the dmaic lean six sigma project and team tools approach improve phase 1

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The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

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Page 1: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

The DMAIC Lean Six Sigma Project and Team Tools Approach

Improve Phase

1

Page 2: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

2

Six Sigma Improve Phase

“The starting point for improvement is to

recognize the need.”

- Imai

Improve - Introduction

Page 3: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

Lean Six Sigma Black Belt Training! Improve Agenda

Welcome Back and brief D M A Review Improve OverviewGenerate and Prioritize SolutionsRisk AssessmentsEvaluate SolutionsApproach for ImplementationTranslate Improvements for CommunicationOther Improvement Approaches and SupportDesign for Six SigmaDesigned ExperimentsApplications / Lessons Learned / Conclusions Next Steps

3

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Improve Phase Review: Key Steps

In alignment with our project goal statement, and given what we have learned in the Define, Measure, and Analyze Phases of our project, during the Improve phase our team will complete:

•Generating and prioritizing Solutions (Improvement actions)•Risk assessment •Evaluation of Solutions and Benefits •Approach for Implementation•Translating and communicating learnings to Champion and

Process Owner(s) as appropriateWe will define and implement GREAT improvement solutions!

Improve – Key Deliverables

Page 5: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

Lean Six SigmaDMAIC Phase Objectives

• Define… what needs to be improved and why

• Measure…what is the current state/performance level and potential causes

• Analyze…collect data and test to determine significant contributing causes

• Improve…identify and implement improvements for the significant causes

• Control…hold the gains of the improved process and monitor

5

Page 6: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

What is Six Sigma?

•A high performance measure of excellence•A metric for quality

•A business philosophy to improve customer satisfaction•Focuses on processes and customers•Delivers results that matter for all key stakeholders

•A tool for eliminating process variation•Structured methodology to reduce defects

•Enables cultural change, it is transformational

6

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Six Sigma Is a Set of Powerful Tools

Define Measure Analyze Improve Control

Problem Definition

Process Mapping

Key Factors (x)

Selection Matrix

OCAP

Project Management

Cause & Effect Matrix

Basic Statistics

Prioritization chart

Standard Work

High Level Mapping

Fishbone Diagram

Regression FMEAFeedback

Loops

Descriptive Statistics

Statistical Analysis

Hypothesis Testing

SimulationTransition

Plans

ParetoValue Stream

MapANOVA

Future State Process

MapControl Plans

Benchmarking MSA FMEA SPC

Cost/Benefit Analysis

Capability Proportions Visual Control

Page 8: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

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The Lean Six Sigma Approach

• Lean Six Sigma is the combination of the Lean and Six Sigma “tool boxes” to create a customer-centric, value-based philosophy and rapid-fire deployment of focused methodologies to transform our business processes to be able to consistently deliver bottom line results that are sustainable and continuously improved.

Design for Six Sigma

Page 9: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

Six Sigma applied effectively…

•Increases customer satisfaction

•Lowers costs

•Builds better leaders

•Empowers an organization to be more data-driven

9

Page 10: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

The Basic Philosophy of Lean Six Sigma

• All processes have variation and waste• All variation and waste has causes • Typically only a few causes are significant• To the degree that those causes can be understood

they can be controlled• Designs must be robust to the effects of the remaining

process variation• This is true for products, processes, information

transfer, transactions, everything• Uncontrolled variation and waste is the enemy

10

Page 11: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

The basic focus of Six Sigma

Therefore, to understand the output (results) we are getting, we must study and understand the process and

inputs that go into producing the output we are getting.

Y = f(Xs)…data-driven problem solving and continuous

improvement

11

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Six Sigma DMAIC Projects

Analyze Phase

– What does the process data reveal?

– What are the Critical Key Xs?

– How much variation in “Y” from the Key “Xs”?

– What “Xs” can be and need to be improved (Root Causes)?

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Y=f(x)

Measure Phase15-70 xs

Process MappingPareto

C&E Matrix, FishboneFMEA

SIPOC Capability Study

Measurement Systems Analysis

Analyze Phase7-15 xs

Improve Phase 3-7 xs

Control Phase 3 or fewer xs

Control Plans, SOPs, SPC, Mistake Proofing

Prioritization Matrix, Improvement Ideas, C&E Matrix, Future State Map, PDSA

Pareto Chart, Correlation/RegressionHypothesis Tests, ANOVA, Descriptive Statistics, t-tests, Proportions

Only the Critical Xs need to be monitored and controlled long term

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Six Sigma Improve Phase (pg. 14 -16)

The Improve Phase is a systematic approach for examining the identified key xs, and determining, testing, and implementing the best solution(s).

Improve – Introduction

1. What changes can we make that will result in a sustainable improvement in the process output?

2. How will we know that a change has resulted in an improvement in the process output?

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Six Sigma Improve Phase (pg. 14 -16)

• Through process analysis, you will generate and test robust solutions shown to affect the proven causes (xs) that affect the critical output (Y) in a positive manner.

• The result will be an improved process that is stable, predictable, and one that consistently meets customer requirements.

Improve – Introduction

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Budget Lids/Hiring Freezes

Across-the-board cuts

Programs eliminated

Consolidation of units

Downsizing/Restructuring

Improve to Six Sigma performance

levels

Eliminate chronicproblems

Eliminate non-value-added work

Eliminate waste / rework

The (Rational) Improvement Alternative to Downward Spiralling

Improve – Introduction

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New and Improved Technology and Training could be the most robust

solution, but always remember to:

“Reach for the mind before you reach for the wallet” - borrowed

Improve Phase: Technology and Training - Right?

Improve – Introduction

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The Default Solutions…

• Training & education• New technology• Working harder or faster• More inspection or auditing• New policies• More people working in a broken process

…Are not always the right solutions!

Improve – Introduction

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Why People Don’t Do What They Are Expected To Do

(Robert Mager)

• They don’t know how to do it.

• They don’t know what’s expected of them.

• They don’t have the authority to do it.

