirable outcomes for patients and

caregivers alike.

� 8 Day Program

GBH096 (Toronto)

Session 1: October 4 - 7, 2010

Session 2: November 1 - 4, 2010

September 9, 2010

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

September 9, 2010

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


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.

September 9, 2010

HEALTHCARE QUALITY CAMPUS

Lean & Six Sigma24 March 5, 2010

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


� 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

September 9, 2010

CONTACT INFORMATION

E-Zsigma (Canada) Inc.

One Dundas St W, suite 2500

Toronto, ON

www.e-zsigma.com


www.e-zsigma.com

[email protected]

O: 416.593.8026

F: 416.204.1939

Thank you for joining us today!

September 9, 2010

green belt for healthcare

Business

primary health care

canadas health care

quality of care

way value

variety of health professions

transformingsix sigma

value creationlean

michaels hospital