leaning radiology and the patient experience...2. identify the key outputs and customers of those...
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LEANing Radiology and the Patient Experience
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AHRA 2010 Annual Conference, Washington DCPresenter: Anne T. Daley, MS, CSSBB, CMQOE
Wednesday, August 25, 2010
2:30pm - 5:30pm
Competition
Every morning in Africa, a Every morning in Africa, a
SeriousCompetition!
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Every morning in Africa, a gazelle wakes up; it knows it
must run faster than the fastest lion or it will not survive.
Every morning in Africa, a lion wakes up; it knows it must outrun the slowest gazelle or it will starve.
It doesn’t matter whether you are a lion or a gazelle: When the sun comes up,
you had better be running!
Welcome and What’s in This for Me?
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Welcome and What’s in This for Me?
Learning Objectives
At the end of the session, participants will be abl e to:
� Understand basic Lean Six Sigma concepts and tools.
� Learn how to apply a few basic Lean Six Sigma tools to understand a patient’s Radiology experience.
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� Learn how to analyze the information obtained and utilize it to drive process improvement within the participant’s own organization.
Outline of Topics
� Lean Lingo and Tidbits
� Basic Lean Concepts and Tools Used to Lean the Patient Experience
Includes 20 min. break between 3:30-4:00
� Next Steps
� Open Discussion/Q&A
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� Open Discussion/Q&A
� Closing Thoughts
Lean Lingo and Tidbits
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Lean Lingo and Tidbits
Philosophy: Quality vs. Value
Quality is “ a state in which the customer and provider realize value entitlement in every aspect of the business relationship.” Mikel Harry, PhD
CostPrice
Product Capacity
Creation of VALUE is Key
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CustomerNeed
ProviderService
ValueExchange
Defects
Time
Quality
Delivery
Service Capability
“We are not in the business of quality,we are focused on the quality of our business.”
Value Proposition: Better Perspective
Financial Performance ���� Margin & Capital
VALUE RIGHT SERVICE, RIGHT TIME, RIGHT PRICE
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People ���� Work Culture
Quality ���� Clinical and Business Processes
Customer Service ���� Customer Satisfaction
Metrics
Four Keys to Lean Six Sigma
The Four Keys:
1. Delight Customers
2. Improve Processes
Lean SixSigma
Variation &
Process F
low
ImproveProcesses
DelightCustomers
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3. Teamwork
4. Data-Based Decisions
Variation &
D
efects
Process F
low
Quality
Speed
Data and Facts
Team-work
Source: What is Lean Six Sigma, George, Rowlands, and Kastle, McGraw-Hill, 2003.
Defining Lean Six Sigma
At a high level, Lean Six Sigma is a process improvement methodology.
Lean: The application of principles whose objective is to eliminate WASTE while improving process flow to achieve speed and agility at lower cost.
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Six Sigma: The application of principles whose objective is to eliminate DEFECTS and VARIATION.
When combined and effectively applied, major improvements are achieved in business
performance.
Process Sigma Process Yield PPM/DPMO
6 99.9997% 3.4
5 99.98% 233
4 99.4% 6210
3.5 97.7% 22,700
What is Six Sigma?
A Statistical Measure of a Process’s Ability to Meet Customer Requirements
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3.5 97.7% 22,700
3 93.3% 66,807
2 69.1% 308,537
A “Stretch” Goal6 Sigma � 3.4 DPMO
HealthcareToday?
Is considered “Virtual Perfection”
Five-Step Process Improvement Methodology
“Define” Introduced byMotorola to ensure
DMAIC
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Motorola to ensure projects are worth the effort ����PDCA = D+MAIC
Combining Lean and Six Sigma Methodologies
Step 1 Step 2 Step 3 Step 4Inputs Outputs
Reduce waste within a process (Lean )
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Reduce variation within a process (Six Sigma )
What is Lean?Lean is the elimination of waste or anything not ab solutely required to deliver a quality product or service, o n time, to our customers.
What Does Lean Do?
� Increases productivity by producing or servicing MORE with the same or less resources.
