Business Model Canvas (BMC)- A new venture concept
Bb training improve_print
1. The DMAIC Lean Six Sigma Project
and Team Tools Approach
Improve Phase
1
2. 2
Six Sigma Improve Phase
“The starting point for improvement is to
recognize the need.”
- Imai
Improve - Introduction
3. Lean Six Sigma Black Belt Training!
Improve Agenda
Welcome Back and brief D M A Review
Improve Overview
Generate and Prioritize Solutions
Risk Assessments
Evaluate Solutions
Approach for Implementation
Translate Improvements for Communication
Other Improvement Approaches and Support
Design for Six Sigma
Designed Experiments
Applications / Lessons Learned / Conclusions
Next Steps
3
4. 4
Improve Phase Review:
Key Steps
In alignment with our project goal statement, and
given what we have learned in the Define, Measure,
and Analyze Phases of our project, during the
Improve phase our team will complete:
•Generating and prioritizing Solutions (Improvement actions)
•Risk assessment
•Evaluation of Solutions and Benefits
•Approach for Implementation
•Translating and communicating learnings to Champion and
Process Owner(s) as appropriate
We will define and implement GREAT improvement solutions!
Improve – Key Deliverables
5. Lean Six Sigma
DMAIC Phase Objectives
• Define… what needs to be improved and why
• Measure…what is the current state/performance level and potential causes
• Analyze…collect data and test to determine significant contributing causes
• Improve…identify and implement improvements for the significant causes
• Control…hold the gains of the improved process and monitor
5
6. What is Six Sigma?
•A high performance measure of excellence
•A metric for quality
•A business philosophy to improve customer satisfaction
•Focuses on processes and customers
•Delivers results that matter for all key stakeholders
•A tool for eliminating process variation
•Structured methodology to reduce defects
•Enables cultural change, it is transformational
6
7. 7
Six Sigma Is a Set of Powerful Tools
Define Measure Analyze Improve Control
Problem
Definition
Process
Mapping
Key Factors (x) Selection Matrix OCAP
Project
Management
Cause & Effect
Matrix
Basic Statistics
Prioritization
chart
Standard Work
High Level
Mapping
Fishbone
Diagram
Regression FMEA Feedback Loops
Descriptive
Statistics
Statistical
Analysis
Hypothesis
Testing
Simulation Transition Plans
Pareto
Value Stream
Map
ANOVA
Future State
Process Map
Control Plans
Benchmarking MSA FMEA SPC
Cost/Benefit
Analysis
Capability Proportions Visual Control
8. 8
The Lean Six Sigma Approach
• Lean Six Sigma is the combination of the Lean
and Six Sigma “tool boxes” to create a
customer-centric, value-based philosophy and
rapid-fire deployment of focused
methodologies to transform our business
processes to be able to consistently deliver
bottom line results that are sustainable and
continuously improved.
Design for Six Sigma
9. Six Sigma applied effectively…
•Increases customer satisfaction
•Lowers costs
•Builds better leaders
•Empowers an organization to be more data-driven
9
10. The Basic Philosophy of Lean Six Sigma
• All processes have variation and waste
• All variation and waste has causes
• Typically only a few causes are significant
• To the degree that those causes can be understood
they can be controlled
• Designs must be robust to the effects of the remaining
process variation
• This is true for products, processes, information
transfer, transactions, everything
• Uncontrolled variation and waste is the enemy
10
11. The basic focus of Six Sigma
Therefore, to understand the output (results) we are
getting, we must study and understand the process and
inputs that go into producing the output we are getting.
Y = f(Xs)
…data-driven problem solving and continuous
improvement
11
12. 12
Six Sigma DMAIC Projects
Analyze Phase
–What does the process data reveal?
–What are the Critical Key Xs?
–How much variation in “Y” from the Key “Xs”?
–What “Xs” can be and need to be improved
(Root Causes)?
13. 13
Y=f(x)
Measure Phase
15-70 xs
Process Mapping
Pareto
C&E Matrix, Fishbone
FMEA
SIPOC
Capability Study
Measurement Systems
Analysis
Analyze Phase
7-15 xs
Improve Phase
3-7 xs
Control Phase
3 or fewer xs
Control Plans, SOPs,
SPC, Mistake Proofing
Prioritization Matrix, Improvement Ideas,
C&E Matrix, Future State Map, PDSA
Pareto Chart, Correlation/Regression
Hypothesis Tests, ANOVA, Descriptive
Statistics, t-tests, Proportions
Only the Critical Xs need to be
monitored and controlled long term
14. 14
Six Sigma Improve Phase (pg. 14 -16)
The Improve Phase is a systematic approach for
examining the identified key xs, and
determining, testing, and implementing the best
solution(s).
Improve – Introduction
1. What changes can we make that will result in a
sustainable improvement in the process output?
2. How will we know that a change has resulted in
an improvement in the process output?
15. 15
Six Sigma Improve Phase (pg. 14 -16)
• Through process analysis, you will generate
and test robust solutions shown to affect the
proven causes (xs) that affect the critical
output (Y) in a positive manner.
• The result will be an improved process that is
stable, predictable, and one that consistently
meets customer requirements.
Improve – Introduction
17. 17
New and Improved Technology and Training
could be the most robust solution, but always
remember to:
“Reach for the mind before you reach for the wallet”
- borrowed
Improve Phase:
Technology and Training - Right?
Improve – Introduction
18. 18
The Default Solutions…
• Training & education
• New technology
• Working harder or faster
• More inspection or auditing
• New policies
• More people working in a broken process
…Are not always the right solutions!