• They don’t get timely information about how well they are doing. (In other words, they don’t get feedback.)

• Their information sources (documentation) are poorly designed, inaccessible, or nonexistent.

Improve – Introduction

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Why People Don’t Do What They Are Expected To Do (Cont’d)

• They don’t have job aids to cue correct performance.

• Their work stations provide obstacles to desired performance.

• The organizational structure makes performing difficult.

• They are punished or ignored for doing things right.

Improve – Introduction

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Why People Don’t Do What They Are Expected To Do (Cont’d)

• They’re rewarded for doing things wrong.

• Nobody ever notices whether they perform correctly or not.

Have we addressed each of these previous 11 concerns as to why people don’t do what they are supposed to do through our Improvement and Control actions?

Improve – Introduction

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Data-Driven Problem Solving

To be successful with any Six Sigma project, you have to affect at least one of the following:

–Reduce Variation

–Shift the Mean

–Eliminate Outliers

Page 23: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

Characteristic of the Performance Gap… (Problem)Accuracy and/or Precision

LSLLSLUSLUSL USLUSLLSLLSL

Off-Target Variation

On-Target

CenterProcess

Reduce Spread

The statistical approach to problem solving

The statistical approach to problem solving

USLUSLLSLLSLLSL = Lower spec limit

USL = Upper spec limit

23

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Lon

g-t

erm

Yie

ld100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%0 21 53 4 6

308,537 DPMO

66,807 DPMO3σ

6,210 DPMO

233 DPMO

3.4 DPMO

Process Sigma

Long-Term Yield vs Process Sigma

690,000 DPMO

Page 25: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

Six Sigma ImproveImproving the identified Key Xs to

Improve the Process (Y) and the Customer’s Experience

25

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Key Deliverables for Improve

• Main elements of Define, Measure, and Analyze completed

• “Obvious Xs” identified and confirmed

• Potential Xs identified, data collected and confirmed (Root Causes)

• Improvement solutions generated and prioritized upon investigation of root causes and supported with data

Improve – Review & Key Deliverables

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Key Deliverables for Improve

• Improvement solutions tested (pilot) and benefits estimated

• Implementation plan for solution(s) drafted with input from process owners

• Champion approval of the key solution(s) implementation

Improve – Review & Key Deliverables

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Six Sigma Improve Phase

“I know of no more encouraging fact than the unquestionable ability of mankind to elevate his life through a conscience endeavor.”

- Henry David Thoreau

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Improve Phase Review: Key Steps

In alignment with our project goal statement, and given what we have learned in the Define, Measure, and Analyze Phases of our project, during the Improve phase our team will complete:

•Generating and prioritizing Solutions (Improvement actions)•Risk assessment •Evaluation of Solutions and Benefits •Approach for Implementation•Translating and communicating learnings to Champion and

Process Owner(s) as appropriate

Improve – Review & Key Deliverables

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Improve Phase: Generate Solutions

• The objective is to generate ideas - come up with ways to impact our key xs in a way that will lead to an improved, consistent output. Be creative, find “out-of-the-box” solutions, invent potential fixes, and find ways to optimize your process.

• There are many ways of generating ideas. Here are four of the most common and useful:– Brainstorming– Affinity Diagrams (using key xs)– Process Mapping (current v. future)– Best practices/benchmarking

Improve – Generate Solutions

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Improve Phase: Generate Solutions – Brainstorming

(pg 27-29)

• A question or statement about an identified key x that negatively impacts Y is written on a board or flip chart for the entire team to see.

• Creative thinking is used as team members suggest potential improvements for the stated x. All ideas are recorded without any judgment initially of their validity. “Out of the box” thinking is strongly encouraged here, and “spring-boarding” off of others ideas is powerful.

• Think beyond the “status quo” or self imposed rules from the culture of the organization.

Improve – Generate Solutions

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Improve Phase: Generate Solutions Brainstorming Questions to Consider

• Where is the process step done? Can it be done elsewhere?

• Who performs the step? Can someone else perform the step?

• When is the step performed? Can the timing be changed?

• Under what conditions is the step performed? Can the conditions be changed?

• What resources are required for the process step? Where else can resources be found? What else can be used?

• How is the process step controlled? Is it value - adding?

• What does the customer really need? How is the customer using the process output - product or service?

Improve – Generate Solutions

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Brainstorming Guidelines• Clarify the question being considered

• Go around to each member asking for input, but also allow ideas to be written down - as on a sticky note, etc.

• Do not make any critical comments about initial ideas submitted by team members - only ask for clarification if needed

• Strive for a high quantity of ideas to begin with, then move toward “quality”

Improve – Generate Solutions

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Improve Phase: Generate Solutions - Affinity Diagrams

(pg 30-31)

• An Affinity Diagram is used to help a team discover meaningful groups of ideas or relationships within a raw list of ideas - as coming potentially from a brainstorming session.

• Affinity diagrams are helpful when: – facts or thoughts are uncertain and need to be organized– preexisting ideas or paradigms need to be overcome– ideas need to be clarified– unity within a team needs to be strengthened

Improve – Generate Solutions

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Improve Phase: Generate Solutions - Affinity Diagrams

• To create an affinity diagram, the team sorts a brainstormed list, moving ideas from the raw list into affinity sets, creating groups of related ideas. This can easily be done by writing on a flipchart, or using post-it notes to “re-stick” into affinity groups.

• Basic guidelines for affinity diagrams: – Rapidly group ideas together that seem to belong together – Clarify any ideas in question– Initially, it isn’t important to define why they belong together – Copy an idea into more than one affinity set if appropriate – Seek to summarize or name each set with appropriate titles and this

may lead to more robust improvement ideas / actions

Improve – Generate Solutions

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Improve Phase: Process Mapping (pg. 34-41)

• A process is a sequence of steps or activities using inputs to produce an output (accomplish a given task).

• A process map is a visual tool that documents a process.

• Several styles and varying levels of detail are used in Process Mapping. Most common and useful styles are SIPOC, Flow Diagrams, Box Step, and Value Stream Maps.