� Improves quality.
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� Reduces inventory.
� Reduces cycle time.
� Improves on-time performance.
� Increases capability by using freed-up resources.
� Increases capacity to increase volumes and expand products or services.
Traditional Thinking:
� Low unit costs
� Work at full capacity
� Tight schedules
� High WIP inventories
� High level of specialization
� Long cycle times
Lean Six Sigma Thinking:
� Value with less error
� Work at necessary capacity
� Flexible schedules
� Low WIP inventories
� Cross-training
� Short cycle times
Application to Imaging
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� Long cycle times � Short cycle times
Common Tools used to Lean the
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Common Tools used to Lean the Patient Experience
Simplified DMAIC Approach
Step 2: Process Measurement
Step 4: Process Improvement
Step 1: Project Definition
Select and Define Opportunity for Improvement
(Balanced Scorecard, Project Charter, VOC, SIPOC)
Understand Waste and Variation within Process
(Waste Reduction, Spaghetti Diagram, Continuous Flow, Push vs. Pull, Standard Work, Statistical Analysis )
Identify, Prioritize, and Implement Solutions for Improvement
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Step 5: Process Control
Monitor the Process and Celebrate Success(Control Methods, Keep it Alive!)
Step 3: Process Analysis
Understand Relationship of Input and Output Variables
(Cause and Effect Analysis, Fishbone Diagram)
Understand the Current Process Flow(Process Mapping, Value Analysis)
KaizenEvent
for Improvement(Visual Workplace, 5S, Kanban, Water Spider, Poka-Yoke, XY
Decision Matrix, Implementation Plan, Leading Change)
Step 1: Define MAIC
Key Concepts and Tools:Balanced Scorecard
Project Charter
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Project CharterVoice of the Customer
SIPOC
If a man knows not what harbor he seeks,
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If a man knows not what harbor he seeks, any wind is the right wind. -Seneca
Balanced Scorecard: Radiology Measurements
Quality Performance
� Improved patient flow through pre-and post-procedure processes
� Improved flow of information in tech/admin processes
� Improved performance via standardization of processes and implementation of best practices
Customer Service
� Improved process cycle time
� Reduction in overall throughput time
� Improved customer satisfaction
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Financial Performance
� Reduction in cost associated with non-value-added activities
� Improved capture of revenue via process improvement
� Improved operating margins
Work Culture
� Improved employee satisfaction
� Reduction in turnover and improved retention
� Improved ability to attract new employees
Define: Project Charters
1. It increases the confidence of the leader and the supporting team.
2. There is more “buy-in” and support when people understand the problem (Problem Statement) and can sense the benefit (Objective Statement).
3. The problem becomes more
The probability of success for an improvement proje ct is greatly improved when it is properly defined.
Why are we here?
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3. The problem becomes more manageable when it is transformed into a project.
4. There is a beginning and an end–you know when you’re finished–instead of an incomplete effort.
5. Most projects have hard financial benefit and/or they improve work conditions, predictability, and customer satisfaction.
� Problem Statement
� Goal/Objective
� Scope
� Timeline
� Resources/Team
Basic Project Charter Elements(Name of Initiative) Project Charter
PROBLEM STATEMENT:
• A specific, quantifiable explanation of the effect or pain the problem is causing within the organization (what, when, where and to what extent). It should not imply a cause, attach blame or responsibility nor should it imply a solution. Include current key performance metric of process or “baseline performance”.
GOAL OR OBJECTIVE:
• Defines the expected outcome or level of performance in measureable terms and is stated in a positive manner (target metric reduction). Include financial performance or return-on-investment expectations (target savings).
SCOPE:
• In Scope: (define what is relevant and to be worked on, include process start and end point) • Out of Scope: (define what is not to be worked on) • Constraints: (possible limitations that will affect project outcomes)
TIMELINE:
• Includes start date, expected completion date and general overview of initiative schedule.