Improve – Introduction
19. 19
Why People Don’t Do
What They Are Expected To Do
(Robert Mager)
• They don’t know how to do it.
• They don’t know what’s expected of them.
• They don’t have the authority to do it.
• They don’t get timely information about how well
they are doing. (In other words, they don’t get
feedback.)
• Their information sources (documentation) are
poorly designed, inaccessible, or nonexistent.
Improve – Introduction
20. 20
Why People Don’t Do
What They Are Expected To Do (Cont’d)
• They don’t have job aids to cue correct performance.
• Their work stations provide obstacles to desired
performance.
• The organizational structure makes performing difficult.
• They are punished or ignored for doing things right.
Improve – Introduction
21. 21
Why People Don’t Do
What They Are Expected To Do (Cont’d)
• They’re rewarded for doing things wrong.
• Nobody ever notices whether they perform correctly
or not.
Have we addressed each of these previous 11
concerns as to why people don’t do what they are
supposed to do through our Improvement and
Control actions?
Improve – Introduction
22. 22
Data-Driven Problem Solving
To be successful with any Six Sigma project, you have
to affect at least one of the following:
–Reduce Variation
–Shift the Mean
–Eliminate Outliers
23. Characteristic of the Performance Gap… (Problem)
Accuracy and/or Precision
LSL USL USLLSL
Off-Target Variation
On-Target
Center
Process
Reduce
Spread
The statistical approach to
problem solving
USLLSL
LSL = Lower spec limit
USL = Upper spec limit
23
25. Six Sigma Improve
Improving the identified Key Xs to
Improve the Process (Y) and the
Customer’s Experience
25
26. 26
Key Deliverables for Improve
• Main elements of Define, Measure, and
Analyze completed
• “Obvious Xs” identified and confirmed
• Potential Xs identified, data collected and
confirmed (Root Causes)
• Improvement solutions generated and
prioritized upon investigation of root causes
and supported with data
Improve – Review & Key Deliverables
27. 27
Key Deliverables for Improve
• Improvement solutions tested (pilot) and
benefits estimated
• Implementation plan for solution(s) drafted
with input from process owners
• Champion approval of the key solution(s)
implementation
Improve – Review & Key Deliverables
28. 28
Six Sigma Improve Phase
“I know of no more encouraging fact
than the unquestionable ability of
mankind to elevate his life through a
conscience endeavor.”
- Henry David Thoreau
29. 29
Improve Phase Review:
Key Steps
In alignment with our project goal statement, and
given what we have learned in the Define, Measure,
and Analyze Phases of our project, during the
Improve phase our team will complete:
•Generating and prioritizing Solutions (Improvement actions)
•Risk assessment
•Evaluation of Solutions and Benefits
•Approach for Implementation
•Translating and communicating learnings to Champion and
Process Owner(s) as appropriate
Improve – Review & Key Deliverables
30. 30
Improve Phase:
Generate Solutions
• The objective is to generate ideas - come up with ways to
impact our key xs in a way that will lead to an improved,
consistent output. Be creative, find “out-of-the-box”
solutions, invent potential fixes, and find ways to optimize
your process.
• There are many ways of generating ideas. Here are four of
the most common and useful:
– Brainstorming
– Affinity Diagrams (using key xs)
– Process Mapping (current v. future)
– Best practices/benchmarking
Improve – Generate Solutions
31. 31
Improve Phase:
Generate Solutions – Brainstorming
(pg 27-29)
• A question or statement about an identified key x that
negatively impacts Y is written on a board or flip chart for the
entire team to see.
• Creative thinking is used as team members suggest potential
improvements for the stated x. All ideas are recorded without
any judgment initially of their validity. “Out of the box”
thinking is strongly encouraged here, and “spring-boarding”
off of others ideas is powerful.
• Think beyond the “status quo” or self imposed rules from the
culture of the organization.
Improve – Generate Solutions
32. 32
Improve Phase: Generate Solutions
Brainstorming Questions to Consider
• Where is the process step done? Can it be done elsewhere?
• Who performs the step? Can someone else perform the step?
• When is the step performed? Can the timing be changed?
• Under what conditions is the step performed? Can the conditions be
changed?
• What resources are required for the process step? Where else can
resources be found? What else can be used?
• How is the process step controlled? Is it value - adding?
• What does the customer really need? How is the customer using the
process output - product or service?
Improve – Generate Solutions
33. 33
Brainstorming Guidelines
• Clarify the question being considered
• Go around to each member asking for input, but also allow
ideas to be written down - as on a sticky note, etc.
• Do not make any critical comments about initial ideas
submitted by team members - only ask for clarification if
needed
• Strive for a high quantity of ideas to begin with, then move
toward “quality”
Improve – Generate Solutions
34. 34
Improve Phase:
Generate Solutions - Affinity Diagrams
(pg 30-31)
• An Affinity Diagram is used to help a team discover
meaningful groups of ideas or relationships within a
raw list of ideas - as coming potentially from a
brainstorming session.
• Affinity diagrams are helpful when:
– facts or thoughts are uncertain and need to be organized
– preexisting ideas or paradigms need to be overcome
– ideas need to be clarified
– unity within a team needs to be strengthened
Improve – Generate Solutions
35. 35
Improve Phase:
Generate Solutions - Affinity Diagrams
• To create an affinity diagram, the team sorts a brainstormed list,
moving ideas from the raw list into affinity sets, creating groups of
related ideas. This can easily be done by writing on a flipchart, or
using post-it notes to “re-stick” into affinity groups.
