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Nuts

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Nuts & Bolts of PI-II at WBH Understanding Performance Improvement Overview of Deployment Model Presented by Jayant Trewn Ph.D., Faculty and Master Black Belt – PowerPoint PPT presentation

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Title: Nuts


1
Nuts Bolts of PI-II at WBH
  • Understanding Performance Improvement
  • Overview of Deployment Model

Presented by Jayant Trewn Ph.D., Faculty and
Master Black Belt Beaumont University
2
Components of a Culture Change
3
PI-II Environment
Margins
Cycle Time
Green Belt
Lean Expert

Cost
COST
Process Capability
Lean/Waste removal
4
Performance Improvement Models
Improvement Model Primary Theory Intended Effect
PDCA - Rapid Cycle Improvement Improve performance through incremental process changes Achieve pre-defined measures of success
Six Sigma Reduce process variation Reduce variation in complex processes
Lean Thinking Remove waste Create value-added processes
5
PDCA Overview
6
Quality the old view
  • Products and services that are exactly to
    specifications
  • In many cases even outside the specifications

7
The TQM view
  • Products and services that totally satisfy the
    customers needs and expectations in every
    respect on a continuous basis. In fact they do
    not just satisfy but delight the customer

8
Quality is customer delight
9
Q What delights the customer?
  • product quality
  • cost
  • delivery
  • service
  • All these constitute Q

10
Total
  • T Quality of
  • all products
  • all services
  • all processes
  • Team work - all employees - working together to
    achieve Q

11
Management
  • M Management
  • integrated approach
  • proper problem solving methodology
  • continuous improvement

12
The TQM Model
JIT just when customer wants it exposes
problems TQC problem solving methods
kills problems TEI total employee involvement
people are the key
World Class
World Class
JIT
TQC
TEI
If you dont improve you deteriorate
Through continuous improvement
Through continuous improvement
13
Total Quality Control

TQC - The heart of TQM
14
TQM vs. Problem
Water high - problems hidden
Water lowered - problems exposed
Water reduced - problems minimised
problems
15
Quality target
  • Target is 100 not even 99.9
  • 2-3 rail accidents every day
  • 25 bombs off target in Kosovo

16
100 inspection
  • The necessity of training farm hands for the
    first class farms in the fatherly handling of
    farm livestock is foremost in the minds of farm
    owners. Since the forefathers of the farm owners
    trained the farm hands for the first class farms
    in the fatherly handling of farm livestock, the
    farm owners feel they should carry on with the
    family tradition of training farm hands of first
    class farms in the fatherly handling of farm live
    stock because they believe it is the basis of
    good fundamental farm management.

17
How to kill problems - PDCA
  • Problem solving
  • seven steps
  • data - in god we trust, the rest of us bring data
  • fact finding
  • 7 7 QC tools
  • Continuous improvement - PDCA
  • Maintenance of improvement - process control -
    average and variability
  • Systems and procedures - Standard Operating
    procedures
  • People and systems - who is the problem?

18
7 QC tools
  • stratify data
  • Pareto diagram
  • cause and effect diagram
  • histogram
  • scatter diagram
  • check sheets
  • control charts

19
7 new quality management tools
  • Affinity diagram
  • Interrelationship digraph
  • Prioritization matrices
  • Matrix diagrams
  • Tree diagram (systematic diagram)
  • Process Decision Program Chart (PDPC)
  • Activity Network Diagram

20
(No Transcript)
21
Six Sigma Problem Solving
22
What is Six Sigma?
  • A business philosophy and initiative that enables
    World Class quality and continuous improvement to
    achieve the highest level of Customer
    Satisfaction. 1
  • Yields dramatic bottom line results by
    redesigning and monitoring activities to minimize
    cost and resources
  • Drives companies to reduce variation, increase
    quality, and generate increased customer
    responsiveness.