Improve – Generate Solutions

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Improve Phase: Process Mapping

• The team should start with the observed, current, as-is process.

• Start high-level, and work to the level of detail necessary for your project (key inputs).

• As inconsistencies are discovered, the team can develop a future state or should-be process map to improve the key xs and the overall output (Y) of the process.

Improve – Generate Solutions

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Analyze Roadmap: Process Analysis

Types of Process Delays or Errors:

• Gaps• Redundancies• Implicit or unclear requirements• Bottlenecks• Hand-offs• Conflicting objectives• Common problem areas

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Improve Phase:

Process Mapping for Process Improvement

True “process improvements” usually DON’T come from:- working harder using a broken or inefficient process- education or re-education- blaming / threatening / coercion / policies

Consider:- making changes that “make it easy to do it right”- hardwire in desired defaults- eliminate process steps that don’t add value- if you have too much variation or “special cause”,

designing a consistent process should be your first step to improvement

Langley, et. al. “The Improvement Guide - A practical Approach to Enhancing Organizational Performance”.

Improve – Generate Solutions

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Improve Phase: Generate Solutions - Best Practices / Benchmarking

(pg. 254-255)

Benchmarking is measuring your process performance against other “best in class” similar processes internally and / or externally as appropriate. Adopt the process steps and parameters as appropriate to obtain the desired output results from your own process.

“Best practices are a sustainable competitive advantage. It’s true that, once a best practice is out there, everybody can imitate it, but organizations that win do two things: they imitate and improve it.” - Jack Welch

Improve – Generate Solutions

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Types of Benchmarks (pg 255)Pros Cons

Internal/Company

Establishes a baseline for external benchmarkingIdentifies differences within the companyProvides rapid and easy-to-adapt improvements

Opportunities for improvement are limited to the company’s internal best practices

Direct Competition

Prioritizes areas of improvement according to competitionInitial area of interest to most companiesBest used for in-depth studies as supplement to competitive intelligence studies

Often a limited pool of participantsOpportunities for improvement are limited to “known” competitive practicesPotential antitrust issues

Industry Provides industry trend informationProvides management with a conventional basis for quantitative and process-based comparison

Opportunities for improvement may be limited by industry paradigms

Best-In-Class

Examines multiple industriesProvides the best opportunity for identifying radically innovative practices and processesProvides a brand new perspectiveFree exchange of information more likely to occur

Often difficult to identify best-in-class companiesSometimes difficult to get best-in-class companies to participate

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Improve Phase: Prioritize Solutions

• Once you have a set of potential solutions, your team will need to narrow down your list by identifying the best solutions to test.

• You will need to consider a number of factors: impact, cost, resources, etc. – Multivoting– Prioritization matrix

Improve – Prioritize Solutions

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Improve Phase: Prioritize Solutions – Multivoting

(pg 31-32)

• Multivoting narrows a large list of possibilities to a smaller list of the top priorities or to a final selection.

• Multivoting is preferable to straight up or down voting because it allows an item that is favored by all, but not the top choice of any, to rise to the top.

• Usually follows brainstorming or affinity diagramming to prioritize the main ideas.

Improve – Prioritize Solutions

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Improve Phase: Prioritize Solutions - Multivoting

• To conduct the multivoting process, the team works from a brainstormed list of ideas, options, etc. This can easily be done by writing on a flipchart, marker board, or using post-it notes. Each team member will have a marker, or self-adhesive dots to use for voting. The number of multiple votes each member gets depends on the size of the list, but it is usually about one third of the total number of items on the list.

• Basic guidelines for multivoting: – All team members get an equal number of votes– A member can distribute their votes or cast all of them for one idea– If two or three ideas are close in voting, then a multivote can occur

with those two or three ideas listed

Improve – Prioritize Solutions

Page 45: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

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Multivoting Example

Budget Priorities

New billing system

Additional staff

Hire Six Sigma consultant

Improve office equipment

Increase travel budget

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Improve Phase: Prioritize Solutions - Prioritization Matrix

• A prioritization matrix is used to compare choices (options, improve approaches, etc.) relative to criteria such as cost, ease of implementation, resources, effort, etc.

• This tool forces a team to focus on the best

things to do, not everything they could do, dramatically increasing the chances for implementation success.

Improve – Prioritize Solutions

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Improve Phase: Prioritize Solutions - Prioritization Matrix

Basic guidelines for a prioritization matrix: – Virtually any criteria or factor can be used for

ranking the options– Effort (resources, costs) vs. Impact is a common

matrix format for ranking potential improvement activities

– A cause and effect matrix is a form of a prioritization matrix

– All team members should come to consensus on the ranking of each option

Improve – Prioritize Solutions

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Sample Prioritization Matrix:Lean Pharmacy

Improve – Prioritize Solutions

Low Impact Medium Impact High Impact

Low Complexity

-Omnicell restock process-Workstation design: Repackaging area

-Kanban inventory; Frozen stock

Medium Complexity

-Crashcart design/quantity; standard work for restock

-Workstation/room layout; IV room-Workstation design; Order entry area

-Kanban inventory: IV fluid boxes-Metrics development and tracking

High Complexity

-Delivery cart setup and delivery process

-Order clarification process-Workstation design: Med pick area-Standard work system; job guidance sheets: all areas

Impact for Pharmacy

Co

mp

lexi

ty /

Am

ou

nt

of

Wo

rk R

equ

ired

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Generate and Prioritize Solutions-Summary

– Brainstorming– Affinity Diagrams (using key xs)– Process Mapping (current v. future)– Best practices/benchmarking– Prioritization

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Improve Phase: Risk Assessment

• Even your solutions may have potential flaws or gaps at which they could break down.

• You will need multiple participants with different perspectives in this process to identify the potential problems and possible modifications to create the most robust improvement solution with minimized risk.