• Basic guidelines for affinity diagrams:
– Rapidly group ideas together that seem to belong together
– Clarify any ideas in question
– Initially, it isn’t important to define why they belong together
– Copy an idea into more than one affinity set if appropriate
– Seek to summarize or name each set with appropriate titles and this
may lead to more robust improvement ideas / actions
Improve – Generate Solutions
36. 36
Improve Phase:
Process Mapping (pg. 34-41)
• A process is a sequence of steps or activities using
inputs to produce an output (accomplish a given
task).
• A process map is a visual tool that documents a
process.
• Several styles and varying levels of detail are used in
Process Mapping. Most common and useful styles
are SIPOC, Flow Diagrams, Box Step, and Value
Stream Maps.
Improve – Generate Solutions
37. 37
Improve Phase: Process Mapping
• The team should start with the observed, current, as-
is process.
• Start high-level, and work to the level of detail
necessary for your project (key inputs).
• As inconsistencies are discovered, the team can
develop a future state or should-be process map to
improve the key xs and the overall output (Y) of the
process.
Improve – Generate Solutions
38. 38
Analyze Roadmap:
Process Analysis
Types of Process Delays or Errors:
• Gaps
• Redundancies
• Implicit or unclear requirements
• Bottlenecks
• Hand-offs
• Conflicting objectives
• Common problem areas
39. 39
Improve Phase:
Process Mapping for Process Improvement
True “process improvements” usually DON’T come from:
- working harder using a broken or inefficient process
- education or re-education
- blaming / threatening / coercion / policies
Consider:
- making changes that “make it easy to do it right”
- hardwire in desired defaults
- eliminate process steps that don’t add value
- if you have too much variation or “special cause”,
designing a consistent process should be your first
step to improvement
Langley, et. al. “The Improvement Guide - A practical Approach to Enhancing Organizational Performance”.
Improve – Generate Solutions
40. 40
Improve Phase:
Generate Solutions - Best Practices / Benchmarking
(pg. 254-255)
Benchmarking is measuring your process performance against
other “best in class” similar processes internally and / or
externally as appropriate. Adopt the process steps and
parameters as appropriate to obtain the desired output results
from your own process.
“Best practices are a sustainable competitive advantage. It’s true
that, once a best practice is out there, everybody can imitate it,
but organizations that win do two things: they imitate and
improve it.” - Jack Welch
Improve – Generate Solutions
41. 41
Types of Benchmarks (pg 255)
Pros Cons
Internal/
Company
Establishes a baseline for external
benchmarking
Identifies differences within the company
Provides rapid and easy-to-adapt
improvements
Opportunities for improvement are
limited to the company’s internal best
practices
Direct
Competition
Prioritizes areas of improvement according to
competition
Initial area of interest to most companies
Best used for in-depth studies as supplement
to competitive intelligence studies
Often a limited pool of participants
Opportunities for improvement are
limited to “known” competitive
practices
Potential antitrust issues
Industry Provides industry trend information
Provides management with a conventional
basis for quantitative and process-based
comparison
Opportunities for improvement may
be limited by industry paradigms
Best-In-
Class
Examines multiple industries
Provides the best opportunity for identifying
radically innovative practices and processes
Provides a brand new perspective
Free exchange of information more likely to
occur
Often difficult to identify best-in-class
companies
Sometimes difficult to get best-in-
class companies to participate
42. 42
Improve Phase:
Prioritize Solutions
• Once you have a set of potential solutions, your team
will need to narrow down your list by identifying the
best solutions to test.
• You will need to consider a number of factors:
impact, cost, resources, etc.
– Multivoting
– Prioritization matrix
Improve – Prioritize Solutions
43. 43
Improve Phase:
Prioritize Solutions – Multivoting
(pg 31-32)
• Multivoting narrows a large list of possibilities to a
smaller list of the top priorities or to a final selection.
• Multivoting is preferable to straight up or down
voting because it allows an item that is favored by all,
but not the top choice of any, to rise to the top.
• Usually follows brainstorming or affinity
diagramming to prioritize the main ideas.
Improve – Prioritize Solutions
44. 44
Improve Phase:
Prioritize Solutions - Multivoting
• To conduct the multivoting process, the team works from a
brainstormed list of ideas, options, etc. This can easily be done by
writing on a flipchart, marker board, or using post-it notes. Each
team member will have a marker, or self-adhesive dots to use for
voting. The number of multiple votes each member gets depends
on the size of the list, but it is usually about one third of the total
number of items on the list.
• Basic guidelines for multivoting:
– All team members get an equal number of votes
– A member can distribute their votes or cast all of them for one idea
– If two or three ideas are close in voting, then a multivote can occur
with those two or three ideas listed
Improve – Prioritize Solutions
46. 46
Improve Phase:
Prioritize Solutions - Prioritization Matrix
• A prioritization matrix is used to compare
choices (options, improve approaches, etc.)
relative to criteria such as cost, ease of
implementation, resources, effort, etc.
• This tool forces a team to focus on the best
things to do, not everything they could do,
dramatically increasing the chances for
implementation success.
Improve – Prioritize Solutions
47. 47
Improve Phase:
Prioritize Solutions - Prioritization Matrix
Basic guidelines for a prioritization matrix:
– Virtually any criteria or factor can be used for
ranking the options
– Effort (resources, costs) vs. Impact is a common
matrix format for ranking potential improvement
activities
– A cause and effect matrix is a form of a
prioritization matrix
– All team members should come to consensus on
the ranking of each option
Improve – Prioritize Solutions
48. 48
Sample Prioritization Matrix:
Lean Pharmacy
Improve – Prioritize Solutions
Low Impact Medium Impact High Impact
Low
Complexity
-Omnicell restock
process
-Workstation design:
Repackaging area
-Kanban inventory; Frozen
stock
Medium
Complexity
-Crashcart
design/quantity;
standard work for
restock
-Workstation/room layout;
IV room
-Workstation design; Order
entry area
-Kanban inventory: IV
fluid boxes
-Metrics development
and tracking
High
Complexity
-Delivery cart setup
and delivery process
-Order clarification process
-Workstation design: Med
pick area
-Standard work system; job
guidance sheets: all areas
Impact for Pharmacy
Complexity/AmountofWorkRequired
50. 50
Improve Phase:
Risk Assessment
• Even your solutions may have potential flaws or gaps
at which they could break down.