1Black Belt Memory Jogger, 2002 Goal/QPC and Six
Sigma Academy
23
What is Six Sigma?
  • A comprehensive and flexible program for
    achieving, sustaining and maximizing business
    success that
  • Is uniquely driven by a clear focus on the Voice
    of the Customer
  • Is founded in a rigorous use of facts, data and
    statistical analysis
  • Provides for diligent attention on managing,
    improving and reinventing business processes.
  • Is a management methodology with three
    perspectives
  • A Measure of Quality
  • A Process for Continuous Improvement
  • An Enabler for Cultural Change

24
A Measure of Quality
  • Six Sigma is a statistical measure that expresses
    how close a service process comes to its quality
    goal
  • Six Sigma refers to a process that produces only
    3.4 defects per million opportunities

Sigma DPMO Yield
2 308,537 69.1463
3 66,807 93.3193
4 6,210 99.3790
5 233 99.9767
6 3.4 99.9997
25
Six Sigma Problem Solving
  • Variation Reduction
  • Project Management Tool
  • Structured Project Guide

26
Six Sigma Vision
  • Every project will contribute to profitability
    and meeting customer needs

Six Sigma Strategy
  • Need to balance needs of customer and company so
    both are happy

27
What is Six Sigma?
  • Drives your company to work in a proactive mode
    and focus on prevention
  • Utilizes data and statistical tools to improve
    processes

28
Six Sigma Roles
  • Black Belts
  • Master Black Belts
  • Green Belts
  • Executive Sponsors
  • Champions
  • Process Owners

29
What is Variation?
30
Service Process Variation
  • Variations in inputs to process
  • Variations in process execution
  • Variation in outputs of process

31
Defining KPOV and KPIV
32
KPOV KPIV
Y f (x)
KPOV Key Process Output Variable
KPIV Key Process Output Variable
33
Key Process Output Variable
  • Output Measures (KPOVs)
  • Performance outcomes
  • More direct and short term
  • Easy to quantify dashboard-able
  • Process Measures (KPIVs)
  • How effectively the process is working
  • Possible to Quantify

34
KPOV
Example
Output(s) Key Process Output Variable
Coffee Strength
Coffee Aroma
Coffee Quantity
Coffee Taste
Coffee Hot-ness
35
KPIV
Input(s) Key Process Input Variable
Ingredient list Completeness
Milk Fat Content
Milk Quantity
Water Quantity
Water Type - Ordinary (or) Mineral
Sugar Quantity
Sugar Type - Sacrine, Sugar grains, Sugar cubes
Coffee Powder Quantity
Coffee Powder Chicory
Coffee Powder Type - instant or filter
36
KPIV Classification
Input Type Description
Controllable KPIVs that can be changed to see the effect on KPOVs, also known as knob variables
Critical Inputs whose variation will impact KPOVs
Uncontrollable (difficult / unable to control) Input variables that impact the KPOVs but are difficult to control. Example Environmental variables such as humidity, temperature etc
Not controlled Inputs that are uncontrollable but chosen not to be controlled
37
The Six Sigma Model
Design Process
Machines
People
Desired Outcomes
Controllable factors
Methods
Materials
Monitor KPOVs
Control KPIVs
Uncontrollable factors
Absorb variation
38
Example of The Six Sigma Model KPOV/KPIV
Process Preparing Carts in CPD for OR cases Sub
Process Process Sets - Assembly
Clean Set Complete Set Missing instrument
list Timely set delivery Organized as
set Replacement instruments Set tray
Set Processing
CPD Techs ORAs
Decon m/c Sterlizer
Labeled Set No missing inst No dirty inst No
broken inst Sterilized inst
Desired Outcomes
Controllable factors
Set Assy Procedure
Kim guards
Control KPIVs
Monitor KPOVs
Broken Instrument Damaged instrument
Absorb variation
Uncontrollable factors
39
DMAIC Methodology
40
PDCA Six Sigma MAP
  1. Identify Metrics
  2. Determine Data
  3. Develop Data Collection Plan
  4. Collect Data
  1. Define Problem
  2. Identify Customer
  3. Identify CTQ
  4. Map Process
  5. Refine Project Scope
  6. Update Project Charter
  1. Select Analysis Tools
  2. Graphically Represent Results
  3. Identify Sources of Variation
  1. Generate Improvement Opportunities
  2. Select Best Alternative
  3. Map New/Improved Process
  4. Conduct FMEA
  5. Pilot Solution
  6. Validate Improvement
  1. Conduct Error-Proofing
  2. Develop Long Term Measurement Plan
  3. Implement Control Charts
  4. Develop SOP and Training Plan