• The two techniques for assessing risk that we will focus on are:– Force Field Analysis (FFA) – Failure Mode and Effect Analysis (FMEA)

Improve – Assess Risks

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Improve PhaseAssess Risks - Force Field Analysis (FFA)

• FFA is a method borrowed from a Mechanical Engineering technique known as Free-Body Diagramming, and from social psychology studies in human behavior.

• FFA is used to identify all the forces surrounding and acting on a body (plan, improvement implementation, etc.)

• The objective is to ascertain the forces leading to an equilibrium state (determine the resources and costs)

• Generates a chart or table for further analysis or presentation

• With FFA, “EQUILIBRIUM” can be:– a desired goal– the status-quo

Improve – Assess Risks

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FFA - Barriers & EnablersDriving Forces Restraining Forces

B

A

R

R

I

E

R

S

E

N

A

B

L

E

R

S

Improve – Assess Risks

Page 53: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

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FFA - Barriers & Enablers

Improve – Assess Risks

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Improve PhaseAssess Risks - FMEA

Failure Mode and Effects Analysis

Improve – Assess Risks - FMEA

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FMEA (Failure Mode and Effects Analysis)

(pg 270-273) • A documented methodology for evaluating, prioritizing, and

analyzing risks with the objective of eliminating or minimizing these risks through a team effort.

• A systematized group of structured activities to: 1. recognize and evaluate the potential failure of a product or process and its

effect, 2. identify actions which could eliminate or reduce the chance of the potential

failure occurring, and 3. document the process.

• An FMEA is very complementary to defining what a product / process must do to consistently meet the needs of the customer.

Improve – Assess Risks - FMEA

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Using FMEA in DMAIC

• During MEASURE to:– Assess the current process failures and risk– Identify potential Xs to be tested

• During IMPROVE to: – To evaluate potential risk for improvement ideas– Prioritize improvements with high risk– To generate additional improvement ideas

Improve – Assess Risks - FMEA

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FMEAs Basically Answer:

• What process step or product function could fail?

• What would be the effect of that failure occurring and how severe would that effect be (severity)?

• What are the potential root causes of the failure and what is the likelihood or frequency of those root causes causing the failure (occurrence)?

• What current controls are in place to stop or immediately detect the potential root causes and how effective are those controls (detection)?

• What recommended actions should be taken to minimize or reduce the likelihood of the greatest risks identified?

Improve – Assess Risks - FMEA

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FMEAs Risk Prioritization

• A ranking system, usually on a scale of 1 to 10, is used by the team for each of these categories:

Severity

Occurrence

Detection

• A Risk Priority Number (RPN) is calculated for each single potential cause and associated failure mode by multiplying the three ranked values. These relative ranked values are used to identify the greatest risks and prioritize actions.

Improve – Assess Risks - FMEA

Page 59: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

ProcessStep/Input Potential Failure Mode Potential Failure Effects

SEV Potential Causes

OCC Current Controls

DET

RPN

Actions Recommended

0 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 0

FMEA Format and Structure

What is the Input

What can go wrong

with the Input?

What is the Effect

on the Outputs?

How Bad?

What are the

Causes?

How Often?

How are these

found or prevented

?

How well?

What can be done?

Steps

Improve – Assess Risks - FMEA59

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FMEA - Step by Step (pg. 270)

1. For each Process Input, determine ways the Input can go wrong (Failure Modes)

2. For each Failure Mode associated with Inputs, determine Effects of Failures on customers

3. Identify potential Cause(s) of each Failure Mode

4. List Current Controls for each Cause or Failure Mode

5. Use standard, or create, Severity, Occurrence, and Detection rating scales

6. Assign Severity, Occurrence, and Detection ratings to each Cause

7. Calculate RPNs for each Cause

8. Determine Recommended Actions to reduce high RPNs

9. Complete Recommended Actions and recalculate RPNs

Improve – Assess Risks - FMEA

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Example FMEA

Improve – Assess Risks - FMEA

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FMEA Hints

•Keep it simple; not complex

•Must involve a team, usually 3 to 6 members, no “lone ranger” development

•Update it as you move through the process and knowledge increases

•Make sure the FMEA is an action tool, not just a document; use the right half of the tool

Improve – Assess Risks - FMEA

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Improve Phase: Evaluation of Solutions (Pilot)

(pg 273-276)

• You will want to run trials of your selected improvement solutions in a real environment.

• A test of all or part of a proposed solution on a small scale in order to better understand its effects and to learn how to make the full-scale implementation more effective.

• It is sometimes called a pilot test, a trial, or a small test of change

Improve – Test Solutions

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PDSA: Plan Do Study Act

• The Deming cycle, or PDSA cycle, is an improvement model consisting of a logical sequence of four repetitive steps for continuous improvement and learning. It may also be called the Deming wheel of continuous improvement.

• Its origin can be traced back to the 1920’s when Walter Shewart, statistics expert at Bell Laboratories, introduced the improvement concept of Plan, Do, and then See.

Improve – PDSA

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Act Plan

Study Do

Basic PDSA StepsPLAN1. Identify the problem and desired outcome2. Identify the most likely causes/factors

using data3. Identify potential solutions and the data needed for evaluation (plan the details of the change: the who, what, when, and where)

DO4. Implement solutions and collect data needed for evaluation. Make sure the data collected allows you to assess progress toward the desired outcome or target.

STUDY5. Analyze data and develop conclusions

ACT6. Recommend further study and/or action

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Improvement Implementation Plan

A P

S D

Prioritized Solutions and Ideas

Changes that result in

improvement

Series of small testsLearn as you goData driven test cycles

“Truth is found more often from mistakesthan from confusion.”