• You will need multiple participants with different
perspectives in this process to identify the potential
problems and possible modifications to create the
most robust improvement solution with minimized
risk.
• The two techniques for assessing risk that we will
focus on are:
– Force Field Analysis (FFA)
– Failure Mode and Effect Analysis (FMEA)
Improve – Assess Risks
51. 51
Improve Phase
Assess Risks - Force Field Analysis (FFA)
• FFA is a method borrowed from a Mechanical Engineering
technique known as Free-Body Diagramming, and from social
psychology studies in human behavior.
• FFA is used to identify all the forces surrounding and acting on a
body (plan, improvement implementation, etc.)
• The objective is to ascertain the forces leading to an equilibrium
state (determine the resources and costs)
• Generates a chart or table for further analysis or presentation
• With FFA, “EQUILIBRIUM” can be:
– a desired goal
– the status-quo
Improve – Assess Risks
52. 52
FFA - Barriers & Enablers
Driving Forces Restraining Forces
B
A
R
R
I
E
R
S
E
N
A
B
L
E
R
S
Improve – Assess Risks
55. 55
FMEA
(Failure Mode and Effects Analysis)
(pg 270-273)
• A documented methodology for evaluating, prioritizing, and
analyzing risks with the objective of eliminating or minimizing
these risks through a team effort.
• A systematized group of structured activities to:
1. recognize and evaluate the potential failure of a product or process and its
effect,
2. identify actions which could eliminate or reduce the chance of the potential
failure occurring, and
3. document the process.
• An FMEA is very complementary to defining what a product /
process must do to consistently meet the needs of the customer.
Improve – Assess Risks - FMEA
56. 56
Using FMEA in DMAIC
• During MEASURE to:
– Assess the current process failures and risk
– Identify potential Xs to be tested
• During IMPROVE to:
– To evaluate potential risk for improvement ideas
– Prioritize improvements with high risk
– To generate additional improvement ideas
Improve – Assess Risks - FMEA
57. 57
FMEAs Basically Answer:
• What process step or product function could fail?
• What would be the effect of that failure occurring
and how severe would that effect be (severity)?
• What are the potential root causes of the failure and
what is the likelihood or frequency of those root
causes causing the failure (occurrence)?
• What current controls are in place to stop or
immediately detect the potential root causes and
how effective are those controls (detection)?
• What recommended actions should be taken to
minimize or reduce the likelihood of the greatest
risks identified?
Improve – Assess Risks - FMEA
58. 58
FMEAs Risk Prioritization
• A ranking system, usually on a scale of 1 to 10, is
used by the team for each of these categories:
Severity
Occurrence
Detection
• A Risk Priority Number (RPN) is calculated for
each single potential cause and associated failure
mode by multiplying the three ranked values.
These relative ranked values are used to identify
the greatest risks and prioritize actions.
Improve – Assess Risks - FMEA
59. Process
Step/Input Potential Failure Mode Potential Failure Effects
S
E
V Potential Causes
O
C
C Current Controls
D
E
T
R
P
N
Actions
Recommended
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
FMEA Format and Structure
What
is the
Input
What
can go
wrong
with the
Input?
What is
the Effect
on the
Outputs?
How
Bad?
What are
the
Causes?
How
Often?
How are
these
found or
prevented
?
How
well?
What can
be done?
Steps
Improve – Assess Risks - FMEA
59
60. 60
FMEA - Step by Step (pg. 270)
1. For each Process Input, determine ways the Input can go wrong
(Failure Modes)
2. For each Failure Mode associated with Inputs, determine
Effects of Failures on customers
3. Identify potential Cause(s) of each Failure Mode
4. List Current Controls for each Cause or Failure Mode
5. Use standard, or create, Severity, Occurrence, and Detection
rating scales
6. Assign Severity, Occurrence, and Detection ratings to each
Cause
7. Calculate RPNs for each Cause
8. Determine Recommended Actions to reduce high RPNs
9. Complete Recommended Actions and recalculate RPNs
Improve – Assess Risks - FMEA
62. 62
FMEA Hints
• Keep it simple; not complex
• Must involve a team, usually 3 to 6 members, no
“lone ranger” development
• Update it as you move through the process and
knowledge increases
• Make sure the FMEA is an action tool, not just a
document; use the right half of the tool
Improve – Assess Risks - FMEA
63. 63
Improve Phase:
Evaluation of Solutions (Pilot)
(pg 273-276)
• You will want to run trials of your selected
improvement solutions in a real environment.
• A test of all or part of a proposed solution on a small
scale in order to better understand its effects and to
learn how to make the full-scale implementation
more effective.
• It is sometimes called a pilot test, a trial, or a small
test of change
Improve – Test Solutions
64. 64
PDSA: Plan Do Study Act
• The Deming cycle, or PDSA cycle, is an improvement
model consisting of a logical sequence of four
repetitive steps for continuous improvement and
learning. It may also be called the Deming wheel of
continuous improvement.