41
Structured Project Guide
  • What is a Structured Project Guide?
  • Structured approach ensures success
  • Objectives of guide
  • Plan
  • Guide
  • Track progress
  • Review
  • Evaluate
  • Document

42
Structured Project Guide Framework
  • Tollgate Model 8 Tollgates
  • Travel to a Tollgate
  • Pay Toll
  • Start journey to next Tollgate
  • Structured progress
  • Progress tracking
  • Tollgate reviews

43
Approach Guide Tollgates
  • DEFINE
  • MEASURE
  • ANALYZE
  • IMPROVE
  • CONTROL
  • Tollgate 1
  • Tollgate 2
  • Tollgate 3
  • Tollgate 4
  • Tollgate 5
  • Tollgate 6
  • Tollgate 7
  • Tollgate 8

44
Lean in Healthcare
45
Lean Thinking
46
A. A. MilneWinnie-the-Pooh
  • Here is Edward Bear,
  • coming downstairs now,
  • bump bump bump
  • on the back of his head,
  • behind Christopher Robin.
  • It is, as far as he knows, the only way of coming
    down stairs, but sometimes he feels that there
    really is another way, if only he could stop
    bumping for a moment and think of it.

47
The Concept Behind Lean Thoughtware...
Significant Sustainable Competitive
Advantage
Lean Behavior
Lean Thoughtware
48
Lean Thoughtware
  1. Value can only be defined from the end user
    customers perspective (Value)
  2. To deliver customer value, the waste must be
    removed from the customer delivery process.
    (Value Stream)
  3. Once the waste is removed, the value must be
    linked together in a continuous flow (Flow)
  4. The flow must deliver to the exact customer
    requirements (pull)
  5. Additional waste is eligible to be removed
    (continuous improvement)

49
A Customer Perspective is a Lean Perspective
  • To be customer focused..an organization must be
    process and lean focused
  • Our processes, more than our products or
    services tell us where and how we are best
    prepared to compete"

50
What is Lean?
  • Lean is a Disciplined, Process Focused
    Production System whose objective is to
    minimize the consumption of resources that add no
    value to a product or servicemeaning Lean is
    the identification and elimination of muda or
    waste.

51
About Lean
  • The disciplined process focused production system
    known a Lean production was born out of the
    Toyota Production System
  • The Toyota production System, however is not
    just a production system. I am confident it will
    reveal its strengths as a management system
  • SourceT.Ohno, Toyota Production System (1988)

52
5 Critical Concepts of Lean
  • Lean Thoughtware and Application are based on 5
    Critical Concepts
  • Specify Value
  • Identify the Value Stream
  • Make the Value Flow
  • Pull to Customer Demand
  • Pursue Perfection

53
Not Just a Manufacturing thingAnalysis of Cycle
times and Value Adding Activities in White Collar
Processes Source Blackburn, Time Based
Competition)
Industry Process Average Cycle time Value Adding Time Value Added
Life Insurance New Policy Application 72 hours 7 min 0.16
Consumer Packaging New Graphic Design 18 days 2 hours 0.14
Footwear Prototype Development 25 weeks 2 days 2.60
Commercial Bank Consumer Load 24 hours 34 min 2.36
Hospital Patient Billing 10 days 3 hrs 3.75
Motor Vehicle Equipment Financial End-of Month Closing 11 days 5 hrs 5.60
Airframe MFR. Engineering Change Orders 21 days 1.75 days 8.5o
54
Nationally Known Healthcare Systems using Six
Sigma
  • BJC Healthcare
  • Catholic Healthcare West
  • Good Samaritan Health System
  • Johns Hopkins
  • Mayo Clinic
  • New England Medical Center in Boston
  • NewYork-Presbyterian Hospital
  • North Shore Long Island Jewish Health System
  • St. John Health (SJH)
  • St. Jude Medical
  • Stanford University Medical Center-Department of
    Radiology
  • Trinity Health
  • University of Virginia (UVA) Medical Center
  • M. D. Anderson Cancer Center
  • Yale-New Haven Hospital

55
Organizations that admit to usingLean Techniques
  • Toyota
  • General Motors
  • Dell
  • Oracle
  • Southwest Airlines
  • Mayo Clinic
  • University of Michigan Health System
  • DaimlerChrysler (LaSorda)
  • Ford Motor Company
  • Boeing
  • McKinsey Company
  • U.S. Army
  • Lockheed Martin