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� Resources/Team Members
� Communication Strategy
� Signatures of Accountability
• Includes start date, expected completion date and general overview of initiative schedule. RESOURCES / TEAM MEMBERS:
• Project Sponsor – Identifies management level key stakeholder who supports project and ensures resources are available. Eliminates complex or political barriers to ensure project moves forward
• Process Owner – Identifies individual accountable for process of concern, owns implementation and control plans
• Team Members – Identifies representatives from each primary group involved in the process to be included in the team. Caution to limit the number of management members, the most productive teams are comprised of those that work the process every day.
• Key Stakeholders – Identifies main individuals or groups impacted by the process. COMMUNICATION STRATEGY:
• Define what will be communicated (project progress) to whom (audience/stakeholders), when (frequency of communication) and how (tactics)
SIGNATURES OF ACCOUNTABILITY:
• Dated signatures indicate agreement with Project Charter content and shared accountability in meeting the project goals and timelines. Include Project Sponsor, Process Owner, Project Facilitator and Team Members
Charter: Goal or Objective Statement
Defines the expected outcome or level of performanc e in measureable terms and is stated in a positive manne r (target metric reduction). Include financial perfo rmance or return-on-investment expectations (target saving s).
Include the following: Improve some METRIC from someBASELINE level to some GOAL, by some TIMEFRAME, to achieve some BENEFIT and improve upon some ORGANIZATIONAL
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Example: Reduce average “patient register to patien t in room” response time for imaging outpatients from 45 minutes to 20 minutes, 95 percent of the time withi n 60 days. The benefit will be to improve patient satis faction.
GOAL or OBJECTIVE .
Charter: Scope and Timeline
SCOPE:
� In Scope: Define what is relevant and to be worked on; include process start and end point.
� Out of Scope: Define what is not to be worked on.
� Constraints: Possible limitations that will affect project outcomes.
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project outcomes.
TIMELINE:
Includes start date, expected completion date, and general overview of initiative schedule.
DEFINE: SIPOC
High-level process diagram that helps teams define:
SUPPLIERS
CUSTOMERS
OutputsInputs Process
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� Project boundaries (process start and end points)
� Who provides input to the process
� What the process produces (output)
� Who the customers are and what they require
� What key performance indicator(s) measure the proce ss
S S
SIPOC: High-Level Process Snapshot
SUPPLIERS
CUSTOMERS
OutputsInputs Process
Common Process Inputs:
Material
Information
Common Process Outputs:
Physical Products
Documents
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A high-level view is often captured as a top-level flowchart.
Patient Scheduled
Patient Registered
Procedure Performed
Report Released
S S
Procedure Billed
Ideas
Leads
Labor
Information
Services
Decisions
SIPOC: How to Diagram
1. Identify process boundaries (start and stop points) and key activities (in between steps).
2. Identify the key outputs and customers of those outputs.
3. Identify inputs and suppliers of those inputs.
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Exercise: SIPOC
SIPOC plus Customer Requirements and Key Performance Metric
Process Outputs CustomersSuppliers Inputs Require Measure
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Voice of the Customer (VOC)Critical to Quality (CTQ) Characteristics:
� Represents the “Voice of the Customer”
� Measurement related to how the customer evaluates the quality of a product or service
� Key performance indicator of the process output or outcome
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output or outcome
Examples of CTQ Indicators:
� Patient Imaging Center Wait Time
� MRI Final Report Turnaround Time
� Patient Demographics Accuracy Rate
SIPOC: How to Diagram
1. Identify process boundaries (start and stop points) and key activities (in between steps).
2. Identify the key outputs and customers of those outputs.
3. Identify inputs and suppliers of those inputs.
4. Identify customer “critical -to-quality”
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4. Identify customer “critical -to-quality” requirements for the inputs, process steps, and outputs.
5. Identify the key performance indicator that measures the customer’s requirement.
Patient Experience: Warm or Cold?
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Which environment do you prefer?
Adding color to an area provides instant “warmth.”
Breast Center
Hospital Outpatient Imaging Center
Step 2: D Measure AIC
Key Concepts and Tools:
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Key Concepts and Tools:Process MappingValue Analysis
Process Hierarchy
Senior Management Owned
A core process is directly related to generating revenue, providing
services to the customer, or creating a strategic
advantage for the company.
