LEAN SIX SIGMA – AN OVERVIEW

Dr. Parag R Rindani MD MBA

Head Medical Strategy & Clinical Excellence

Wockhardt Hospitals Ltd

Quality in Healthcare

Safety

Appropriateness

Access

Consumer centeredness

Effectiveness

Efficiency

Strategy

“Would you tell me, please, – asked Alice, Which way I ought to Walk from here?”

That depends a good deal on where you want to get to,” said the Cat.“I don’t much care where…” said Alice“Then it doesn’t matter which way you walk,” said the Cat.

- From 'Alice in Wonderland’ - Lewis Carroll

• Better management through reduction in turn around time – OPD waiting times, discharge times, ambulance dispatch times

• Increase in clinical efficiency – Emergency room • Increase in clinical efficiency – Emergency room assessment and triage, standardization of protocols for stroke, myocardial infarction, trauma

• Decrease in negative outcomes – infections, falls, injuries

What is a Process??

Any sequence of activities that use a set of INPUTS to produce an OUTPUT is called a

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INPUTS to produce an OUTPUT is called a PROCESS

A Process is a means for doing work

Every Process has a CUSTOMER. A Customer is the immediate recipient of the Output from the Process

Supplier: The provider of inputs to your process

Input: Materials, resources or data required to execute your process

Process: A collection of activities that takes one or

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Process: A collection of activities that takes one or more kinds of input and creates outputthat is of value to the customer

Output: The products or services that result from the process

Customer: The recipient of the process output – may be internal or external

Process

InputOutputs

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Process Variables

InputVariables

Outputs

What can go wrong??

A Process may not produce the desired output leading to CUSTOMER DISSATISFACTION.

The output from a process may have defects or errors in

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The output from a process may have defects or errors in it and this leads to REWORK or REJECTION. This leads to the generation of WASTE.

The produced output may be unpredictable in its ability to meet customer requirements and this is caused due to high VARIATION in a Process.

The process may be unstable and this leads to generation of WASTE in the process itself

The key deficiencies of any Process include:

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VARIATION

WASTE

How to prevent variation and waste??

Identify Chronic Problems (diseases) in the Process

Ensure that adequate Measurement Systems have been defined to accurately measure the damage i.e. Rework,

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defined to accurately measure the damage i.e. Rework, Rejections, Variation, etc caused by these problems

Use structured Problem Solving Methodologies to permanently eliminate or minimize the Waste and Variation

Improve the Capability of the Process to meet customer requirements Consistently at Optimized Costs

Process Deficiencies are solved by a Project by Project approach.

Each Project needs to address a specific PAIN (deficiency) in the process

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Each Project is a structured approach to Problem Solving involving the five steps;

Defining the Problem

Measuring the Problem

Analyzing the Root Causes

Implementing the Improvements

Sustaining the gains

Each Project needs to have a specific GOAL for improvement in terms of either eliminating or minimizing the deficiency.

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the deficiency.

Each Project needs to be conducted by a CROSSFUNCTIONAL TEAM consisting of members from the functions most affected by the pain.

Each Project needs to be TIMEBOUND

Each Project must have a goal to generate

savings as ELIMINATING OR MINIMIZING

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savings as ELIMINATING OR MINIMIZING

DEFICIENCIES will always REDUCE COSTS. This

reduction in costs translates to SAVINGS TO THE

BOTTOMLINE

What is Six Sigma??

“The real problem at Motorola is that our quality stinks”

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……1979, Art Sundry

“A product found defective and corrected during manufacturing had high probability of failing during early use by customer”

……1985, Bill Smith

What does Quality Mean…….

Detecting and correcting mistakes in the product such that it meets compliance standards.

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that it meets compliance standards.

OR

Preventing defects in the first place through process controls and product design such that it meets performance standards.

Motorola believed….

“Highest Quality Producer was the Lowest Cost

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“Highest Quality Producer was the Lowest Cost Producer”

In 1987, a new approach to quality came out of Motorola’s Communication Sector –

6Six Sigma

PPM/DPMOSigma Level

691,4621

308,5382

10 Times Improvement

3 - Historical Standard 93.32% yield

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308,5382

66,8073

6,2104

2335

3.46

Improvement

1800 TimesImprovement

6 – New Standard 99.99966% yield

4 - Current Standard 99.38% yield

99% GOOD (399% GOOD (3)) 99.99966% GOOD (699.99966% GOOD (6))

20,000 LOST ARTICLES OF MAIL PER HR.