56
Organizations that are teaching Lean Techniques
  • Harvard
  • MIT
  • JCAHO
  • Purdue
  • University of Michigan
  • Oakland University
  • Oakland Community College
  • Institute for Healthcare Improvement
  • AICPA
  • GE Healthcare
  • Agency for Healthcare Research and Quality
  • Michigan Center for Nursing
  • American College of Healthcare Executives
  • American Society for Healthcare Engineering

57
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58
What is Lean in Health Care?
The endless transformation of waste into value
from the customers perspective.
Womack and Jones, Lean Thinking
59
Lean in Health Care?
  • Can healthcare use
  • - the Toyota Production System
  • - product development - production
  • - supplier management - customer support
  • - planning
  • - to transform waste into value?
  • Can a health system use
  • - fewer inputs (time, human effort, materials)
  • - than traditional care process
  • - to produce a wide variety of products
  • - with fewer defects more quickly with less
    stress?
  • Lean is not about working harder or faster, it is
    about finding waste and transforming it into
    value our customers want.

60
The 5 Steps of LeanCan Work in Healthcare
  • Specify value from customers perspective
  • Identify the value stream for each product, and
    remove the waste
  • Make value flow without interruptions from
    beginning to end
  • Let the customer pull value from our process
  • Pursue perfection continuous improvement
  • Do this every day in all our activities

Source Womack Jones Lean Thinking
61
The clinic appointment
  • You call the clinic, go through 3 voice prompts,
    are put on hold, and leave a message
  • The clerk calls you back and sets a date in 3
    weeks
  • You arrive for the visit, check in, sit in
    waiting room
  • You are called into the exam room, wait for
    doctor
  • The doctor sees you, saying shes been waiting
    for you to arrive diagnoses a URI, and BP is
    worse
  • The doctor prints an antibiotic prescription,
    goes to the staffroom to get it. You are allergic
    to that drug.
  • You wait to pick up the prescriptions.
  • The doctor says she wants to see you back in a
    week, no appointment is available.
  • The MA does an EKG.

62
The clinic appointment
  • You call the clinic, go through 3 voice prompts,
    are put on hold, and leave a message
  • The clerk calls you back and sets a date next
    week
  • You arrive for the visit, check in, sit in
    waiting room
  • You are called into the exam room, wait for
    doctor
  • The doctor sees you, saying shes been waiting
    for you to arrive diagnoses a URI
  • The doctor prints an antibiotic prescription,
    goes to the staffroom to get it. You are allergic
    to that drug.
  • The MA does an EKG.
  • At check out you ask the cost clerk says
    theyll bill you

63
The 5 Principles of Lean Work
  • Specify value from customers perspective
  • A quick clinic visit
  • Identify the value stream for each product, and
    remove the waste
  • Time on hold, callbacks, walking
  • Make value flow without interruptions from
    beginning to end
  • No waiting
  • Let the customer pull value from the process
  • Pull the appointment when you want it
  • Pursue perfection continuous improvement
  • Every clerk, doctor and nurse works to redesign
    for better value to the customer

64
Diversity in Healthcare as a Challenge to Lean
  • Large number of product lines
  • Adult vs. Peds
  • Specialty vs. Primary Care
  • Inpatient vs. Outpatient
  • Surgical vs. Non-surgical
  • Chronic vs. Acute Care
  • Each patient is unique
  • More like a custom repair (job shop) than an auto
    manufacturer
  • Almost infinite variability in mix of diseases
    and symptoms
  • Variable age, family, gender, race, social,
    insurances factors
  • Variable health habits, tobacco/alcohol/drugs,
    compliance
  • Mental health as a primary or complicating
    problem
  • Patient preferences must be respected

65
Use Lean tools to transform waste into value from
the customers perspective. Is There Waste
(Muda) in Healthcare?
  • Defects in products
  • Overproduction of goods
  • Inventories of goods awaiting future processing
    or consumption
  • Unnecessary movement of workers
  • Overprocessing
  • Unnecessary transport of goods
  • Waiting(for process equipment to finish or on an
    upstream activity)
  • Design of goods and services which do not meet
    users needs

66
Do the Eight Forms of Waste Make Sense at
Beaumont?
  • Overproduction/Production of Unwanted Products
  • Material Movement and Worker Motion
  • Waiting
  • Over-processing
  • Inventory
  • First Time Quality Problems Defects requiring
    correction
  • Wasted Creativity of Employees

67
Decon Performance Improvement Project
  • Project Start 6/22/05
  • Project End 10/30/05

68
Problem Statement
  • Workflow in CPD Decon does not capture priority
    sets to be cleaned.
  • Missing instruments from sets in Decon have never
    been tracked and reported back to OR Surgical
    Services.
  • No consistent policy for how things should be
    done in the Decon area.

