the dmaic lean six sigma project and team tools approach improve phase 1
TRANSCRIPT
The DMAIC Lean Six Sigma Project and Team Tools Approach
Improve Phase
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Six Sigma Improve Phase
“The starting point for improvement is to
recognize the need.”
- Imai
Improve - Introduction
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
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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
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
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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
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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
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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
Six Sigma applied effectively…
•Increases customer satisfaction
•Lowers costs
•Builds better leaders
•Empowers an organization to be more data-driven
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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
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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
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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
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
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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
2σ
66,807 DPMO3σ
6,210 DPMO
4σ
233 DPMO
5σ
3.4 DPMO
6σ
Process Sigma
Long-Term Yield vs Process Sigma
690,000 DPMO
1σ
Six Sigma ImproveImproving the identified Key Xs to
Improve the Process (Y) and the Customer’s Experience
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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
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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
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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
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
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
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
Red = Zone 1 Operator
Blue = Processor
Move Steps in the Process Closer Together & Synchronize
After
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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
Did somebody order some 5S?
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Post 5S Improvement Results
Improve – Change Work Environment
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:
83
# 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
Design for Six Sigma
DFSS
87
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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
89
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
90
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
91
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
92
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
93
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
94
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
95
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
96
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
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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100
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
101
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
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?
104
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!
105
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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Terminology
• Main Effects – the differences between each factor level
• Interactions – differences between two or more factor level combinations
107
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
109
Set up a 22 Full Factorial Experiment
• Stat>DOE>Factorial>Create Factorial Design
Select the number of replicates
110
Set up a 22 Full Factorial Experiment
• Stat>DOE>Factorial>Create Factorial Design
Name the factor
Select the data typeSet the levels
111
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
Analyze Factorial Design
• Stat>DOE>Factorial>Analyze Factorial Design
113
Analyze Factorial Design
• Stat>DOE>Factorial>Analyze Factorial Design
114
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
115
Analyze Factorial Design
Graphical Illustration of the significance of the factors tested
116
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
117
Main Effects and Interactions Plots• Stat>DOE>Factorial>Factorial Plots
118
Main Effects and Interactions Plots
119
Designed Experiments
Statapult Example
120
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
121
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
Set up a 2 x 2 x 3 Full Factorial Designed Experiment
• Stat>DOE>Factorial>Create Factorial Design
123
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
Analyze a 2 x 2 x 3 Full Factorial Designed Experiment
• Stat>DOE>Factorial>Analyze Factorial Design
125
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
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)
127
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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129
Review of Improve Phase
Improve – Review & Key Deliverables
130
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
131
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