simplifying process improvement/lean/six sigma programs for healthcare
DESCRIPTION
This presentation was presented during the IIE Engineering Lean and Six Sigma Conference, Sept 24, 2013 by Craig A. StevensTRANSCRIPT
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IIE Engineering Lean and Six Sigma
Conference 2013
September 23-25, 2013
Crowne Plaza at Ravinia Atlanta
Simplifying Process Improvement/Lean/Six Sigma
Programs for Healthcare
1
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The Most Efficient Doctor Visit What does excellent look like?
Doctor Lucy
Treatments
5 C
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Creating a Team Focused Improvement
Program
Agenda
Our Foundations of CPI
This is an example text. Go ahead and replace it
✓
6
5
4
3
2
1
3
TQM, Lean, Six-Sigma, Strategic Project Management
Three Easy To Understand Phases
Summary of PI Program Approach
Training Levels, Tools, and Big Rocks
Levels of Resources
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Westbrook Stevens, Seven Attributes of
Excellent Management Model, 1990 ©
People
and
Team
Building
4
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1. Excellent Leadership = Leadership
Throughout the Organization, Everyone is
Empowered to Lead Their Own Work
– What Does Excellent Leadership Look Like?
– What Does Our Leadership Look Like?
• Are Leaders On Board and Do we have a Leader for the CPI
Project?
– Where are the Gaps?
– Fix the Gaps!
Our Foundations of CPI The Seven Attributes of Excellent Management
1/7/2013 5
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Improvement Efforts and Missing
Elements of Change
Adapted from Palma Buttles-Valdez, Carnegie Mellon ,Process improvement Briefing to Software Engineering
Institute, 2008 – who adapted it from and Dr. Mary Lippitt, Enterprise Management, LTD., 1987,
ttp://www.jcse.org.za/upload/events/37/organisational_culture_and_people_issues_in_process_improvementdrpalma_
buttlesvaldez.pdf 2/13 2013
Vision
Vision
Vision
Vision
Vision
Vision
Vision
Resources
Resources
Resources
Resources
Resources
Resources
Resources
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Incentives
Incentives
Incentives
Incentives
Incentives
Incentives
Incentives
Action Plan
Action Plan
Action Plan
Action Plan
Action Plan
Action Plan
Action Plan
Change
Confusion
Anxiety and
Frustration
False Starts
Slow or Little
Progress
Reinventing
the Wheel
Barriers to
Change
Sporadic
Change
Leadership Systems
and
Processes
Problem
Solving /
Skills
Culture Problem
Solving/Skills
Tools
People Systems
and
People
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2. Excellent Culture = The Culture of the
Organization, The Culture of the Group
– What Does Excellent Organizational Culture Look
Like?
– What Does Our Culture Look Like?
• Are All Stakeholders On Board and Do we have a Willing
Culture for the CPI Project?
– Where are the Gaps?
– Fix the Gaps!
Our Foundations of CPI The Seven Attributes of Excellent Management
1/7/2013 7
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Improvement Efforts and Missing
Elements of Change
Adapted from Palma Buttles-Valdez, Carnegie Mellon ,Process improvement Briefing to Software Engineering
Institute, 2008 – who adapted it from and Dr. Mary Lippitt, Enterprise Management, LTD., 1987,
ttp://www.jcse.org.za/upload/events/37/organisational_culture_and_people_issues_in_process_improvementdrpalma_
buttlesvaldez.pdf 2/13 2013
Vision
Vision
Vision
Vision
Vision
Vision
Vision
Resources
Resources
Resources
Resources
Resources
Resources
Resources
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Incentives
Incentives
Incentives
Incentives
Incentives
Incentives
Incentives
Action Plan
Action Plan
Action Plan
Action Plan
Action Plan
Action Plan
Action Plan
Change
Confusion
Anxiety and
Frustration
False Starts
Slow or Little
Progress
Reinventing
the Wheel
Barriers to
Change
Sporadic
Change
Leadership Systems
and
Processes
Problem
Solving /
Skills
Culture Problem
Solving/Skills
Tools
People Systems
and
People
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3. Excellent Customer Focus
– What Does Excellent Customer Focus Look Like?