• Its origin can be traced back to the 1920’s when
Walter Shewart, statistics expert at Bell Laboratories,
introduced the improvement concept of Plan, Do,
and then See.
Improve – PDSA
65. 65
Act Plan
Study Do
Basic PDSA Steps
PLAN
1. Identify the problem and desired outcome
2. Identify the most likely causes/factors
using data
3. Identify potential solutions and the
data needed for evaluation (plan
the details of the change: the who,
what, when, and where)
DO
4. Implement solutions and collect
data needed for evaluation. Make
sure the data collected allows you
to assess progress toward the
desired outcome or target.
STUDY
5. Analyze data and develop conclusions
ACT
6. Recommend further study and/or action
66. 66
Improvement Implementation Plan
A P
S D
Prioritized Solutions and Ideas
Changes that
result in
improvement
Series of small tests
Learn as you go
Data driven test cycles
“Truth is found more often from mistakes
than from confusion.”
- Francis Bacon, 1561 - 1626
67. 67
Appropriate Scope for a Pilot Test
Implement
Large Scale
Test
Small Scale
Test
Cost of
failure
small
Large Scale
Test
Small Scale
Test
Very Small
Scale Test
Cost of
failure
large
High
Confidence
that change
idea will lead to
Improvement
Small Scale
Test
Very Small
Scale Test
Very Small
Scale Test
Cost of
failure
small
Very Small
Scale Test
Very Small
Scale Test
Very Small
Scale Test
Cost of
failure
large
Low
Confidence
that change
idea will lead to
Improvement
ReadyIndifferentResistantCurrent Situation
Readiness for Change
Provost, Lloyd. CHAI Fall Conference. Nashville, TN. Sep 2004
Improve – Test Solutions
68. 68
Improve Phase:
Benefits Estimation
How much positive change in “Y” will occur as a result
of this improvement, and how much is this positive
change worth to our organization?
― Unit cost
― Total Resource
― Benchmark (Gold standard)
― Process Flow
Improve – Benefits Estimation
69. 69
Improve Phase: Benefits Estimation
• Unit cost
– Cost of each defect x number of occurrences
• Total Resource
– Total resources used to do an activity
– % of time on non-value add activity = total opportunity
• Benchmark (Gold standard)
– Compare our performance to a gold standard; what is the
quantifiable gap
• Process Flow
– From our process map, what are the NVA steps/activities
– Design new process to eliminate NVA steps
Improve – Benefits Estimation
70. 70
Improve Phase:
Approach for Implementation of Improvements
• Clearly identify who the process owner is and all associates
involved in the process
• Identify all documentation related to the process being improved
and determine what modifications / updates need to be made
(Policies, Procedures, Work Instructions, etc.)
• Develop a communication plan
– Who will be impacted by the change?
– Communicate before the change goes into effect
• Create a simple responsibility matrix to identify who will be doing
what when, and ensure Champion is in agreement
• Monitor and Adjust if needed as the improvement is incorporated
into the process
Improve – Implementation Approach and Plan
71. 71
Improve Phase:
Translating and Communicating Learnings for
Champion Approval
• For all significant improvement changes, the project’s
Executive Champion must be informed and must formally
approve the implementation.
• Before discussing improvement implementation with your
champion, you must have “done your homework” and
have data to support your plan including risk assessment,
pilot testing results, resources needed, and potential
benefits.
Improve – Champion Approval
73. 73
Resource Guide to Change Concepts
The Improvement Guide (pg. 293-299)
• Consider potential consequences of applying change concepts
• The concepts are guidelines and general in nature
• Every change concept does not apply to every problem
• What change can we make that will result in improvement?
• “While all changes do not lead to improvement, all
improvement requires change.”
Improve – Change Concepts
74. 74
Value Added vs. Non-Value Added
• Value Adding Process
– A process step that transforms or shapes a product
or service towards that which is sold to a
customer. Changes “form, fit, or function” in a
way that customers are willing to pay for
• Non-Value Adding Process
– Those process steps that take time, resources, or
space, but do not add to the value of the product
or service itself (These activities should be
eliminated, simplified, reduced or integrated)
Improve – Eliminate Waste
76. 76
Why Lean Tools?
• Six Sigma and Lean are very complimentary
approaches to improvement
• Often creates rapid improvement and elimination of the
eight wastes
• Creates a stable process which can be further
improved
• When deployed correctly, embeds a rapid continuous
improvement mindset in the culture
• Drives shorter lead-times, reduced inventory, lowers
costs
Improve – Eliminate Waste
77. 77
Does a distance of 45 feet Matter?
Example: LeBonheur Lab Renovation Initial Design -
Tube System Location
45 feet each way = 90 feet walked per specimen
250,000 core lab specimens per year
= 22,500,000 feet per year walked
= 4,260 miles per year walked (the distance from New York to Rome)
At two miles per hour, = 2130 hours per year
= 1.02 FTEs per year moving the sample from tube station to
receiving area
Improve – Improve Work Flow
78. Red = Zone 1 Operator
Blue = Processor
Move Steps in the Process
Closer Together & Synchronize
After
78
79. 79
Do Tasks in Parallel /
Eliminate Batching
Smaller centrifuge
allows for
individual
single piece
testing, instead of
waiting for a large
centrifuge to fill
with specimens
before
spinning (batch)
Improve – Improve Work Flow
80. 80
Take Care of Basics: 5S
1) Sort
Clear out rarely used
items by red tagging
4) Standardize
Create rules to sustain
the first 3S’s
2) Straighten
Organize and label a
place for everything
3) Shine
Clean it
5) Sustain
Use regular
management audits to
stay disciplined
Improve – Change Work Environment
83. Sustain
5S within OR Rooms OR #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8
Stock Turnover: Are bins being completely emptied prior to
refill to ensure turn-over of stock? (Yes or No)
Restock Carts: Are empty bins being placed into the restock
carts as they are emptied?