- Francis Bacon, 1561 - 1626

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Appropriate Scope for a Pilot Test

ImplementLarge Scale

TestSmall Scale

Test

Cost of failure small

Large Scale Test

Small Scale Test

Very Small

Scale Test

Cost of failure large

High Confidence that change idea will lead to Improvement

Small Scale Test

Very Small Scale Test

Very Small

Scale TestCost of failure small

Very Small Scale Test

Very Small Scale Test

Very Small

Scale Test

Cost of failure large

Low Confidence that change idea will lead to Improvement

ReadyIndifferentResistantCurrent Situation

Readiness for Change

Provost, Lloyd. CHAI Fall Conference. Nashville, TN. Sep 2004

Improve – Test Solutions

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Improve Phase: Benefits Estimation

How much positive change in “Y” will occur as a result of this improvement, and how much is this positive change worth to our organization? ― Unit cost― Total Resource― Benchmark (Gold standard)― Process Flow

Improve – Benefits Estimation

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Improve Phase: Benefits Estimation• Unit cost

– Cost of each defect x number of occurrences

• Total Resource– Total resources used to do an activity– % of time on non-value add activity = total opportunity

• Benchmark (Gold standard)– Compare our performance to a gold standard; what is the

quantifiable gap

• Process Flow– From our process map, what are the NVA steps/activities– Design new process to eliminate NVA steps

Improve – Benefits Estimation

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Improve Phase: Approach for Implementation of Improvements

• Clearly identify who the process owner is and all associates involved in the process

• Identify all documentation related to the process being improved and determine what modifications / updates need to be made (Policies, Procedures, Work Instructions, etc.)

• Develop a communication plan– Who will be impacted by the change?– Communicate before the change goes into effect

• Create a simple responsibility matrix to identify who will be doing what when, and ensure Champion is in agreement

• Monitor and Adjust if needed as the improvement is incorporated into the process

Improve – Implementation Approach and Plan

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Improve Phase: Translating and Communicating Learnings for

Champion Approval

• For all significant improvement changes, the project’s Executive Champion must be informed and must formally approve the implementation.

• Before discussing improvement implementation with your champion, you must have “done your homework” and have data to support your plan including risk assessment, pilot testing results, resources needed, and potential benefits.

Improve – Champion Approval

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Lean Six Sigma

Improvement Approaches and Support Tools

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Resource Guide to Change Concepts The Improvement Guide (pg. 293-299)

• Consider potential consequences of applying change concepts

• The concepts are guidelines and general in nature

• Every change concept does not apply to every problem

• What change can we make that will result in improvement?

• “While all changes do not lead to improvement, all improvement requires change.”

Improve – Change Concepts

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Value Added vs. Non-Value Added

• Value Adding Process– A process step that transforms or shapes a

product or service towards that which is sold to a customer. Changes “form, fit, or function” in a way that customers are willing to pay for

• Non-Value Adding Process– Those process steps that take time, resources, or

space, but do not add to the value of the product or service itself (These activities should be eliminated, simplified, reduced or integrated)

Improve – Eliminate Waste

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Waiting

zzzzz

Over-Production & Over- Processing

Sign-offs

Transportation

12 1 10 9 86 4 13 2 3 11 5 7

Waste of People: Underutilized orUnused Creativity

Noway!

Motion: Walkingor Reaching

Inventory Rework / Quality Defects

Wrong infoInfo missingKeypunch errorMedical Error

Eight Wastes

Inspection

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Why Lean Tools?• Six Sigma and Lean are very complimentary

approaches to improvement

• Often creates rapid improvement and elimination of the eight wastes

• Creates a stable process which can be further improved

• When deployed correctly, embeds a rapid continuous improvement mindset in the culture

• Drives shorter lead-times, reduced inventory, lowers costs

Improve – Eliminate Waste

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Does a distance of 45 feet Matter?

Example: LeBonheur Lab Renovation Initial Design - Tube System Location

45 feet each way = 90 feet walked per specimen

250,000 core lab specimens per year= 22,500,000 feet per year walked

= 4,260 miles per year walked (the distance from New York to Rome)

At two miles per hour, = 2130 hours per year

= 1.02 FTEs per year moving the sample from tube station to receiving area

Improve – Improve Work Flow

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Red = Zone 1 Operator

Blue = Processor

Move Steps in the Process Closer Together & Synchronize

After

78

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Do Tasks in Parallel / Eliminate Batching

Smaller centrifugeallows for individual

single piece testing, instead of waiting for a large centrifuge to fill with specimens

beforespinning (batch)

Improve – Improve Work Flow

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Take Care of Basics: 5S1) Sort

Clear out rarely used items by red tagging

4) Standardize

Create rules to sustain the first 3S’s

2) Straighten

Organize and label a place for everything

3) Shine

Clean it

5) Sustain

Use regular management audits to

stay disciplined

Improve – Change Work Environment

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Did somebody order some 5S?

81

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Post 5S Improvement Results

Improve – Change Work Environment

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Sustain

5S within OR Rooms OR #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8Stock Turnover: Are bins being completely emptied prior to refill to ensure turn-over of stock? (Yes or No)Restock Carts: Are empty bins being placed into the restock carts as they are emptied?Stock Amounts: Are bins being properly filled and not overstocked?Visual Control: If the associates are too busy to restock are they placing the restock carts in the hallway (with empty bins) Visual Control: Are all necessary items labeled for proper location and shadowed appropriately?Sort, Shine, Stabilize: Are rooms clean and organized? All items in the proper place, excess items removed, etc?Standardization: Are items in the rooms properly placed into their designated locations?

OR Storeroom:Kanban Cards: Are Kanban cards properly located according to minimum stock amount listed on card? (Verify 5 cards on 5 separate carts, list SAP# checked)

Inventory: Are supplies properly organized so longer outdates and last used? Longer outdates on right/bottom/back and shorter outdates on left/top/front? (Verify 5 cards on 5 separate carts, list SAP# checked)

Process: Are Kanban card properly located in the "To Be Ordered" location when appropriate and moved to "Ordered" when order is placed?

Orderliness: Is the storeroom clean and organized, items removed from walkways? All carts properly located?

Timeliness: Are supplies being ordered in a timely manner so that out-of stock does not occur? (Look for empty supply locations)

CSR: Are CSR stocked items (red stripe on Kanban cards) properly filled and organized?

Other:Hallway: Are items in hallways properly labeled and shadowed for position and all items accounted for? Are hallways free of debris, etc?