Enabling Processes Core Processes Enabling processes do not directly impact the customer. They must exist to enable
and support the execution of the core
processes.
PM SummaryPM Summary PM SummaryPM SummaryMiddle Management Owned
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ProcessMember and
Process Owner Responsibilities
Process A Process B Process C Process D Process E The many detailed activities, tasks, and decisions involved
in satisfying a process output.
Process Architecture
Subprocess 2Subprocess 1
Major Processes
Many people think of what they do
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1. Obtain …2. Add …3. Move to …
Tasks
Activities
We all perform tasks at various levels and are therefore quite familiar with this concept.
Many people think of what they do as a set of activities that they do repeatedly. To create a more effective approach, their thoughts have to transform from activity thinking to process thinking.
Cost of Poor Quality and the Hidden Operation
Workarounds Quick Fixes
Inspections
Rework
FrustrationDefects
Cost Op i Op i + 1
Off -line
Verified?
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Scrap
Extra Equipment
IncreasedInventory
Increased Cycle Time
Customer Dissatisfaction
Analysis ScrapOff -lineCorrection
Correctable?
NoYes
There are usually three views of a process:
What it ACTUALLY is..
22 33What it SHOULD be..
Process Mapping
What you THINK it is..
11
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Process Mapping Basic Components
ProcessStep
InspectFirst Step ProcessStep
ProcessStep
ProcessStep
NO
YES
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DelayProcessStep
ProcessStep
Last Step
Basic Process Mapping
Beginning steps to create a process map:
1. Label the process start point and end pointusing an oval shape .
2. Label each process step with a separate square shape .
3. Label each decision step with a separate diamond shape , adding subprocess steps and
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diamond shape , adding subprocess steps and decisions.
4. Label each delay (queue) step with a separate triangle shape .
5. AVOID temptation to add arrows at this time. (It is the last step in developing the map; we will add more to the map later.)
Process Mapping Tips� Use self-stick notes.
(Precut shapes in process step color are pure joy)
� Tape multiple large sheets of paper on wall to hold work.(Flip chart paper and masking tape best)
� If step is forgotten and needs to be added in, move the self-stick notes to accommodate.
� Walk the process after completing to validate work. (Expect to discover changes)
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� Always label and date a process map.
� As ideas are generated, capture in a “Parking Lot.” (Improvement ideas, assumptions, questions, additional observations, and out-of-scope issues and ideas)
� Concentrate on the process, not the tools and symbo ls.
� Discuss what metrics could be used to measure proce ss effectiveness, efficiency, and customer satisfactio n; take notes.
Source: The Lean Six Sigma Pocket Toolbook, George, Rowlands, Price, and Maxey, McGraw-Hill, 2005, pg. 40-41.
What is a Value Stream? All the actions and activities required by the current state of the process to meet the consumer demand.
What is a Value Stream Map? A process map that visually documents how materials and information flow through the process.
When do you apply Value Stream Mapping?
Value Stream Mapping
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When do you apply Value Stream Mapping?� Process cycle time is too high or long wait
times.� Need to communicate data and process flow.� Process crosses many functions and has
many handoffs.� Buildup of inventory or work in progress.
Value Defined
Value: The worth of a product as judged by the patient (customer).
The key question of all Lean processes is:
Does the process add value to the delivery of the product or service?
Value-added has three characteristics:
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Value-added has three characteristics:1. The customer recognizes the value and is
willing to pay for it,2. It changes the product, and 3. It is done right the first time.
Process activities can be categorized in two additional value groups:
Value enabling means things that are:� Required by law, regulation, or contract.� Necessary for health, safety, environmental,
or ethical considerations.
Non-value -added is:
Additional Value Categories
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Non-value -added is: � Considered pure waste.� Everything not classified as value-added or
enabling .
Case Study:Current State Patient Process Flow
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Case Study: Common Observations
Strengths:
� Scheduling centralized for patient appointments.
� Significant available capacity at all sites.
