Lean Six Sigma Projects & Value Stream Mapping in Action!

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

2. 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

3. Basic Definitions: The Keys to LSS

4. Example 15S Overview: Taking Action! • Sort • Set in Order (simplified) • Shine (sweep) • Standardize • Sustain 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 • It’s the foundation for continuous improvement, zero defects, cost reduction & safe work area • It’s 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 increasesthe 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. 3S: SHINE Cleanliness: get the area looking clean and new • 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

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 everyone’s 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.

14. 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

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 (that’s 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 you’re trying to fix (the “problem-solving” part) Tracking TAT in Radiology

16. Radiology Unverified Reports Turn-around Time (TAT)

17. D M A I C 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 Radiology Technician Project Team: Schedule: Measurement: In progress Analyze: TBD Improvement: TBD Control: TBD

18. D M A I C 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. D M A I C High Level Map Project Output

20. D M A I C 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 Start HCP orders a study HCP send Pt to Rad Pt shows up @ Rad No • Pt may not show (1) • Pt may show w/o order (2) • non-valid order (3) • 98-99% • ~10% found invalid by Radiologist Yes Tech or Clerk takes Pt to exam Rm Rad staff determines if exam is done T or sched Pt examined Yes Pt rec’d prep info & scheduled Process Images Images Taken No • 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

22. D M A I C Low Level Process Map(2 of 2) Click pix:

23. D M A I C Measure Phase – Data Collection (1 of 2) Click Pix

24. D M A I C Measure Phase – Data Collection Note: FY07 Tracking data; no decrease in baseline data report between Nov 2002 – Sep 2006

25. D M A I C Analyze Phase - Status In Progress... click pix

26. Example 3: Lean + Six Sigma • Process Flow • DMAIC Fishing for Success in Pharmacy

27. Project Y’s Baseline GOAL units Wait Time 25 90 % Satisfaction Survey Report 36 90 % 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

28. Fishbone Define Phase:

29. Improving Pharmacy Efficiency – “Producing Results with Little Waste” [Define Phase: 5M’s & 1P] Men (personnel) Materials Measurement Grey Cart (Lisa) Lack of/limited Information to patients Mail boxes (???) Service after P2K Increased patient Wait time 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 Prepackaging (volunteers) Copy Rm Safety (ECC) Schedules (2wk/4wk/6wk) Faxed orders not rec’d 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 Mother Nature (environment) Method 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 6 1 1 3 8 Window #1 Window #2 Window #3 Window #4 Window #5 Window #6 Refill Refill

34. Box Plot Chart & FMEA Analyze Phase: Note: Measure Phase used C&E 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: • Communication • Organization • Staff involvement/awareness • 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