Scrubs: Are Kanban cards properly located and is process being followed? (Empty bins cards at front desk, Full 2nd bin has card located on it)Small Equipment Room: Are equipment and supplies properly located, organized, labeled and shadowed within this area?

Auditor: Date:

Standardized Process Audit - Supply Management

Additional Comments or Suggestions:

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# Work Elements / Important Steps Est. Time Reasons for Key Points

1Clinician will send patient back to triage, if lobby is backed up call patient back to triage

42Using FIFO helps patient satisfaction and does not use the ED as a fast track system

2 Get patient weight prior to entering triage room. 60 weight is critical for the providers

3Obtain brief chief complaint while getting vital signs

120Saves cycle time when done together

4 Put complaint and vital signs in computer 167necessary information for the provider

5 Complete full triage in computer 60 key for provider to have upfront

6 Determine ACUITY level of patient. 26Diagnosis, not acuity level drives the LCT

7Escort patient to lobby if LCT exam rooms are full

5

8

9

10

11 Total Estimated Time 480

We are using a FIFO (first-in-first-out) system, unless high acuity dictates differently

Document wt on Registration form

Do vitals and chief complaint in parrallel

Document vital signs on registration form, do not write down the patients information, enter it directly into the computer

Past medical history and home medications

Although assigning acuity level we are assigning patients to the LCT by diagnosis, (refer to diagnosis sheet for lean track patients

WORK STANDARD & JOB BREAKDOWN SHEET

Job Function: Triage Nurse

Key Points Sketch/Drawing/Picture

Sheet No. 1 Of 1

Area: Front of ED

Operation Name: Triage

Date: 9-18-07

Prepared By BeLinda Conti

Approved By

Update Name

Dept. Emergency Department

Triage 1 & 2 Greeter & Clinician

Standard Work

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Ten Types of Human Errors(and how to protect against them)

1. Forgetfulness - Protection: alerting operators in advance, regular checking, automated reminders

2. Misunderstanding - Protection: std work, training, checking in advance3. Identification – Protection: training, attentiveness, vigilance4. Lack of experience – Protection: Skill building, work standardization5. Ignoring rules – Protection: Basic education, experience, audits,

discipline6. Inadvertent – Protection: Attentiveness, discipline, std work7. Slowness, delays in judgment – Protection: Skill building, std work8. No standards – Protection: work instructions, std work9. Surprise – Protection: Preventative maintenance, std work10.Intentional – Protection: Education, discipline

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Defect Sources• Omitted processing• Processing errors• Setting up work pieces• Missing parts• Wrong parts• Processing wrong work piece• Misoperation• Adjustment error• Improper setup• Tools, fixtures, jigs improperly prepared

Improve – Design Systems to Avoid Mistakes86

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Design for Six Sigma

DFSS

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Improvement from the Start

• DFSS (Design for Six Sigma) builds a process that is designed to operate at a Six Sigma level of performance from the very launch of the new process. It focuses on the customer (needs), reviews current related processes, and benchmarks internally and externally

Design for Six Sigma

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Design for Six Sigma

• DMAIC is structured to improve an existing process - reduce variation, eliminate defects.

• Design for Six Sigma (DFSS) uses DMADV (Define Measure, Analyze, Design, Validate); or IDOV (Identify, Design, Optimize, Verify) to create a new process that produces minimal defects from the start

• We usually focus on DMAIC

Design for Six Sigma

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Design for Six Sigma

• The intent of DFSS is to bring a new product or service to “market” with a process performance near a six sigma level for each key customer requirement of the product / service.

• DFSS is essentially an attitude and approach toward new or re-designed products and services, and not a methodology. The DFSS concept utilizes methodologies such as DMADV or IDOV.

Design for Six Sigma

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Design for Six Sigma

• DMADV and IDOV are very similar and basically provide a structured roadmap to create a new product or design a new process that has minimal variation and defects

• The key initial focus areas of DFSS include collecting, analyzing, and clearly understanding the VOC and CTQs - “What would a Six Sigma level performing product or process need to look like, or consistently produce?”

Design for Six Sigma

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Design for Six Sigma - IDOV

• Identify - Quantified customer information along with technical requirements, specifications, and performance targets are identified and documented.

• Design - The CTQs are emphasized, and all key inputs considered as conceptual designs are evaluated to create a new process that produces minimal defects

Design for Six Sigma

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Design for Six Sigma - IDOV

• Optimize - The capability of the new process to meet all critical requirements is evaluated, and the design is optimized through simulation, small scale tests, benchmarked data, etc.

• Verify - The optimized process design is formally tested and validated to consistently meet critical requirements. Longer term monitoring and feedback may be necessary.

Design for Six Sigma

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Design for Six Sigma - DMADV• Define - Define the project goals and customer

deliverables

• Measure - Determine customer needs and specifications

• Analyze - Study process options to meet the customer’s needs

• Design - Develop process details to meet the critical requirements

• Validate - Verify the design performance and ability to consistently meet customer’s needs

Design for Six Sigma

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Design for Six Sigma Common Tools

• SIPOC (VOC and CTQ emphasized)

• Detailed Process Maps

• QFD - Quality Function Deployment

• FMEA

• Simulation and Small Scale Testing

• Poka-Yoke (Mistake Proofing)

Design for Six Sigma

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IDOV DMADV Deliverable ToolIdentify Define Intiate, scope, and plan

the projectCharterBenchmarkingFMEA on current process

Measure Understand customer needs and specify CTQs

VOCQuantify specifications, technical requirementsDefine key inputsHigh-level map of current process or SIPOC

Analyze Develop design concepts and high-level design

High-level design of new processQuality Function Deployment (QFD)Process Capability analysis

Optimize Design Develop detailed design and control/test plan

Detailed process mapSimulationFMEAPoka-yokeFFA

Verify Verify Test, design, and implement full-scale processes

Control plan and feedback loopData collection and analysisSPCCapability AnalysisStandard Operating Procedures

Design

IDOV and DMADV

Page 97: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

Designed Experimentsor

Design of Experiments (DOE)

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Design of Experiment

• DOE identifies how factors (Xs) alone and in combination affect a process and its outputs (Ys).

