leaning radiology and the patient experience...2. identify the key outputs and customers of those...

LEANing Radiology and the Patient Experience

©2010 Chi Solutions, Inc. Proprietary and Confidential.

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!

2 ©2010 Chi Solutions, Inc. Proprietary and Confidential.

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?


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.


� 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


� Open Discussion/Q&A

� Closing Thoughts

Lean Lingo and Tidbits


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


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


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


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.


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


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


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 )


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.


� 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


� Long cycle times � Short cycle times

Common Tools used to Lean the


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


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


Project CharterVoice of the Customer

SIPOC

If a man knows not what harbor he seeks,


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


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?


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.


� 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


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.


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


� 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


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.


Exercise: SIPOC

SIPOC plus Customer Requirements and Key Performance Metric

Process Outputs CustomersSuppliers Inputs Require Measure


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


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”


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?


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:


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


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


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?


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


Process Mapping Basic Components

ProcessStep

InspectFirst Step ProcessStep

ProcessStep

ProcessStep

NO

YES


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


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)


� 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


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:


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


Non-value -added is: � Considered pure waste.� Everything not classified as value-added or

enabling .

Case Study:Current State Patient Process Flow


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)


� 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


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


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


XXXXXXXXXXXXThe quantity of X’s

remaining after DMAIC

reducing as you work the project

Cause and Effect Diagram (Fishbone)


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


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


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.


workflow inefficiencies and provides a method of modeling out potential improvements before making major (or minor) process changes.


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.


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.


� 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


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;


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


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


� 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


� 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


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


� 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.


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


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


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


Improving patient first impression: Remove clutter from registration area–added benefit is it provides more workspace.

Applying 5S: Supply Room

Before After


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:


� 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


Visual Management: Kanban Supply System


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


� 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,


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).


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


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


� 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


4. Address Resistance

5. Empower Employees

6. Communicate the Wins

Step 5: DMAI Control

Key Concepts and Tools:


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


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:


� Balanced scorecard

� Quality metrics–establish limits of performance that trigger review

� Integrate into individual performance expectations

Next Steps


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.


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


� 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


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


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


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


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


Presenter Contact Information: Anne T. DaleySenior ConsultantChi Solutions, Inc.(800) 860-5454 [email protected]