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Process Improvement
1. Initial Perception of problem 2. Clarify Problem 3. Locate Point of Cause 4. Root Cause Analysis 5. Design Solutions 6. Measure Effectiveness
7. Standardize
Improve
Analyze
Guinness Brewery
1900
Ford Assembly Line
1930
Gilbreth, Inc. Management Theory Industrial Engineering
1950
Toyota Production System
Black Belt
12/5/2013
Background on Lean
Lean comes out of the industrial engineering world Taiichi Ohno Toyota Production System.
1940s-1950s company was on verge of bankruptcy Dynamics of industry were changing moving from mass production to more flexible, shorter, varied batch runs (people wanted more colors, different features, more models, etc).
SPC
TQM
1980
Just inTime
1990
Lean Mfg.
2000
Path To Lean
Theory Application Waste is Deadly 1. Define Value act on what is important to the customer 2. Identify Value Stream understand what steps in the process add value and which dont 3. Make it flow keep the work moving at all times and eliminate waste that creates delay 4. Let customer pull -- Avoid making more or ordering more inputs for customer demand you dont have 5. Pursue perfection -- there is no optimum level of performance Flow Focused Non-Value added steps exit Reduced cycle time
Waste Defined
Wastes
Transport Inventory Motion
1. 2. 3. 1. 2. 3. 1. 2.
Healthcare Examples
Moving patients from room to room Poor workplace layouts, for patient services Moving equipment in and out of procedure room or operating room Overstocked medications on units/floors or in pharmacy Physician orders building up to be entered Unnecessary instruments contained in operating kits Leaving patient rooms to: Get supplies or record Documents care provided Large reach/walk distance to complete a process step Idle equipment/people Early admissions for procedur es later in the day Waiting for internal transport between departments Multiple signature requirements Extra copies of forms Multiple information systems entries Printing hard copy of report when digital is sufficient Asking the patient the same questions multiple times Unnecessary carbon copying Batch printing patient labels Hospital-acquired illness Wrong-site surgeries Medication errors Dealing with service complaints Illegible, handwritten information Collection of incorrect patient information Not using peoples mental, creative, and physical abilities Staff not involved in redesigning processes in their workplace Nurses and Doctors spending time locating equipment and supplies Staff rework due to system failures
Skills
1. 2. 3. 1. 2. 3. 4. 1. 2. 3. 1. 2. 3. 4. 5. 6. 1. 2. 3. 4.
Lean Foundations
Standardized Work people should analyze their work and define the way that best meets the needs of all stakeholders.
The current one best way to safely complete an activity with the proper outcome and the highest quality, using the fewest possible resources Standardized not Identical mindless conformity and the thoughtful setting of standards should not be confused Written by those who do the work.
Select Clarify Organize Run Evaluate
Lean Methods
Kaizen Events (or SCORE events)
Planned and structured process that enables a small group of people to improve some aspect of their business in a quick, focused manner.
5S this methodology reduces waste through improved workplace organization and visual management
Sort, Store, Shine, Standardize and Sustain
Level loading smoothing the workflow and patient flow throughout the hospital. Kaizen continuous improvement
12/5/2013
2 3 4 5
Voice of Customer Voice of Process
Six Sigma training might be specialized to the quality department, but everyone in the organization should be trained in Lean
Customer Target
LSL
USL
Customer Target
12/5/2013
Define
Define Scope of the Problem
Document the Process Collect and Translate the Voice of the Customer
Define (continued)
Create Project Charter
Confirm Improvement Methodology Define Project Roles and Responsibilities Identify Risks Establish Timeline Managerial Buy-in
Measure
Measure what is measurable, and make measurable what is not so Galileo
Analyze
Identify Potential Causes (Xs) Investigate Significance of Xs
Collect data on xs Graphical/Quantitative analysis
Pareto Chart Fishbone Diagram (cause and effect) Chi Square Test Regression Analysis Failure Mode Effects Analysis
Define As Is process
Value stream map/process flow diagram
Here you identify the critical factors of a good output and the root causes of defects or bad output.
Improve
Generate Potential Solutions Select & Test Solution Develop Implementation Plan
Control
Create Control & Monitoring Plan
Mistake proof the process Determine the xs to control and methods Determine Ys to monitor
Finalize Transition
Develop transition plan Handoff process to owner