Stock Amounts: Are bins being properly filled and not
overstocked?
Visual Control: If the associates are too busy to restock are
they placing the restock carts in the hallway (with empty bins)
Visual Control: Are all necessary items labeled for proper
location and shadowed appropriately?
Sort, Shine, Stabilize: Are rooms clean and organized? All
items in the proper place, excess items removed, etc?
Standardization: Are items in the rooms properly placed into
their designated locations?
OR Storeroom:
Kanban Cards: Are Kanban cards properly located according
to minimum stock amount listed on card? (Verify
5 cards on 5 separate carts, list SAP# checked)
Inventory: Are supplies properly organized so longer
outdates and last used? Longer outdates on
right/bottom/back and shorter outdates on left/top/front?
(Verify 5 cards on 5 separate carts, list SAP# checked)
Process: Are Kanban card properly located in the "To Be
Ordered" location when appropriate and moved to "Ordered"
when order is placed?
Orderliness: Is the storeroom clean and organized, items
removed from walkways? All carts properly located?
Timeliness: Are supplies being ordered in a timely manner so
that out-of stock does not occur?
(Look for empty supply locations)
CSR: Are CSR stocked items (red stripe on Kanban cards)
properly filled and organized?
Other:
Hallway: Are items in hallways properly labeled and
shadowed for position and all items accounted for? Are
hallways free of debris, etc?
Scrubs: Are Kanban cards properly located and is process
being followed? (Empty bins cards at front desk, Full 2nd bin
has card located on it)
Small Equipment Room: Are equipment and supplies
properly located, organized, labeled and shadowed within this
area?
Auditor: Date:
Standardized Process Audit - Supply Management
Additional Comments or Suggestions:
83
84. # Work Elements / Important Steps Est. Time Reasons for Key Points
1
Clinician will send patient back to triage, if lobby
is backed up call patient back to triage
42
Using FIFO helps patient
satisfaction and does not use the
ED as a fast track system
2 Get patient weight prior to entering triage room. 60 weight is critical for the providers
3
Obtain brief chief complaint while getting vital
signs
120
Saves cycle time when done
together
4 Put complaint and vital signs in computer 167
necessary information for the
provider
5 Complete full triage in computer 60 key for provider to have upfront
6 Determine ACUITY level of patient. 26
Diagnosis, not acuity level drives
the LCT
7
Escort patient to lobby if LCT exam rooms are
full
5
8
9
10
11 Total Estimated Time 480
We are using a FIFO (first-in-first-out) system,
unless high acuity dictates differently
Document wt on Registration form
Do vitals and chief complaint in parrallel
Document vital signs on registration form, do not
write down the patients information, enter it directly
into the computer
Past medical history and home medications
Although assigning acuity level we are assigning
patients to the LCT by diagnosis, (refer to
diagnosis sheet for lean track patients
WORK STANDARD & JOB
BREAKDOWN SHEET
Job Function: Triage Nurse
Key Points Sketch/Drawing/Picture
Sheet No. 1 Of 1
Area: Front of ED
Operation Name: Triage
Date: 9-18-07
Prepared By BeLinda Conti
Approved By
Update Name
Dept. Emergency Department
Triage1&2 Greeter&Clinician
Standard Work
84
85. Ten Types of Human Errors
(and how to protect against them)
1. Forgetfulness - Protection: alerting operators in advance, regular
checking, automated reminders
2. Misunderstanding - Protection: std work, training, checking in advance
3. Identification – Protection: training, attentiveness, vigilance
4. Lack of experience – Protection: Skill building, work standardization
5. Ignoring rules – Protection: Basic education, experience, audits,
discipline
6. Inadvertent – Protection: Attentiveness, discipline, std work
7. Slowness, delays in judgment – Protection: Skill building, std work
8. No standards – Protection: work instructions, std work
9. Surprise – Protection: Preventative maintenance, std work
10.Intentional – Protection: Education, discipline
85
86. Defect Sources
• Omitted processing
• Processing errors
• Setting up work pieces
• Missing parts
• Wrong parts
• Processing wrong work piece
• Misoperation
• Adjustment error
• Improper setup
• Tools, fixtures, jigs improperly prepared
Improve – Design Systems to Avoid Mistakes
86
88. 88
Improvement from the Start
• DFSS (Design for Six Sigma) builds a process that is
designed to operate at a Six Sigma level of
performance from the very launch of the new
process. It focuses on the customer (needs), reviews
current related processes, and benchmarks internally
and externally
Design for Six Sigma
89. 89
Design for Six Sigma
• DMAIC is structured to improve an existing
process - reduce variation, eliminate defects.
• Design for Six Sigma (DFSS) uses DMADV (Define
Measure, Analyze, Design, Validate); or IDOV
(Identify, Design, Optimize, Verify) to create a
new process that produces minimal defects from
the start
• We usually focus on DMAIC
Design for Six Sigma
90. 90
Design for Six Sigma
• The intent of DFSS is to bring a new product or
service to “market” with a process performance
near a six sigma level for each key customer
requirement of the product / service.
• DFSS is essentially an attitude and approach toward
new or re-designed products and services, and not
a methodology. The DFSS concept utilizes
methodologies such as DMADV or IDOV.