69
Project Goals
  • To optimize work flow in the Decon area.
  • Create a system to prioritize sets for cleaning
    as they enter the Decon area.
  • Create a system to track and report missing
    instruments from sets and reduce instrument loss.
  • Create a clear policy and procedure book for the
    Decon area to promote consistency.

70
Processes and Tools Used
  • Data Collection
  • Voice of Customer
  • Pareto Charting
  • Flowcharting
  • QFD Function Matrix
  • Lean/Six Sigma Tools

71
Value Chain Concept
  1. Complete Sets
  2. Clean Sets
  3. Organized Sets
  4. Paper pulled out of sets
  5. Sets received in timely manner
  6. Indicate missing instruments from sets.
  7. Priority Set Marker
  8. What time set needed for next case
  9. Remove extra instruments
  1. Complete Sets- Include Pans
  2. Send Carts ASAP
  3. Enzymatic Spray - Rinse Instruments
  4. Organize Sets
  5. All Sharps Removed
  6. Return Paperwork
  7. Feedback on Priority sets
  8. Feedback on Missing Instruments

Instrument Flow
72
Cycle Time Analysis Decon Process VA/NVA
9
9
9
9
9
9
9
Wait times between Value Added Steps Total Non
Value Added 3340 min.
Non Value Added
Time
  1. Cart arrives in Decon
  2. Cart Set Scanned Decon Received
  3. Wheel Cart to work Station
  4. Sets scanned Set for Decon
  5. Load Sets onto workstation
  6. Separate out hand wash
  7. Count instruments string and clean
  8. Cart goes to washer
  9. Waiting, Idle Time

Value Added
1
4
5
6
7
8
3
2
Total Value Added 2100 min.
73
Discussion
  • Lean in your department relate lean to one
    process of your department and discuss
    opportunities

74
PI-II Implementation

Management of Change
75
The path of the calf
  • Once upon a time there was a calf. One evening he
    walked home through a thick jungle. The distance
    to his home was only one kilometer but he walked
    three kilometers since, like all calves, he
    wandered here and there, left and right, up and
    down.
  • The next morning a shepherds dog passed that way
    and saw the calfs hoof marks, and followed the
    path of this calf through the woods. Shortly
    after, the first sheep of a flock followed the
    path and behind him all other sheep. Thus a path
    was made through the wood.
  • Men began to use that path, cursing its twists
    and turns as they did, but doing nothing about
    it.
  • The path gradually became a lane, the lane became
    a road and horses and bullock carts followed it -
    followed the steps of the wandering calf.
  • A century later the road became a street, and
    then a citys crowded thoroughfare, with
    thousands following in the footsteps of the
    wobbly calf.
  • Three centuries later the road became a street,
    and then the main street of a very large city,
    Buses, lorries, trams and cars followed the
    zigzag path of the calf.

76
Integrated approach to TQM is most necessary
  • Two levels of implementation
  • Everyone involved - continuous improvement -
    small improvement/GHK programme - mass movement
  • Big problems - cross functional groups
  • data based
  • seven steps
  • group leadership and facilitation

77
PI-II Program Model
  • Knowledge Ref Page 2 of PI-II concept document
  • BU sponsored and managed curriculum
  • Progression driven course delivery
  • Management Development and Leadership Development
    courses to supplement PI curriculum
  • Tools and Aids
  • PI-II structured project guide
  • Progression path YB -gt GB -gt BB -gt MBB
  • Support structure for learners
  • GB supported by BB and BB supported by MBB
  • People Ref Page 3 of PI-II concept document
  • Empower employees to participate in change YBs
  • Empower Supervisors to drive change linked to
    champion goals GB
  • Empower experts to facilitate change BB
  • Empower leaders to align goals and objectives to
    organization strategic plans Champions
  • Motivation
  • Tied to Pay for Performance
  • Rewards
  • Six Sigma and Lean methodology as enablers (means
    to achieve) of Pay for Performance objectives