• DOE is a systematic approach • Provides a mathematical model• Identifies the best combinations of Xs

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Why is DOE needed?

• A man decided to investigate the causes of intoxication.• On his first trial, he drank whiskey and water and became

intoxicated.• On his second trial, he held all variables constant except one…

he replaced the whiskey with vodka… and became intoxicated• On the third trial, he used bourbon instead of whiskey and

vodka… and became intoxicated.

• After recovering, he concluded that water causes intoxication, because it was the only constant variable!

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Designed Experiments or Design of Experiments (DOE)

pg 184 - 194

• DOE is a structured approach to improve an existing process by testing multiple factors at a time thus reducing the number of experimental runs and time needed for testing

• The most important factors affecting a given output of a process, and the controlled tested factor’s best settings are identified.

Six Sigma DOE

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Alternatives• One Factor at a Time (OFAT) – A given factor tested at

multiple levels while holding everything else constant. This approach may work OK in a high school chemistry lab, but it can be very time consuming and inefficient when applied to a complex process in a “working” environment.

• Many Things at Once – it becomes difficult to determine which changes contributed to the effects and to what degree, might keep doing something that is harmful to results, impossible to assess cost/benefit for each change

Six Sigma DOE

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Alternatives

• Not every project has to include a designed experiment. Many will use pilots of controlled small tests of change or work-out sessions to achieve improvements… but considering DOE as appropriate doesn’t hurt, either!

Six Sigma DOE

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Designed Experiments or Design of Experiments (DOE)

• Results from DOEs identify main effects from the tested controlled factors as to the extent the factors influence chosen response variables.

• The factors would be considered the inputs, and the response variables would be the outputs.

• Results from DOEs also look at how the interactions of the factors influence the response variables.

Six Sigma DOE

Page 104: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

One Factor at a Time

Gas Type Timing Set up MPG

G1 T1 30

G2 T1 20

Which gas type and engine timing setting will produce the best gas mileage?

Since G1 produced the best mileage, test it against both timing settings…

Gas Type Timing Set up MPG

G1 T1 30

G1 T2 25

Best Value!But… what did we miss?

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Page 105: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

DOE shows the effects of interactionsGas Type Timing Set up MPG

G1 T1 30

G1 T2 25

G2 T1 20

G2 T2 45

20

50

40

30

T2T1

G1

G2

This interaction was missed using one factor at a time!

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Terminology

• Factors – the variables you are testing• Levels – the settings you are checking for each

factor• Factorial – describes the basic design

– 2 x 3 x 3 design describes 3 factors– one at 2 levels and two at 3 levels… 18 trials or “runs” in all

– 2k describes an experiment with k factors, each at 2 levels. A 23 design means 3 factors with 2 levels each, or 8 runs in all

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Page 107: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

Terminology

• Main Effects – the differences between each factor level

• Interactions – differences between two or more factor level combinations

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Main Effects and Interactions Plots

20

50

40

30

T2T1

20

50

40

30

T2T1

25

30

T2T1

G1

G2G2

G1

Main Effects Interactions

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Terminology

• Run – Each trial with a combination of factors yielding a result

• Replicates – The number of times you repeat the full set of runs

• Full Factorial – A design that tests each factor at every level

• Fractional Factorial – A design that tests only selected combinations of factors

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Page 110: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

Set up a 22 Full Factorial Experiment

• Stat>DOE>Factorial>Create Factorial Design

Select the number of replicates

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Page 111: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

Set up a 22 Full Factorial Experiment

• Stat>DOE>Factorial>Create Factorial Design

Name the factor

Select the data typeSet the levels

111

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Set up a 22 Full Factorial Experiment Full Factorial Design

Factors: 2 Base Design: 2, 4Runs: 8 Replicates: 2Blocks: 1 Center pts (total): 0

All terms are free from aliasing.

Add column for results. Run the experiment and record responses.

Standard sequenceRandomized “run” sequence

112

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Analyze Factorial Design

• Stat>DOE>Factorial>Analyze Factorial Design

113

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Analyze Factorial Design

• Stat>DOE>Factorial>Analyze Factorial Design

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Analyze Factorial Design Factorial Fit: Mileage versus Gas, Timing

Estimated Effects and Coefficients for Mileage (coded units)

Term Effect Coef SE Coef T PConstant 29.500 0.7289 40.47 0.000Gas 4.000 2.000 0.7289 2.74 0.052Timing 7.500 3.750 0.7289 5.14 0.007Gas*Timing 14.500 7.250 0.7289 9.95 0.001

S = 2.06155 PRESS = 68R-Sq = 97.08% R-Sq(pred) = 88.32% R-Sq(adj) = 94.89%

Analysis of Variance for Mileage (coded units)

Source DF Seq SS Adj SS Adj MS F PMain Effects 2 144.500 144.500 72.250 17.00 0.011 Gas 1 32.000 32.000 32.000 7.53 0.052 Timing 1 112.500 112.500 112.500 26.47 0.0072-Way Interactions 1 420.500 420.500 420.500 98.94 0.001 Gas*Timing 1 420.500 420.500 420.500 98.94 0.001Residual Error 4 17.000 17.000 4.250 Pure Error 4 17.000 17.000 4.250Total 7 582.000

Estimated Coefficients for Mileage using data in uncoded units

Term CoefConstant 29.5000Gas 2.00000Timing 3.75000Gas*Timing 7.25000

Timing settings and the combination of timing settings and gas type are statistically significantThe factors we tested account for 95% of the variation in the result

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Analyze Factorial Design

Graphical Illustration of the significance of the factors tested

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Analyze Factorial DesignResidual Plots