Challenges:
� Scheduling unable to easily determine first available appointment within system locations.
� Lack of standardized physician ordering requisition ; information received rarely complete (lack ICD-9 code, pre-cert number, procedure type unclear)
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� Inconsistent handling of physician orders–informati on obtained is variable and generally not received until patient presents f or procedure. Occasional faxing.
� Registration follows hospital IP protocol; excessiv e patient questions
� Billing practices and pricing follows hospital inpa tient protocol; not competitive with local competition.
� Patient time spent in obtaining scan is significant compared to freestanding imaging center– one person stated, it i s an “afternoon event” vs. “over the lunch hour.”
Benefits of Mapping the Value Stream
� Visualize flow
� Identify sources of waste
� Get to a common language
� Make decisions about flow obvious
� Establish the foundation for improvement activities
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improvement activities
� Links material flow to information flow
� walk the process� write it down…and most importantly…
Understand the process through facts and data!
Step 3: DM Analyze IC
Key Concepts and Tools:Cause and Effect Diagram
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Cause and Effect DiagramWaste Reduction
Spaghetti DiagramsStandard Work
Cause and Effect Analysis
X X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X X
X X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X XX X X X X X X X X X
X X X X X XX X X X X X XX X X X X X XX X X X X X XX
The many X’s when we first start
(the trivial many)
The quantity of X’s keep
reducing as you
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XXXXXXXXXXXXThe quantity of X’s
remaining after DMAIC
reducing as you work the project
Cause and Effect Diagram (Fishbone)
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Provides “pain point” discovery
Case Study:Fishing for Patient Satisfaction
UnsatisfactoryPatient Experience
Management Process People
Clinician orders unclear
Staff shortage,especially
during break times
Pre-registration information excessive
Requisition not standardizedamong system sites
Bills confusing
Procedure roomunavailable
Multiple bills
Patient prep not acceptable
ER patient delays
Supervisor not on-site
<10% orders faxedto dept before appt
Signage from parking to department unclear
Follow hospitalinpatient process
Billing requirements
Equipment down
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Findings: Primary “pain points” were process-related.
Materials & Equipment Environment
Registration not always located or
performed in Imaging
ER patient delaysOutpatient
Parking limited
Equipment down
Heavy workload
Difficult to determinefirst available appointment
RIS limited functionality, Site schedules not consolidated
Over-processing
Motion Waiting
Defects Over-production
Transporting
Inventory
1. Defects
Time doing something incorrectly Correcting errors, rework Inspecting for errors Miscommunication
2. Overproduction/Making Too Much
Unnecessary paperwork generated Doing more than needed Doing something sooner than needed
3. Transporting/Moving Things
Waste Reduction: Types of Radiology MUDA
Types ofWaste
Human Potential
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6. Unnecessary Motion
Extra steps and data entry Supplies spread out in work area
7. Overprocessing
Handling paperwork not required Process steps that do not add value Data collection for information not used
8. Human Potential
Failure to engage people Skill not matched to task
Extra steps in the process Hand-offs, sign-offs
4. Inventory/Unnecessary Stock
Excess supplies on hand Supplies not used before expiration date Equipment spare parts that are not critical
5. Waiting
For other functions or disciplines Patients awaiting exams in hallways Unnecessary STATs
Spaghetti Diagrams
Illustrates the physical flow of a person, product, or information as it moves through multiple steps in a process.
Benefit: Identifies workflow inefficiencies
Basic Cooking Steps:
1. Gather the tools.
2. Draw the basic work area or workstations.
3. Diagram the workflow.
4. Analyze the diagram.
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workflow inefficiencies and provides a method of modeling out potential improvements before making major (or minor) process changes.
4. Analyze the diagram.
5. Design and test an improved workflow.
6. Communicate and pilot the changes.
7. Evaluate effectiveness.
Spaghetti Diagram of Patient Waiting Room
Findings:Patient moved multiple times
during the registration
process, while Imaging
personnel had minimal
movement.
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Solution:Cross-train
Imaging receptionists to
do patient registration.