78
PI-II Model launch
Ref Page 3 of PI-II concept document
79
Current GB Projects
  • 1  Reduction in biling concern/call routing
    (Service Excellence - Corporate)
  • Green Belts  Marie Baloga Julie Morse
  • Black Belts  Wendy Dingwall and Kristen Cavender
  •  
  • 2  Reducing/eliminating duplicate chart
    requests (PT/OT - Troy)
  • Green Belts  Elizabeth Van Hoek Karol Clason
  • Black Belts  Jayant Trewn
  •  
  • 3  Reducing wasted bone products ordered for
    surgery from the Blood Bank (Blood Bank - RO)
  • Green Belts  Randy Sprouse Anne Sepienza
  • Black Belts  Judy Easter Brian Vargo
  •  
  • 4  Reducing Critical Call turn-around time for
    critical lab values (Lab - RO)
  • Green Belts  Bob Church/Terre St. Peter/Connie
    Diggs
  • Black Belts  Grace Bostic Salil Balar
  •  
  • 5  Entering accurate and complete data into HR
    database (HR - Corporate)
  • Green Belts  Jean Ann Larson/Carol
    Holth/Ludmilla Tscherniwetz
  • Black Belts  Eric Ellerholz/Ron Grant

80
PI-II Delivery Structure
Ref Page 2 of PI-II concept document
81
PI-II Progression Matrix
Notes 1 Expected effort for teams with novice GB
and or BB, will be less for mature teams
Ref Page 3 of PI-II concept document
82
PI-II Team Composition
Six Sigma Project Team
1 Green Belt
Ref Page 2 of PI-II concept document
83
Typical PI-II Project Lifecycle
  • Define 2 sessions 1 Month
  • Measure 1 session 2 weeks
  • Analyze 2 sessions 1 Month
  • Improve 2 sessions 1 Month
  • Control 1 session 2 weeks
  • Documentation 1 week

Anticipated timelines some projects may take
longer or shorter dependent on the maturity of
the process (defined process, available data,
etc.) and maturity of team members
84
PI-II Project Implementation Tool
  • Structured Project Guide (SPG)
  • What
  • Structured project PLAN
  • Embedded TEMPLATES/TOOLS
  • Method
  • When What
  • TIMELINE driven TASKLIST
  • How Who
  • TEMPLATES and RESPONSIBLE Person
  • Use
  • Champion and MBB Project Tracker
  • BB
    Project Facilitation tool
  • GB
    Project guide and documentation tool
  • YB Tools
    and templates

85
PI-II Project Support Structure
  • Support list with contact info on BU
  • Master Black Belt support
  • E-Mail/phone/consult support for Black Belts
  • Guides weekly ½ hr project reviews with Black
    Belts/GBs
  • Monthly 2 hour open house QA for Black Belts
  • Black Belt Support for Green Belts
  • E-Mail/phone/consult support for Green Belts
  • Project facilitation facilitate 6s projects 2
    hrs per week
  • Green Belt Collaboration
  • HPIC/HCBC monthly lunch learn meetings share
    experiences
  • Quarterly GB colloquiums QA with BBs and MBB
  • Annual 6s symposium hear and learn

Ref Page 5 of PI-II concept document
86
PI-II Curriculum
Ref Page 4 of PI-II concept document
87
Certification Proposal
  • YB Certified on completion of PI 100 200
    300 on-line test
  • GB (Progression certification)
  • Class on-line test - multiple choice
    (certificate applicant)
  • Lead 1 successful Project (certificate
    candidate)/mentored
  • Internal Test (Certified problem solving
    scenario test for GB)
  • BB (Progression certification)
  • Class (certificate applicant)
  • Facilitate 1 Project (certificate
    candidate)/mentor
  • Internal Test written 4 hour with problems
    (Certified)
  • Lean (Application certification)
  • Class (certificate applicant)
  • Lead 1 successful Project (certificate candidate)
  • Internal Test written 4 hour with a practical
    test/lean case (Certified)

88
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89
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