– What Does Our Customer Focus Look Like?
– Where are the Gaps?
– Fix the Gaps!
Our Foundations of CPI The Seven Attributes of Excellent Management
1/7/2013 9
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4. Excellent Team Building = All Things People,
Team Issues, and Motivational Theories
– What Does Excellent People Management Look Like?
– What Does Our People Management Look Like?
– Where are the Gaps?
– Fix the Gaps!
Our Foundations of CPI The Seven Attributes of Excellent Management
1/7/2013 10
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Improvement Efforts and Missing
Elements of Change
Adapted from Palma Buttles-Valdez, Carnegie Mellon ,Process improvement Briefing to Software Engineering
Institute, 2008 – who adapted it from and Dr. Mary Lippitt, Enterprise Management, LTD., 1987,
ttp://www.jcse.org.za/upload/events/37/organisational_culture_and_people_issues_in_process_improvementdrpalma_
buttlesvaldez.pdf 2/13 2013
Vision
Vision
Vision
Vision
Vision
Vision
Vision
Resources
Resources
Resources
Resources
Resources
Resources
Resources
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Incentives
Incentives
Incentives
Incentives
Incentives
Incentives
Incentives
Action Plan
Action Plan
Action Plan
Action Plan
Action Plan
Action Plan
Action Plan
Change
Confusion
Anxiety and
Frustration
False Starts
Slow or Little
Progress
Reinventing
the Wheel
Barriers to
Change
Sporadic
Change
Leadership Systems
and
Processes
Problem
Solving /
Skills
Culture Problem
Solving/Skills
Tools
People Systems
and
People
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5. Excellent Problem Solving = All Things Skills,
Core Competencies, and Problem Solving
Tools (Project Management, Six Sigma, Lean,
Accounting, Etc.)
– What Does Excellent Skills and Tools Look Like?
– What Does Our Skills and Tools Look Like?
– Where are the Gaps?
– Fix the Gaps!
Our Foundations of CPI The Seven Attributes of Excellent Management
1/7/2013 12
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Improvement Efforts and Missing
Elements of Change
Adapted from Palma Buttles-Valdez, Carnegie Mellon ,Process improvement Briefing to Software Engineering
Institute, 2008 – who adapted it from and Dr. Mary Lippitt, Enterprise Management, LTD., 1987,
ttp://www.jcse.org.za/upload/events/37/organisational_culture_and_people_issues_in_process_improvementdrpalma_
buttlesvaldez.pdf 2/13 2013
Vision
Vision
Vision
Vision
Vision
Vision
Vision
Resources
Resources
Resources
Resources
Resources
Resources
Resources
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Incentives
Incentives
Incentives
Incentives
Incentives
Incentives
Incentives
Action Plan
Action Plan
Action Plan
Action Plan
Action Plan
Action Plan
Action Plan
Change
Confusion
Anxiety and
Frustration
False Starts
Slow or Little
Progress
Reinventing
the Wheel
Barriers to
Change
Sporadic
Change
Leadership Systems
and
Processes
Problem
Solving /
Skills
Culture Problem
Solving/Skills
Tools
People Systems
and
People
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6. Excellent Continuous Improvement = All
Things Change Related, Continuous
Improvement, Systems, and Processes
(Systems Thinking, CPI)
– What Does Excellent Change Management (Systems
and Process Improvement) Look Like?
– What Does Our Change Management (Systems and
Process Improvement) Look Like?
– Where are the Gaps?
– Fix the Gaps!
