Lean Six Sigma Projects

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Lean Six Sigma Projects Value Stream Mapping
in Action!

• CPT Sylvia Beady
• Chief, Ancillary Services
• R.W. Bliss Army Health Center
• Ft. Huachuca, AZ

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Objectives

• 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

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Basic Definitions The Keys to LSS
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Example 15S Overview Taking Action!

• Sort
• Set in Order (simplified)
• Shine (sweep)
• Standardize
• Sustain

Anchoring Success in the Lab
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Shipping Lean Six Sigma Improving Efficiencies
Anchoring Success
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PURPOSE

• To create and maintain an organized, clean,
  safe, and high-performance workplace

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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

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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

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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

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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!

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Cleanliness get the area looking clean and new
3S SHINE

• Make it a habit
• Assign responsibilities
• 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

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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

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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.

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SUMMARY

• 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

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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
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Radiology Unverified Reports Turn-around Time
(TAT)

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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
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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

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High Level Map Project Output
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Low Level Process Map (1 of 2)
Flow chart
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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)

• 98-99
• 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

• TAT (7)
• non-responsive facilities
• 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)
• HCP notification
• DINPACS, CHCS, AHLTA

• checks balance in place (7)
• outside script

BB CPT Beady
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Low Level Process Map (2 of 2)
Click pix
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Measure Phase Data Collection (1 of 2)
Click Pix
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Measure Phase Data Collection
Note FY07 Tracking data no decrease in baseline
data report between Nov 2002 Sep 2006
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Analyze Phase - Status
In Progress... click pix
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Example 3 Lean Six Sigma

• Process Flow
• DMAIC

Fishing for Success in Pharmacy
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Purpose

• Improve efficiency in pharmacy, wait time and
  patient satisfaction report card
• Project Goal
• 90 improvement in wait time within 30 minutes
• 90 patient satisfaction survey report card

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Fishbone
Define Phase
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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 58,59,60,61
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
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Current Process Flow
Lean Tool Box
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Process Observation
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Process Flow chart
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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
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Box Plot Chart FMEA
Analyze Phase Note Measure Phase used CE
Matrix similar to Radiology
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Analyze Wait Time vs. Week Day
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Area to improve
Longest wait time
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Failure Mode Effects Analysis
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Key Points
Improve Phase
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Processes Under Improvement

• Communication
• Organization
• Staff involvement/awareness
• Overall wait times

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Example 4VSM Simulation
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QUESTIONS.
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References

• George, M., Rowlands, D., Kastle B. What is Lean
  Six Sigma? 2004 George Group
• Phillips Corporation presentation