SEVEN LOST ARTICLES OF MAIL PER HR.

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PER HR. PER HR.

UNSAFE DRINKING WATER 15 MIN. PER DAY

UNSAFE DRINKING WATER FOR ONE MINUTE EVERY SEVEN MONTHS

5,000 INCORRECT SURGICAL OPERATIONS PER WEEK

1.7 INCORRECT SURGICAL OPERATIONS PER WEEK

99% GOOD (399% GOOD (3)) 99.99966% GOOD (699.99966% GOOD (6))

2 SHORT OR LONG LANDINGS AT MOST MAJOR AIRPORTS EACH

ONE SHORT OR LONG LANDING EVERY FIVE YEARS

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MOST MAJOR AIRPORTS EACH DAY

EVERY FIVE YEARS

200,000 WRONG DRUG PRESCRIPTIONS EACH YEAR

68 WRONG DRUG PRESCRIPTIONS EACH YEAR

NO ELECTRICITY FOR ALMOST 7 HOURS PER MONTH

NO ELECTRICITY FOR ONE HOUR EVERY 34 YEARS

• Sigma is used in statistics to denote standard deviation.

What is Sigma?

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deviation.

• A sigma value is used to relate the ability of a process to perform defect free work.

• The higher the sigma value the better the process is performing and the lower the probability that a defect will occur.

Standard Deviation:

Metric that displays variation from it’s “target”.

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One standard deviation around the mean is about 68% of the total “opportunities” for meeting customer requirements!

1 Std. Dev.(“Sigma”)

If we can squeeze six standard deviations in between our target and the customer’s requirements...

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…….99.99966% of “opportunities” to meet customer requirements are included!

1 2 3 4 5 6123456

What is Lean??

"Lean", is a practice that considers the expenditure of resources for any goal other than the creation of value for the end customer to be wasteful, and thus

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value for the end customer to be wasteful, and thus a target for elimination.

Working from the perspective of the customer who consumes a product or service, "value" is defined as any action or process that a customer would be willing to pay for

Lean is a generic process management philosophy derived mostly from the Toyota Production System (TPS)

Lean is renowned for its focus on reduction of the seven

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Lean is renowned for its focus on reduction of the seven wastes in order to improve overall customer value.

“All we’re trying to do is shorten the time line…. from order receipt to collecting cash for the goods or services provided.” …….1975, Taiichi Ohno

SEVEN

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CLASSICAL

WASTES

1. Waste of over production

2. Waste of inventory

3. Waste of correction (rework)

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3. Waste of correction (rework)

4. Waste of motion

5. Waste of over processing

6. Waste of transportation

7. Waste of waiting

Overproduction

This is the waste of producing too much at a particular point in time. This waste is generally characterized by:

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Producing more than is needed by the next process or customer

Producing earlier than is needed by the next process or customer

Producing faster than is needed by the next process or customer

Inventory

• This is the waste of having excess inventory at all stages of the service delivery process.

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stages of the service delivery process.

• Inventory is considered waste as it does not add value and only increases the cost of service delivery.

• High inventory only means high costs of storage, handing, preservation and movement.

• Economic Order Quantity – Healthcare !!

Correction (Repair/Reject)

• Repair This is the waste of reworking on a process output that should have been delivered right the first time and added value to the customer.

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time and added value to the customer.

• Any repair or rework reduces the value of the output and also increases the cost of delivery.

• Reject This is the waste of scrapping the output of a process.

• Rejections nullify the purpose of the value creation process and double the cost of service delivery

Motion

• This is the waste of excessive motion of the human body such as lifting heavy loads, bending awkwardly,

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body such as lifting heavy loads, bending awkwardly, repeatedly climbing staircases, stretching too far, etc.

• Such work environments create plenty of safety hazards and may lead to injuries and lost time or resources.

• This leads to increase in time and cost of service delivery.

Over Processing

• This is the waste of unnecessary inspection in a process.

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process.

• Over processing loads a process with additional steps that do not add any value to the process output, but are included because the team has low confidence in the capability of the process.

• Over processing only helps to slow the process speed and increase cost.

Transport

• This is the waste of transportation of materials / people from one part of the process to another.

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people from one part of the process to another.

• This leads to long cycle times and also increases the cost of service delivery.

• The waste of transportation promotes the practice of working in batch mode.