Our Foundations of CPI The Seven Attributes of Excellent Management
1/7/2013 14
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Improvement Efforts and Missing
Elements of Change
Adapted from Palma Buttles-Valdez, Carnegie Mellon ,Process improvement Briefing to Software Engineering
Institute, 2008 – who adapted it from and Dr. Mary Lippitt, Enterprise Management, LTD., 1987,
ttp://www.jcse.org.za/upload/events/37/organisational_culture_and_people_issues_in_process_improvementdrpalma_
buttlesvaldez.pdf 2/13 2013
Vision
Vision
Vision
Vision
Vision
Vision
Vision
Resources
Resources
Resources
Resources
Resources
Resources
Resources
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Workforce
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Capable Processes
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Organizational Culture
Incentives
Incentives
Incentives
Incentives
Incentives
Incentives
Incentives
Action Plan
Action Plan
Action Plan
Action Plan
Action Plan
Action Plan
Action Plan
Change
Confusion
Anxiety and
Frustration
False Starts
Slow or Little
Progress
Reinventing
the Wheel
Barriers to
Change
Sporadic
Change
Leadership Systems
and
Processes
Problem
Solving /
Skills
Culture Problem
Solving/Skills
Tools
People Systems
and
People
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7. Excellent Performance Measures
– What Do Excellent Performance Measures Look Like?
• Seven Steps (1. Know the Rules, 2. Know the Goals, 3. Know
the Criterion for the Goals, 4. Know the Indicators of the
Criterion, 5. Collect the Data, 6. Analyze the Data, and 7. Use
the Data)
– What Does Our Performance Measures Look Like?
– Where are the Gaps?
– Fix the Gaps!
Our Foundations of CPI The Seven Attributes of Excellent Management
1/7/2013 16
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Creating a Team Focused Improvement
Program
Agenda
Our Foundations of CPI
This is an example text. Go ahead and replace it
✓
7
6
5
4
3
2
1
17
✓ TQM, Lean, Six-Sigma, Strategic Project Management
Three Easy To Understand Phases
Summary of PI Program Approach
Training Levels, Tools, and Big Rocks
Levels of Resources
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Lean
Lean
Focuses on reducing waste and improving
cycle time through continuous quality
improvement
Impact – Improves process flow and efficiency
Improvement Focused Teams
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Six Sigma
Six Sigma
Focuses on reducing errors through rigorous
data analysis and statistical controls
Impact – Improves quality and reduces
process variation
Improvement Focused Teams
Example From the HCA PI Teams
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1st Order Changes or Continuous
Improvement
1/7/2013 20 Copyright © 2007, www.WestbrookStevens.Com 20
1/7/2013
Start
Adapt
Adapt
Adapt
Some 1st Order
Changes become 2nd
Order Changes
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Project Management is Required for 2nd Order
Changes (or A Major Step Change)
1/7/2013 21
Copyright © 2007, www.WestbrookStevens.Com 21 1/7/2013
Before the Change During the Change After the Change
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Project Management
Project Management
Major Changes Require Mastering
Project Management
Improvement Focused Teams
Example From the HCA PI Teams
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Strategic Project Management
Strategic Project Management
Considers the overall value of the
project related to desired strategic and
tactical results
Example From the HCA PI Teams
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Strategic Planning Project Selection
Portfolio Management Project Management
Program Management
Process Improvement
Lean
Productivity Improvement
Indu
str
ial/S
yste
ms E
ngin
eering
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Creating a Team Focused Improvement
Program
Agenda
Our Foundations of CPI ✓
6
5
4
3
2
1
25
✓
✓
TQM, Lean, Six-Sigma, Strategic Project Management
Three Easy To Understand Phases
Summary of PI Program Approach
Training Levels, Tools, and Big Rocks
Levels of Resources
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Three Easy to Understand and Use