Standard WorkPurpose: To create a consistent, safe, efficient, high quali ty, and low cost product or service that:
� Breaks work down into elements.
� Defines the amount of work performed by each operat or to achieve balanced flow.
� Maximizes throughput capacity and productivity.
� Reduces process variation.
� Used to balance workloads with customer demand.
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� Used to balance workloads with customer demand.
� Developed through a team approach and owned by them.
“One must standardize, and thus stabilize the proce ss before continuous improvement can be made.”
-Masaaki Imai (father of Kaizen)
Step 4: DMA Improve C
Key Concepts and Tools:Visual Workplace
5S
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5SKanban
XY Decision MatrixImplementation Plan
Leading Change
Case Study:Common Top 7 Potential Opportunities1. Standardize physician order requisition across th e system
for any non-hospital patient.
2. Obtain copy of physician order at time of schedul ing; scan paperwork into a system that Pre-Registration and I maging can view.
3. Reduce amount of information obtained from patien t during registration; consolidate forms.
4. Expand the initial process mapping of patient flow;
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4. Expand the initial process mapping of patient flow; educate staff on Lean workflow concepts and tools.
5. Continue review of billing practices (hospital vs . freestanding) to improve price competitiveness.
6. Obtain Voice of the Customer–provide each patient with a “How are we doing?” card.
7. Work with IT to develop first available appointme nt scheduling capability.
Case Study:Future State Patient Process Flow
ng Reception &
egistration
Scheduling &
Pre-Registration
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Billing
Technical
Procedure
Imagin Re
Principle: As you clean up a workplace you make the problems of that workplace visual!
Visual Control: Any communication device in the work environment that informs:
� How work should be done.
� Whether work is deviating from the standard.
Visual Workplace
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� Whether work is deviating from the standard.
Examples:
� Magnetic room/patient scheduling board
� Graphs that show daily performance
� Supply storage shelf labeling
Visual Communication: Information Empowers
The distinctive aspect of Visual Communication is i t provides a group of workers timely information on process performance.
Visual Communication can be:� A sign� A label� A photograph
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� A photograph� A display� A trend chart� A color scheme� Whatever serves the purpose
A Visual Message is observed by everyone working in a given area, everyone who passes throug h the area, and everyone who comes into range of visibili ty.
Visual Management: Communication Boards
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Communicating the Five Pillars of Performance:People, Quality, Service, Growth, and Finance
Breast Center
Hospital Radiology Department
SORT STRAIGHTEN STANDARDIZE SUSTAINSHINE
� Exposes Problems
� Safe Working Areas
� Space Reduction
� One-Piece Flow
� Discipline to Follow
Foundation and Building Blocks
for All Other Activities
Workplace Organization: 5S
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� Discipline to Follow Standard Work Activities
DrivesProductivity!
Sort Straighten
Shine Standardize
Sustain
5S Translation - Workplace Organization
Step Japanese Literal Translation Eng lish
Step 1: Seiri Clearing Up Sorting
Focus on using the English words, much easier to remember.
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Step 2: Seiton Organizing Straightening
Step 3: Seiso Cleaning Shining
Step 4: Seketsu Standardizing Standardizing
Step 5: Shitsuke Training and Discipline Sustaining
A Method for Sorting
Keep and Monitor
Unknown UselessUseful
Item
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Dispose
Useless
Monitor
Keep and Store
Useful
ABC Storage
Sorting
Purpose: Practice using 5S concepts and tools.
Materials: Colored dots (red/yellow/green), large carry bag (purse, tote bag).
Exercise:
1. Place the contents of the bag on the table.
2. Attach colored dot to each item using the
Applying Lean: 5S Dot Exercise
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2. Attach colored dot to each item using the following description:
Green - Use daily or multiple times per week.
Yellow - Use weekly, or critical when needed.
Red - Rarely or never used, able to obtain.
Debrief: Be ready to discuss your findings.
Time: 5 minutes.
Before
After
Applying 5S to Increase Work Space
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Improving patient first impression: Remove clutter from registration area–added benefit is it provides more workspace.