• Normality plot is tight

• Versus Fits is evenly distributed about 0

• Histogram looks non-normal, but not enormously skewed

• Versus order doesn’t matter since sequence wasn’t important in the experiment

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Main Effects and Interactions Plots• Stat>DOE>Factorial>Factorial Plots

118

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Main Effects and Interactions Plots

119

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Designed Experiments

Statapult Example

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Page 121: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

Set up a 2 x 2 x 3 Full Factorial Designed Experiment

Factors• Rubber Band Tension

– Level 1 setting: 1– Level 2 setting: 4

• Pull-Back Angle– Level 1 setting: 160o

– Level 2 setting: 180o

• Stop Angle– Level 1 setting: 1– Level 2 setting: 3– Level 3 setting: 6

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Page 122: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

Set up a 2 x 2 x 3 Full Factorial Designed Experiment

Results• Distance – measured from front edge of

statapult to impact point• Skew – measured from right edges of foil to

impact point (a measure of how far off-center the ball landed)

122

Page 123: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

Set up a 2 x 2 x 3 Full Factorial Designed Experiment

• Stat>DOE>Factorial>Create Factorial Design

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Analyze a 2 x 2 x 3 Full Factorial Designed Experiment

• Stat>DOE>Factorial>Analyze Factorial DesignGeneral Linear Model: Distance versus Rubber Band, Stop Angle, ...

Factor Type Levels ValuesRubber Band fixed 2 1, 4Stop Angle fixed 3 1, 3, 6Pull Back Angle fixed 2 160, 180

Analysis of Variance for Distance, using Adjusted SS for Tests

Source DF Seq SS Adj SS Adj MS F PRubber Band 1 33063 33063 33063 493.79 0.000Stop Angle 2 43258 43258 21629 323.02 0.000Pull Back Angle 1 30392 30392 30392 453.90 0.000Rubber Band*Stop Angle 2 3295 3295 1648 24.61 0.000Rubber Band*Pull Back Angle 1 3173 3173 3173 47.39 0.000Stop Angle*Pull Back Angle 2 919 919 460 6.87 0.004Rubber Band*Stop Angle* 2 155 155 78 1.16 0.331 Pull Back AngleError 24 1607 1607 67Total 35 115863

S = 8.18281 R-Sq = 98.61% R-Sq(adj) = 97.98%124

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Analyze a 2 x 2 x 3 Full Factorial Designed Experiment

• Stat>DOE>Factorial>Analyze Factorial Design

125

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Analyze a 2 x 2 x 3 Full Factorial Designed Experiment

• Stat>DOE>Factorial>Effects Plots

Notice the curved effect on Stop Angle

Results scale

Interaction Effects Plots can be difficult to read, so pay close attention to what they are telling you! 126

Page 127: The DMAIC Lean Six Sigma Project and Team Tools Approach Improve Phase 1

Results

• Practically, the DOE has given us some information about the optimal settings to maximize the distance of the ping-pong ball– Stop Angle at 6– Rubber Band tension at 1– Pull back to 180o (less significant factor)

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Summary

• DOE can provide you with vital information about your critical Xs and their interactions

• DOE takes time and thought to set up and time and discipline to conduct

• DOE results also take time and thought to understand, interpret, and apply

• DOE improves your process by getting the factors set at the optimum levels

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Review of Improve Phase

Improve – Review & Key Deliverables

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Key Deliverables for Improve

• Main elements of Define, Measure, and Analyze completed

• “Obvious Xs” identified and confirmed

• Potential Xs identified, data collected and confirmed (Root Causes)

• Improvement solutions generated and prioritized upon investigation of root causes and supported with data

Improve – Review & Key Deliverables

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Key Deliverables for Improve

• Improvement solutions tested (pilot) and benefits estimated

• Implementation plan for solution(s) drafted with input from process owners

• Champion approval of the key solution(s) implementation

Improve – Review & Key Deliverables

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Improve Phase Review: Key Steps

In alignment with our project goal statement, and given what we have learned in the Define, Measure, and Analyze Phases of our project, during the Improve phase our team will complete:

•Generating and prioritizing Solutions (Improvement actions)•Risk assessment •Evaluation of Solutions and Benefits •Approach for Implementation•Translating and communicating learnings to Champion and

Process Owner(s) as appropriateWe will define and implement GREAT improvement solutions!

Improve – Review & Key Deliverables

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Start Date: Enter Date End Date: Enter Date

Benchmark Analysis Project Charter Formal Champion

Approval of Charter (signed)

SIPOC - High Level Process Map

Customer CTQs Initial Team meeting

(kickoff)

Start Date: Enter DateEnd Date: Enter Date

Identify Project Y(s) Identify Possible Xs

(possible cause and effect relationships)

Develop & Execute Data Collection Plan

Measurement System Analysis

Establish Baseline Performance

Start Date: Enter DateEnd Date: Enter Date

Identify Vital Few Root Causes of Variation Sources & Improvement Opportunities

Define Performance Objective(s) for Key Xs

Quantify potential $ Benefit

Start Date: Enter DateEnd Date: Enter Date

Generate Solutions Prioritize Solutions Assess Risks Test Solutions Cost Benefit

Analysis Develop &

Implement Execution Plan

Formal Champion Approval

Start Date: Enter DateEnd Date: Enter Date

Implement Sustainable Process Controls – Validate:

Control System Monitoring Plan Response Plan System Integration

Plan $ Benefits Validated Formal Champion

Approval and Report Out

Author: Enter NameDate: April 19, 2023

Project Name:Problem Statement:Mislabeled example

Project Scope:Enter scope description

Champion: NameProcess Owner: NameBlack Belt: NameGreen Belts:Names

Customer(s):CTQ(s):Defect(s):Beginning DPMO:Target DPMO:Estimated Benefits:Actual Benefits:

Not Complete Complete Not Applicable

MeasureMeasureDefineDefine

Directions:•Replace All Of The Italicized, Black Text With Your Project’s Information•Change the blank box into a check mark by clicking on Format>Bullets and•Numbering and changing the bullet.

AnalyzeAnalyze ImproveImprove ControlControl