Improvement Phases
26
A =
Assessments
P = Problem Solving
I = Implementation
Using Project Management Tools/Support
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Assessment Phase
27
A =
Assessments
P = Problem Solving
I = Implementation
Using Project Management Tools/Support
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Solve Problems and
Apply GFR (Benchmarking)
28
A =
Assessments
P = Problem Solving
I = Implementation
Using Project Management Tools/Support
GFR
GFR GFR
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Step 6 – Select the Solutions and Build
a Project Portfolio
29
A =
Assessments
P = Problem Solving
I = Implementation
Using Project Management Tools/Support
GFR
GFR GFR
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Creating a Team Focused Improvement
Program
Agenda
Our Foundations of CPI ✓
6
5
4
3
2
1
30
✓
✓
✓
TQM, Lean, Six-Sigma, Strategic Project Management
Three Easy To Understand Phases
Summary of PI Program Approach
Training Levels, Tools, and Big Rocks
Levels of Resources
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Three Types of Assessments
Level One - Self-
Assessments – Tool Box Available to All Sites
– PM Driven
– PI Supported
– Operations Follow Up
Level Two - Onsite
Assessments – Only a Few DVP/GVP Chosen Sites
– PI Driven
– PM Support (and others)
– Operations Follow Up
Level Three - Third-Party Supported Assessments
Level Three (A) – Third-Party Supported Assessment of Current Practices – For a Few Highly Complicated or Politically
Charged Sites
– PI Driven
– Contractor Supported
– Operations Follow Up
Level Three (B) – Third-Party Assessment of New Acquisition – For the Critical New Sites Chosen by
DVP/GVPs
– TM Ops/Contractor Driven
– PI Supported
– Operations Follow Up
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PM Driven
Self-Assessments (Level 1)
PIP Team Onsite Assessments (Level 2)
Three Types/Levels of Assessments
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Level One - Self-Assessments
• Materials/Tools
– On-line Tool Box
• A Menu of Tools
• Triggers for When to Use the Tools
– 30 Minutes to an Hour Audios with PowerPoint Presentation
– Example Projects (Green Flag Report Lessons Learned)
• Scheduling, Staffing/Labor, Patient Flow, Telephones
• General Assessing, Problem Solving, and Implementation Tools
• Website, SharePoint Site, Newsletter
– Lessons Learned and Materials
– Face-to-Face, WebEx, and Online Education and Training
• Organizational Support Development
– “The HCAPS Way” with a Culture of Continuous Improvement
– Obtain Resources for Improvement and Sustainability
Team Room Link: http://teamrooms.hca.corpad.net/sites/hcapsproject/OPSS/Process%20Improvement/Forms/AllItems.aspx
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Create the Tools and Teach How to Find and Use
Them
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Activity Tiers For Level Two
A =
Assessments
P = Problem Solving
I = Implementation
Using Project Management Tools/Support
Week 1 = Off-Site Kickoff,
Surveys, and Data Gathering
Week 2 = Off-Site Data
Gathering, Interviews, and Analysis
Week 3 = Managed Assessment
and Problem Solving
Week 4 + = PMs Continue
Problem Solving and
Implementation
Using Project
Management
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Build a Assessment Candidate Portfolio
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Creating a Team Focused Improvement
Program
Agenda
Our Foundations of CPI
TQM, Lean, Six-Sigma, Strategic Project Management
✓
6
5
4
3
2
1
Three Easy To Understand Phases
Summary of PI Program Approach
Training Levels, Tools, and Big Rocks
Levels of Resources
37
✓
✓
✓
✓
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CPI Training Modules
Training Modules Description
Suggested and Optional Modules
Leaders Tools
Only
Master CPIP
Team
Introduction and Orientation
T.001.1234 - O.10.S - PI Training
Introduction 20130208
This is a 30 Minute orientation to summarize
the program. O X X X
T.001.1234 - O.10.L - PI Training
Introduction - Hour 20130313
(one or the other)
More detailed Orientation - This is a 60
Minute summarization of the program for
those whom will not take other training.