Design for Six Sigma
91. 91
Design for Six Sigma
• DMADV and IDOV are very similar and basically
provide a structured roadmap to create a new
product or design a new process that has minimal
variation and defects
• The key initial focus areas of DFSS include
collecting, analyzing, and clearly understanding the
VOC and CTQs - “What would a Six Sigma level
performing product or process need to look like, or
consistently produce?”
Design for Six Sigma
92. 92
Design for Six Sigma - IDOV
• Identify - Quantified customer information along
with technical requirements, specifications, and
performance targets are identified and
documented.
• Design - The CTQs are emphasized, and all key
inputs considered as conceptual designs are
evaluated to create a new process that produces
minimal defects
Design for Six Sigma
93. 93
Design for Six Sigma - IDOV
• Optimize - The capability of the new process to
meet all critical requirements is evaluated, and
the design is optimized through simulation,
small scale tests, benchmarked data, etc.
• Verify - The optimized process design is formally
tested and validated to consistently meet critical
requirements. Longer term monitoring and
feedback may be necessary.
Design for Six Sigma
94. 94
Design for Six Sigma - DMADV
• Define - Define the project goals and customer
deliverables
• Measure - Determine customer needs and
specifications
• Analyze - Study process options to meet the customer’s
needs
• Design - Develop process details to meet the critical
requirements
• Validate - Verify the design performance and ability to
consistently meet customer’s needs
Design for Six Sigma
95. 95
Design for Six Sigma
Common Tools
• SIPOC (VOC and CTQ emphasized)
• Detailed Process Maps
• QFD - Quality Function Deployment
• FMEA
• Simulation and Small Scale Testing
• Poka-Yoke (Mistake Proofing)
Design for Six Sigma
96. 96
IDOV DMADV Deliverable Tool
Identify Define Intiate, scope, and plan
the project
Charter
Benchmarking
FMEA on current process
Measure Understand customer
needs and specify CTQs
VOC
Quantify specifications, technical requirements
Define key inputs
High-level map of current process or SIPOC
Analyze Develop design concepts
and high-level design
High-level design of new process
Quality Function Deployment (QFD)
Process Capability analysis
Optimize Design Develop detailed design
and control/test plan
Detailed process map
Simulation
FMEA
Poka-yoke
FFA
Verify Verify Test, design, and
implement full-scale
processes
Control plan and feedback loop
Data collection and analysis
SPC
Capability Analysis
Standard Operating Procedures
Design
IDOV and DMADV
98. Design of Experiment
• DOE identifies how factors (Xs) alone and in
combination affect a process and its outputs
(Ys).
• DOE is a systematic approach
• Provides a mathematical model
• Identifies the best combinations of Xs
98
99. Why is DOE needed?
• A man decided to investigate the causes of intoxication.
• On his first trial, he drank whiskey and water and became
intoxicated.
• On his second trial, he held all variables constant except one…
he replaced the whiskey with vodka… and became intoxicated
• On the third trial, he used bourbon instead of whiskey and
vodka… and became intoxicated.
• After recovering, he concluded that water causes intoxication,
because it was the only constant variable!
99
100. 100
Designed Experiments or
Design of Experiments (DOE)
pg 184 - 194
• DOE is a structured approach to improve an
existing process by testing multiple factors at a
time thus reducing the number of experimental
runs and time needed for testing
• The most important factors affecting a given
output of a process, and the controlled tested
factor’s best settings are identified.
Six Sigma DOE
101. 101
Alternatives
• One Factor at a Time (OFAT) – A given factor tested at
multiple levels while holding everything else constant.
This approach may work OK in a high school chemistry lab,
but it can be very time consuming and inefficient when
applied to a complex process in a “working” environment.
• Many Things at Once – it becomes difficult to determine
which changes contributed to the effects and to what
degree, might keep doing something that is harmful to
results, impossible to assess cost/benefit for each change
Six Sigma DOE
102. 102
Alternatives
• Not every project has to include a designed
experiment. Many will use pilots of controlled
small tests of change or work-out sessions to
achieve improvements… but considering DOE as
appropriate doesn’t hurt, either!
Six Sigma DOE
103. 103
Designed Experiments or
Design of Experiments (DOE)
• Results from DOEs identify main effects from the
tested controlled factors as to the extent the factors
influence chosen response variables.
• The factors would be considered the inputs, and the
response variables would be the outputs.
• Results from DOEs also look at how the interactions of
the factors influence the response variables.
Six Sigma DOE
104. One Factor at a Time
Gas Type Timing Set up MPG
G1 T1 30
G2 T1 20
Which gas type and engine timing setting will
produce the best gas mileage?
Since G1 produced the best mileage, test it against
both timing settings…
Gas Type Timing Set up MPG
G1 T1 30
G1 T2 25
Best Value!
But… what did we miss?
104
105. DOE shows the effects of interactions
Gas Type Timing Set up MPG
G1 T1 30
G1 T2 25
G2 T1 20
G2 T2 45
20
50
40
30
T2T1
G1
G2
This interaction
was missed using
one factor at a
time!