Applying 5S: Supply Room
Before After
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Sorted through supplies (discarding those expired a nd not used), set to order, and standardized remaining ite ms
What is a Kanban?Kanban - A signaling system to manage and control the movement, production, or supply of material within aprocess. Kanbans have two primary functions:
� Instruct processes to make products.
� Instruct material handlers to move products.
Benefits:
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� Promotes visual management.� Provides pickup or transport information.� Prevents overproduction and excessive transportatio n.� Controls the amount of WIP in the system.� Serves as a visual work order.� Exposes waste and forces a root cause solution.
Kanban Signaling System
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Visual Management: Kanban Supply System
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5S Assessment Deployment
Assessing the level of 5S in a work space:
� SortOnly items currently used remain in work space
� StraightenEverything has a place and everything is in its pla ce
� Shine
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� ShineItems are maintained, marked off, areas clean
� StandardizeProcesses identified, documented, and consistent
� SustainSelf-triggered activities on a daily basis to maint ain
Fact-Based Decision Making (XY Matrix)
The XY Decision Matrix is a statistical-based tool used to make criteria-based decisions.
Benefit: Used to facilitate complex decisions,
Basic Steps:
1. Define decision to be made and desired outcome.
2. Select evaluation criteria.
3. Establish weighting for each criteria in level of importance (1=low,
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complex decisions, assuring focus remains on desired outcomes, minimizing personal bias. Also used to prioritize multiple choices or options.
importance (1=low, 3=med, 9=high).
4. Analyze the diagram.
5. Evaluate choices or options.
6. Review results and make decision.
XY Decision Matrix Example
Desired Criteria/Expectations:
TO
TA
L
Criteria Weight (Low=1, Med=3, High=9)
ScoreWtd.
ScoreScore
Wtd.Score
ScoreWtd.
ScoreScore
Wtd.Score
ScoreWtd.
ScoreScore
Wtd.Score
Candidate Background HighlightsCandidate A MBA/HCM, 15 years supervisory
experience plus 5 technical, external applicant. 9 81 1 9 1 3 9 27 9 9 9 9 138
XY Decision Matrix - Selecting Technical Supervisor
Technical Knowledge
Personality fit with Team
Internal Candidate
Lean Workflow Experience
Supervisor Experience
Regulatory Knowledge
9 9 3 3 1 1
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Interpretation: Which candidate would you select?
Candidate B BS, no supervisory experience,10 years technical experience, internal applicant 9 81 3 27 9 27 1 3 1 1 3 3 142
Candidate C BS, 2 yrs supervisory experience plus 2 technical, currently at major competitor 3 27 9 81 3 9 9 27 3 3 9 9 156
Candidate D AS, recent graduate, 4 years supervisory experience at local coffee shop 1 9 9 81 9 27 1 3 3 3 1 1 124
Implementation Plan
Basic project management components:
� Action steps to be taken
� Assigned accountabilities
� Timeline tracked
� ROI tracked
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� Progress report
Ref. No Action Steps Task Leader(s) Comments
Wk of 4/7 4/14 4/21 4/28 5/5 5/12 5/19 Later
Planned ActivityOn Schedule / Activity CompletedOff Schedule - Should Not Impact TimelineOff Schedule, Will Impact Overall Project Timeline
List Category #1 List Action Step List Leader Name Add notes or provide update on progress Done
List Action Step List Leader Name Add notes or provide update on progressList Action Step List Leader Name Add notes or provide update on progress Delay
Leading Change
Effective Approach to Leading Change
1. Establish a Sense of Urgency
2. Create a Support Network
3. Develop and Communicate the Vision
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4. Address Resistance
5. Empower Employees
6. Communicate the Wins
Step 5: DMAI Control
Key Concepts and Tools:
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Key Concepts and Tools:Control Methods
Keep it Alive!
Maintain the Gains
OP Imaging Center Average Wait Time (min)
UCL 45.982
CL 33.082
30.700
40.700
50.700
60.700
70.700
80.700
Ave
rage
Wai
t Tim
e (m
in)
“Leaned” Patient Registration Process
Major Patient Dissatisfaction
“Leaned” Physician Order Process
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Outcome: Reduced Outreach Imaging Center Patient Wait Time
Most improvement initiatives involve multiple solutions; goal is to eliminate waste and reduce process variation.