X O O O
White Belt Training (2 hours)
T.002.1234 - W-20-X1 - PI White
Belt Training 20130208
20 Minutes - General Introduction to Lean/6
Sigma/TQM/Change Management/Project
Management
O X X X
T.002.1234 - W-20-X2 - PI White
Belt Training 20130208
20 Minutes - Leadership - Situational
Leadership O X X
T.002.1234 - W-20-X3 - PI White
Belt Training 20130208
20 Minutes - Leadership - Understanding
Empowerment and how to get results O X X
T.002.1234 - W-20-X4 - PI White
Belt Training 20130212
30 Minutes - Culture – Understanding
culture. O O X X
T.002.1234 - W-20-X5 - PI White
Belt Training 20130214
30 Minutes - General Introduction to
Customer Focus, People, Skills/Problem
Solving Tools, Change/Improvement, and
Performance Measures
O O X X
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120 Min.
For Leaders
For Supervisors
1 Day – Mainly Lean Tools with some Culture,
Teams, and Motivation
For Practitioners
2 Weeks Worth of Training, Projects and Tools
For CPI Mentors and Facilitators
3 Months Worth of Implementation – Mentoring and Implementation Study
Training by Levels of Expertise
Create an Understanding with a focus on
Leadership and Empowerment (White Belt)
Be Able to Manage and Contribute to
Improvements (Yellow Belt)
Be Able to Perform Improvement
Projects Independently (Green
Belt)
Be able to Teach and
Facilitate Improvement
Projects for Others
(Black Belt)
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White Belt – 120 Minutes of Building Leaders
40
Element
% of Introduction
Time
Minutes of a 120 Minutes Presentation
1 -Leadership 50 60
2 - Culture 25 30
3 - Customer Focus 5 6
4 - People and Teams 5 6
5 - Skills and Tools 5 6
6 - Processes and Systems 5 6
7 - Performance Measures 5 6
Goal: To Create an Understanding
1 -Leadership
2 - Culture
3 - Customer Focus
4 - People and Teams
5 - Skills and Tools
6 - Processes and Systems
7 - Performance Measures
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• Situational Leadership
– When and how much to lead
• Incubation of Leaders
– About people, Empowerment
and
– how to motivate and lead
people to get results
Leadership Training - (50% of Time)
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• What is Culture
• How to Assess the
Culture
• How to Create a
Cultural Desire to
Improve
Organizational Culture
Training – (25% of Time)
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120 Min.
For Leaders
For Supervisors
1 Day – Mainly Lean Tools with some Culture,
Teams, and Motivation
For Practitioners
2 Weeks Worth of Training, Projects and Tools
For CPI Mentors and Facilitators
3 Months Worth of Implementation – Mentoring and Implementation Study
Training by Levels of Expertise
Create an Understanding with a focus on
Leadership and Empowerment (White Belt)
Be Able to Manage and Contribute to
Improvements (Yellow Belt)
Be Able to Perform Improvement
Projects Independently (Green
Belt)
Be able to Teach and
Facilitate Improvement
Projects for Others
(Black Belt)
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Yellow Belt – 1 Day – Building Direct Supervisors
Element % of Leaders’
Time Minutes of 1
Day
1 -Leadership 2 10
2 - Culture 2 10
3 - Customer Focus 4 20
4 - People and Teams 4 20
5 - Skills and Tools 63 300
6 - Processes and Systems 13 60
7 - Performance Measures 13 60
Goal: To Be Able to Manage and
Contribute to Improvements
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1 -Leadership
2 - Culture
3 - Customer Focus
4 - People and Teams
5 - Skills and Tools
6 - Processes and Systems
7 - Performance Measures
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• Highest Impact Tools and Solutions
– Doctor Schedule Templates
– Patient Throughput
– Phones
– Room Utilization
– Staffing
• Green Flag Reports
Yellow Belt – Problem Solving (Skills and Core Competiveness) (63%of time)
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Yellow Belt – Problem Solving (Skills and Core Competiveness) (63%of time)
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• Introduce Lean Tools – In addition to the Big Rocks & GFRs
– Observations
– Value Stream Mapping
– Flow Charting
– A3 Processing and Reporting
– Spaghetti Diagram
– 5 S Events
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120 Min.
