1 Lean Six Sigma Projects Value Stream Mapping in Action!
CPT Sylvia Beady
Chief Ancillary Services
R.W. Bliss Army Health Center
Ft. Huachuca AZ
An introduction to the basic definition and steps of Lean Six Sigma (LSS)
An overview of how the LSS tools works in other part of the healthcare services besides the laboratory (i.e. radiology pharmacy
A live demonstration of value stream mapping (VSM) simulation
3 Basic Definitions The Keys to LSS 4 Example 15S Overview Taking Action!
Set in Order (simplified)
Anchoring Success in the Lab 5 Shipping Lean Six Sigma Improving Efficiencies Anchoring Success 6 PURPOSE
To create and maintain an organized clean safe and high-performance workplace
7 Why Implement 5S
Enables anyone to distinguish between normal abnormal
Its the foundation for continuous improvement zero defects cost reduction safe work area
Its a systematic way to improve the workplace processes products through employee involvement
Minimize Non-Value Added eliminate waste that does not add value to the process or product
8 What is Value Added
Value Added any activity that increases the form or function of the product. (These are things the customer is willing to pay for)
Non-Value Added any activity that does not add value to the form or function or is not necessary.
Customer is not willing to pay for non-value added.
Non-value added activities should be eliminated simplified reduced or integrated into other activities
9 1S SORT Goal Remove all items from the workplace that are not needed for current production or tasks
It does not mean that you remove only the items that you know you will never need
It does not mean that you simply arrange things in a neater fashion
When you sort you leave only the bare essentials When in doubt move it out
10 2S SET IN ORDER
The goal is to Set in Order
Ensures what is needed for a job is in place and easy to find use and put back!
Find ways to prevent the need for future cleaning!
11 Cleanliness get the area looking clean and new 3S SHINE
Make it a habit
Make cleaning and organizing part of regular work duties
Perform regular 5S audits and post results
Prevention (take it to the next level)
Make it difficult to NOT put things away
12 4S STANDARDIZE
Goal Creating a consistent way of implementing the tasks performed daily including Sort Set in order Shine.
It should be obvious at a glance when an item is not in its designated place
Doing the right things the right way every time
13 5S SUSTAIN
This takes discipline on everyones part. Sustain make it a habit to follow the procedures
Practice practice practice!
Teamwork! Personal accountability!
Sustain ties Sort Set in order and Shine together.
With 5S ANYONE should be able to tell the difference between normal abnormal
Celebrate accomplishment continue improving
Make time each week to brainstorm implement improvement suggestions
15 Example 2 DMAIC
Define Measure Analyze Improve Control (DMAIC)
A structured data-based problem-solving process. That means
Doing specific activities in a specific sequence (thats the structured process parts
Gathering data in nearly every phase to help you make decisions (the data-based part)
Making sure that the solutions your team decides to use will eliminate the cause of the problem youre trying to fix (the problem-solving part)
Tracking TAT in Radiology 16 Radiology Unverified Reports Turn-around Time (TAT)
17 Unverified Reports TAT Objective The purpose of this project is to improve the unverified reports TAT within SOP guidelines of 3 working days. Benefits Providers and Patients will receive timely reports and minimize delays in patient care. Chief Ancillary Services Assistant Chief Ancillary Services NCOIC Radiology Radiologists Ra diology Technician Project Team Schedule Measurement In progress Analyze TBD Improvement TBD Control TBD 18 Baseline Data Base line information 1434 unverified studies 140 unread 12 dictated status Data period 11/1/02 9/30/06
FY07 unverified status are tracked separately
19 High Level Map Project Output 20 Low Level Process Map (1 of 2) Flow chart 21 Radiology Study Process(With Severity Scores) Rad staff checks validity of order Return to HCP via telephone
What problem 1-2
30/month on average (4)
Rad staff check-in Pt HCP orders a study HCP send Pt to Rad Pt shows up _at_ Rad No Start
Pt may not show (1)
Pt may show w/o order (2)
non-valid order (3)
10 found invalid by Radiologist
Yes Rad staff determines if exam is done T or sched Tech or Clerk takes Pt to exam Rm Pt recd prep info scheduled Pt examined Yes No Images Taken Process Images
delay in treatment/diagnosis
only 2 cassette readers (5)
1 down- slows down process
O.k. Radiologist checks validity O.k. Yes Tech request prior images from originating facility Prior images received Yes QC Check Images sent to Radiologist Radiologist Evaluate Film Priors Needed (this is standard) A Not O.k. Not O.k. No No Proceed to Radiologist read films Sub Process for later Return to step 1 Retake Radiologist reads dictate films/ reviews priors Fwd to transcription for editing of texts (dictation) Radiologist receives reviews corrects electronically signs Power-scribe sends completed rpt to CHCS AHLTA Power-scribe sends alert to ordering HCP HCP reviews report Stop A
occasional problem w/ upload (5)
DINPACS CHCS AHLTA
checks balance in place (7)
BB CPT Beady 22 Low Level Process Map (2 of 2) Click pix 23 Measure Phase Data Collection (1 of 2) Click Pix 24 Measure Phase Data Collection Note FY07 Tracking data no decrease in baseline data report between Nov 2002 Sep 2006 25 Analyze Phase - Status In Progress... click pix 26 Example 3 Lean Six Sigma
Fishing for Success in Pharmacy 27 Purpose
Improve efficiency in pharmacy wait time and patient satisfaction report card
90 improvement in wait time within 30 minutes
90 patient satisfaction survey report card
28 Fishbone Define Phase 29 Improving Pharmacy Efficiency Producing Results with Little Waste Define Phase 5Ms 1P Men (personnel) Materials Measurement Lack of/limited Information to patients Grey Cart (Lisa) Mail boxes Increased patient Wait time () Service after P2K Flammable Storage Macessan software more steps more training Key Box Q-Matic estimated Wait Time vs. transaction time Red Bins Exemption from duty (golf cart) Sign in board posted Help w/ Office Supply Staff shortage per day Shred it Move to new side (Tom) Stop Pick-point Support Patient complaints Cork board (break room) Increased Staff workflow TV (Tom) Efficiency Copy Rm Prepackaging (volunteers) Safety (ECC) Schedules (2wk/4wk/6wk) Faxed orders not recd or incomplete Staff office (mbr teams 58596061 System failure (audio care computer) Data South Printer location Prepacks (fast mover) Key Control Interview Rm Zebra Printers LCD Screen Method Mother Nature (environment) Machine 30 Current Process Flow Lean Tool Box 31 Process Observation 32 Process Flow chart 33 Door Admin Area Staff Work Stations Sterile Room Supply Office Rx Shelf Rx Shelf Fill Station 4 Baker Cell 3 Rx Shelf Rx Shelf Rx Shelf Rx Shelf Rx Shelf Fill Station 7 2 5 Fax 3 5 2 Refill Bins Refill Bins 2 Rx Shelf 6 4 Rx Shelf 1 1 6 8 3 1 Window 3 Window 1 Window 2 Window 4 Window 5 Window 6 Refill Refill 34 Box Plot Chart FMEA Analyze Phase Note Measure Phase used CE Matrix similar to Radiology 35 Analyze Wait Time vs. Week Day 36 Area to improve Longest wait time 37 Failure Mode Effects Analysis 38 Key Points Improve Phase 39 Processes Under Improvement
Overall wait times
40 Example 4VSM Simulation 41 QUESTIONS. 42 References
George M. Rowlands D. Kastle B. What is Lean Six Sigma 2004 George Group
Phillips Corporation presentation
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