Waiting

• This is the waste of equipment and people in one step of the process remaining idle as the previous

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step of the process remaining idle as the previous step of the process is far too slow in servicing the next step.

• This leads to low utilization of resources and in turn increases time and cost of service delivery.

Why Lean Six Sigma??

• The primary focus of Lean has been on maximizing process velocity and eliminating waste so as to deliver products and services to customers at the lowest cost

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products and services to customers at the lowest cost with maximum speed. That is why Lean has been the primary weapon in the War on Waste.

• Lean Principles help to bring agility in a process by using a combination of highly effective process speed tools within a structured framework.

• The primary focus of Six Sigma has been on reducing defects and variation in a process so as to deliver near perfect products and services to customers at lowest

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perfect products and services to customers at lowest possible cost. That is why Six Sigma has been the primary weapon in the War on Variation.

• Six Sigma helps to bring stability and consistency in a process by using a combination of highly effective process quality tools within a structured framework.

• Why Lean Six Sigma ? - Because Lean provides the agility and repeatability in many basic processes. Once repeatability has taken hold, much of the variation due to human intervention goes away. The data collected to support Six Sigma activities

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goes away. The data collected to support Six Sigma activities thereby becomes much more reliable and accurate.

• Lean Six Sigma’s ability to achieve NEAR PERFECT PRODUCTS AND SERVICES AT AN ACCELERATED SPEED offers an organization a powerful tool to achieve their strategic goals with faster pace.

Quality is a state in which

value entitlement value entitlement is realized

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value entitlement value entitlement is realized

by the customer and provider

in every aspect of the

business relationship.

SIX SIGMA

Impro

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Impro

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LEAN SIX SIGMA

Time

Impro

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Time

Impro

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Time

Impro

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• Reduce Variation

• Reduce Waste Focus of

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• Reduce Defects

• Delighting Customer

• Reduce Cost

• Reduce Delivery Time

of Lean Six Sigma

1. Genuine Focus on Customer

2. Data and Fact-Driven Management

Six Themes of

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3. Processes are where the Action Is

4. Proactive Management

5. Boundary Less Collaboration

6. Drive for Perfection; Tolerate Failure

of Lean Six Sigma

Pitfalls in Deployment

• Projects drift away from strategic management priorities

• Scoping projects very broadly - too long, loss of focus

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• Scoping projects very broadly - too long, loss of focus

• Undertaking too many projects at the same time

• Inadequate tracking of results

• Little or no sharing of Best Practices

• Forgetting people not directly involved in deployment

Summary• Lean Six Sigma reduces waste and variation in a

product / service by improving the process that delivers the product / service.

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product / service by improving the process that delivers the product / service.

• Lean Six Sigma is equally effective on manufacturing and service processes.

• Effective Lean Six Sigma implementation requires the allocation of correct resources.

Summary

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• Direct involvement of Top Management is essential. Lean Six Sigma cannot be delegated.

• Lean Six Sigma is not completely new. It uses the same tools in a structured manner through the various phases of problem solving.

� �

In 2010, Quality Council of India (QCI) conceptualized a National Demonstration Project (NDP) on Lean Six Sigma (LSS) in Healthcare. The project was executed by Qimpro with great success.

Over 50 healthcare professionals and hospital administrators were trained on LSS. Thereafter they used the LSS methodology to successfully complete improvement projects that resulted in significant change in the efficiency of hospital processes

Who Should Attend

Hospital management representatives Hospital administrators Healthcare professionals Healthcare management students Hospital quality managers Everybody from healthcare

who believe in “change”projects that resulted in significant change in the efficiency of hospital processes and patient experience. This success is proof of confirmation that LSS is equally effective in improving hospital processes.

Quality in healthcare is a deep concern amongst patients and society at large. The QCI, recognizing this issue, have underlined the criticality of Continuous Quality Improvement as a key factor for NABH Accreditation. In this scenario it has become essential for healthcare professionals and hospital administrators to have Lean Six Sigma Green Belt (LSSGB) credentials.

who believe in “change”

Course Faculty

Dr Parag RindaniHead - Medical Strategy& Clinical ExcellenceWockhardt Hospitals

Anirudha ChakravartyDirectorQimpro HealthcareSix Sigma Master Black Belt

Contact: Vidhya Unni, Qimpro Consultants Tel: (91-22) 6634 8701 |Email: healthcare@qimpro.com