LCL 20.182
10.700
20.700
30.700
1-Sep
3-Sep
5-Sep
7-Sep
9-Sep
11-S
ep13
-Sep
15-S
ep17
-Sep
19-S
ep21
-Sep
23-S
ep25
-Sep
27-S
ep29
-Sep
1-Oct
3-Oct
5-Oct
7-Oct
9-Oct
11-O
ct13
-Oct
15-O
ct17
-Oct
19-O
ct21
-Oct
23-O
ct25
-Oct
27-O
ct29
-Oct
31-O
ct
Date
Order Process
Keep it Alive!
� Communicate success:
� Storyboards/bulletin boards
� Showcase of excellence event
� Article in organizational newsletter
� Monitor ongoing performance:
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� Balanced scorecard
� Quality metrics–establish limits of performance that trigger review
� Integrate into individual performance expectations
Next Steps
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Next Steps
Moving to the Future: Kaizen Events
“Kaizen Blitz” events move the organization from its current state to the future state
using Lean Six Sigma principles in a rapid manner.
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KaizenEvent
Overview of Kaizen Approach
1. Construct project charter to clarify scope, goal, key stakeholders, timeline, and deliverables (Define )
2. Collect performance data on process to be improved ( Measure )
3. Facilitate team meetings:
� First: Define and Measure
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� First: Define and Measure
� Second: Analyze and Improve
� Third: Analyze and Improve
� Fourth: Analyze and Improve (if needed)
� Fifth: Control and Celebrate
Summary of Process Improvement Process
Step 2: Process Measurement
Step 4: Process Improvement
Step 1: Project Definition
Select and Define Opportunity for Improvement (Balanced Scorecard, Project Charter, VOC, SIPOC)
Understand Waste and Variation within Process
(Waste Reduction, Spaghetti Diagram, Continuous Flow, Push vs. Pull, Standard Work, Statistical Analysis )
Identify, Prioritize and Implement Solutions for Improvement
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Step 5: Process Control
Monitor the Process and Celebrate Success(Control Methods, Keep it Alive!)
Step 3: Process Analysis
Understand Relationship of Input and Output Variables
(Cause and Effect Analysis, Fishbone Diagram)
Understand the Current Process Flow(Process Mapping, Value Analysis)
KaizenEvent
Improvement(Visual Workplace, 5S, Kanban, Water Spider, Poka-Yoke, XY
Decision Matrix, Implementation Plan, Leading Change)
Why use Lean Six Sigma? Speed Variation
Improve Patient Safety
Improve Physician Satisfaction
Enhance Customer Value
60% Process Time Improvement
50% Improvement in Throughput
20% Floor Space Reduction
Speed
Operational Excellence Top Quality Service
Lean Six Sigma Business
Processes
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Increase Company Value
Improve Employee Satisfaction
30% Improvement in Quality Levels
40% Cost Reduction
Reduction
Customer’s Perception of Value and Safety
Processes
Radiology Application Examples
� Patient Scheduling/Registration: A frequent opportunity target in many radiology services.
� Staffing vs. Workload: Helps to break away from “historical staffing patterns” to “workload-based staffing.”
� Billing Process Improvement: The majority of outreach programs do not effectively manage
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outreach programs do not effectively manage revenue.
� Spatial Design: Application of Lean thinking regarding process improvement before design is finalized leads to effective use of space and reduced construction cost.
Open Discussion/Q&A
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Open Discussion/Q&A
For additional information and Lean tool templates visit: www.chisolutionsinc.com
To navigate the website:Knowledge Center/Presentations/AHRA 2010 Annual Mee ting/ LEANing Radiology and the Patient Experience
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Presenter Contact Information: Anne T. DaleySenior ConsultantChi Solutions, Inc.(800) 860-5454 x414adaley@chisolutionsinc.com
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