For Leaders
For Supervisors
1/2 Day – Culture, Teams, Motivation
For Practitioners
2 Weeks Worth of Training, Projects and Tools
For CPI Mentors and Facilitators
3 Months Worth of Implementation – Mentoring and Implementation Study
Training by Levels of Expertise
Create an Understanding with a focus on
Leadership and Empowerment (White Belt)
Be Able to Manage and Contribute to
Improvements (Yellow Belt)
Be Able to Perform Improvement
Projects Independently (Green
Belt)
Be able to Teach and
Facilitate Improvement
Projects for Others
(Black Belt)
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Green Belt – 4 Days & Project – Building Practitioners
Element
% of Practitioners’
Time Hr
Training
1 -Leadership 2 1/2
2 - Culture 2 1/2
3 - Customer Focus 6 2
4 - People and Teams 10 3
5 - Skills and Tools 60 20
6 - Processes and Systems 10 3
7 - Performance Measures 10 3
Goal: To Be Able to Perform
Improvement Projects
Independently
Requires Completion of a Complete Improvement Project
1 -Leadership
2 - Culture
3 - Customer Focus
4 - People and Teams
5 - Skills and Tools
6 - Processes and Systems
7 - Performance Measures
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Green Belt – Select a Green Belt
Project that Relates to Your Work Area
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• Use the Three Phases
– Assess Using the Seven Attributes
• Plant Green and Red Flags
• Build Red Flag Portfolio
– Perform Problem Solving On One or More of the Red Flags
• Facilitate a Team Problem Solving Effort
• Build a Solution Portfolio and Select the Best (May Be a Real Project)
– Implement Solutions
• Build a Project Portfolio Based on the Solutions
• Implement some Quick Fixes and
• Select and Use PM tools to Implement a Real (Larger) Project
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• Learn the Key Six Sigma Tools
– Stats and Use the Lean Tools
• Review and Expand on the Other
Subjects
• Apply to The Selected Project
• Learn Project Management Tools
Green Belt – Training
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120 Min.
For Leaders
For Supervisors
1/2 Day – Culture, Teams, Motivation
For Practitioners
2 Weeks Worth of Training, Projects and Tools
For CPI Mentors and Facilitators
3 Months Worth of Implementation – Mentoring and Implementation Study
Training by Levels of Expertise HCAPS Improvement Focused Teams
Create an Understanding with a focus on
Leadership and Empowerment (White Belt)
Be Able to Manage and Contribute to
Improvements (Yellow Belt)
Be Able to Perform Improvement
Projects Independently (Green
Belt)
Be able to Teach and
Facilitate Improvement
Projects for Others
(Black Belt)
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Black Belt – 6 Months Experience, Training, & 4
Projects for CPI Facilitators
Element
% of Facilitators'
Time Hours over 6
Months
1 -Leadership 5 2
2 - Culture 5 2
3 - Customer Focus 5 2
4 - People and Teams 20 8
5 - Skills and Tools 30 10
6 - Processes and Systems 30 10
7 - Performance Measures 5 2
Goal: To Be able to Teach and
Facilitate Improvement Projects for
Others
Requires Facilitating the Successful Completion of 4
Complete Improvement Projects for Others
1 -Leadership
2 - Culture
3 - Customer Focus
4 - People and Teams
5 - Skills and Tools
6 - Processes and Systems
7 - Performance Measures
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• Review and Expand on the
Attributes and Tools
• Add Systems Thinking
Archetypes
• Apply to The Selected Projects
• Have a Strategic Focus
• Focus on Mentoring Others
• Focus on Training-the-Trainer
Black Belt – Training
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Creating a Team Focused Improvement
Program
Agenda
Our Foundations of CPI
TQM, Lean, Six-Sigma, Strategic Project Management
✓
6
5
4
3
2
1
Three Easy To Understand Phases
Summary of PI Program Approach
Training Levels, Tools, and Big Rocks
Levels of Resources
54
✓
✓
✓
✓
✓
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Results
55
A =
Assessments
P = Problem Solving
I = Implementation
Using Project Management Tools/Support
GFR
GFR GFR