Nuts & Bolts of PI-II at WBH

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 Facilitator – Black Belt 6s Quality Margins Cycle Time Green Belt Lean Expert Cost COST Process Capability Lean/Waste removal

4. Performance Improvement Models

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 customer’s 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 don’t improve you deteriorate’ Throughcontinuous improvement Throughcontinuous improvement

13. Total Quality Control TQC - The heart of TQM

14. TQM vs. Problem Water lowered - problems exposed Water reduced - problems minimised Water high - problems hidden 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

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. 1BlackBelt 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

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 Customer Needs / Data Outputs Inputs Supplier Processes Customer Process Data • 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

35. KPIV

36. KPIV Classification

37. The Six Sigma Model Output 1 Output 2 Output 3 …….. Output z Input 1 Input 2 Input 3 …….. Input n Process Noise 1 Noise 2 ……. Noise m 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 MEASURE ANALYZE DEFINE CONTROL IMPROVE • Identify Metrics • Determine Data • Develop Data Collection Plan • Collect Data • Define Problem • Identify Customer • Identify CTQ • Map Process • Refine Project Scope • Update Project Charter • Select Analysis Tools • Graphically Represent Results • Identify Sources of Variation • Generate Improvement Opportunities • Select Best Alternative • Map New/Improved Process • Conduct FMEA • Pilot Solution • Validate Improvement • Conduct Error-Proofing • Develop Long Term Measurement Plan • Implement Control Charts • 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. DEFINE MEASURE ANALYZE IMPROVE CONTROL Tollgate 1 Tollgate 2 Tollgate 3 Tollgate 4 Tollgate 5 Tollgate 6 Tollgate 7 Tollgate 8 Approach Guide Tollgates

44. Lean in Healthcare

45. Lean Thinking

46. A. A. MilneWinnie-the-Pooh Here is Edward Bear, coming downstairs now, bump bumpbump 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 • Value can only be defined from the end user customers perspective (Value) • To deliver customer value, the “waste” must be removed from the customer delivery process. (Value Stream) • Once the waste is removed, the value must be linked together in a continuous flow (Flow) • The flow must deliver to the exact customer requirements (pull) • 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 service…meaning: Lean is the identification and elimination of “muda” or “waste”.