105
106. Terminology
• Factors – the variables you are testing
• Levels – the settings you are checking for each
factor
• Factorial – describes the basic design
– 2 x 3 x 3 design describes 3 factors– one at 2 levels
and two at 3 levels… 18 trials or “runs” in all
– 2k describes an experiment with k factors, each at
2 levels. A 23 design means 3 factors with 2 levels
each, or 8 runs in all
106
107. Terminology
• Main Effects – the differences between each
factor level
• Interactions – differences between two or
more factor level combinations
107
108. Main Effects and Interactions Plots
20
50
40
30
T2T1
20
50
40
30
T2T1
25
30
T2T1
G1
G2
G2
G1
Main Effects Interactions
108
109. Terminology
• Run – Each trial with a combination of factors
yielding a result
• Replicates – The number of times you repeat
the full set of runs
• Full Factorial – A design that tests each factor
at every level
• Fractional Factorial – A design that tests only
selected combinations of factors
109
110. Set up a 22 Full Factorial Experiment
• Stat>DOE>Factorial>Create Factorial Design
Select the number of
replicates
110
111. Set up a 22 Full Factorial Experiment
• Stat>DOE>Factorial>Create Factorial Design
Name the factor
Select the data type
Set the levels
111
112. Set up a 22 Full Factorial Experiment
Full Factorial Design
Factors: 2 Base Design: 2, 4
Runs: 8 Replicates: 2
Blocks: 1 Center pts (total): 0
All terms are free from aliasing.
Add column for results.
Run the experiment and
record responses.
Standard sequence
Randomized “run” sequence
112
115. Analyze Factorial Design
Factorial Fit: Mileage versus Gas, Timing
Estimated Effects and Coefficients for Mileage (coded units)
Term Effect Coef SE Coef T P
Constant 29.500 0.7289 40.47 0.000
Gas 4.000 2.000 0.7289 2.74 0.052
Timing 7.500 3.750 0.7289 5.14 0.007
Gas*Timing 14.500 7.250 0.7289 9.95 0.001
S = 2.06155 PRESS = 68
R-Sq = 97.08% R-Sq(pred) = 88.32% R-Sq(adj) = 94.89%
Analysis of Variance for Mileage (coded units)
Source DF Seq SS Adj SS Adj MS F P
Main Effects 2 144.500 144.500 72.250 17.00 0.011
Gas 1 32.000 32.000 32.000 7.53 0.052
Timing 1 112.500 112.500 112.500 26.47 0.007
2-Way Interactions 1 420.500 420.500 420.500 98.94 0.001
Gas*Timing 1 420.500 420.500 420.500 98.94 0.001
Residual Error 4 17.000 17.000 4.250
Pure Error 4 17.000 17.000 4.250
Total 7 582.000
Estimated Coefficients for Mileage using data in uncoded units
Term Coef
Constant 29.5000
Gas 2.00000
Timing 3.75000
Gas*Timing 7.25000
Timing settings and the combination of timing
settings and gas type are statistically
significant
The factors we tested account for 95% of the
variation in the result
115
117. Analyze Factorial Design
Residual Plots
• Normality plot is tight
• Versus Fits is evenly
distributed about 0
• Histogram looks non-
normal, but not enormously
skewed
• Versus order doesn’t
matter since sequence
wasn’t important in the
experiment
117
118. Main Effects and Interactions Plots
• Stat>DOE>Factorial>Factorial Plots
118
121. Set up a 2 x 2 x 3 Full Factorial
Designed Experiment
Factors
• Rubber Band Tension
– Level 1 setting: 1
– Level 2 setting: 4
• Pull-Back Angle
– Level 1 setting: 160o
– Level 2 setting: 180o
• Stop Angle
– Level 1 setting: 1
– Level 2 setting: 3
– Level 3 setting: 6
121
122. Set up a 2 x 2 x 3 Full Factorial
Designed Experiment
Results
• Distance – measured from front edge of
statapult to impact point
• Skew – measured from right edges of foil to
impact point (a measure of how far off-center
the ball landed)
122
123. Set up a 2 x 2 x 3 Full Factorial
Designed Experiment
• Stat>DOE>Factorial>Create Factorial Design
123
124. Analyze a 2 x 2 x 3 Full Factorial
Designed Experiment
• Stat>DOE>Factorial>Analyze Factorial Design
General Linear Model: Distance versus Rubber Band, Stop Angle, ...
Factor Type Levels Values
Rubber Band fixed 2 1, 4
Stop Angle fixed 3 1, 3, 6
Pull Back Angle fixed 2 160, 180
Analysis of Variance for Distance, using Adjusted SS for Tests
Source DF Seq SS Adj SS Adj MS F P
Rubber Band 1 33063 33063 33063 493.79 0.000
Stop Angle 2 43258 43258 21629 323.02 0.000
Pull Back Angle 1 30392 30392 30392 453.90 0.000
Rubber Band*Stop Angle 2 3295 3295 1648 24.61 0.000
Rubber Band*Pull Back Angle 1 3173 3173 3173 47.39 0.000
Stop Angle*Pull Back Angle 2 919 919 460 6.87 0.004
Rubber Band*Stop Angle* 2 155 155 78 1.16 0.331
Pull Back Angle
Error 24 1607 1607 67
Total 35 115863
S = 8.18281 R-Sq = 98.61% R-Sq(adj) = 97.98%
124
125. Analyze a 2 x 2 x 3 Full Factorial
Designed Experiment
• Stat>DOE>Factorial>Analyze Factorial Design
125
126. Analyze a 2 x 2 x 3 Full Factorial
Designed Experiment
• Stat>DOE>Factorial>Effects Plots
Notice the curved
effect on Stop Angle
Results
scale
Interaction Effects Plots can be
difficult to read, so pay close
attention to what they are
telling you! 126
127. Results
• Practically, the DOE has given us some
information about the optimal settings to
maximize the distance of the ping-pong ball
– Stop Angle at 6
– Rubber Band tension at 1
– Pull back to 180o (less significant factor)
127
128. Summary
• DOE can provide you with vital information
about your critical Xs and their interactions
• DOE takes time and thought to set up and
time and discipline to conduct
• DOE results also take time and thought to
understand, interpret, and apply
• DOE improves your process by getting the
factors set at the optimum levels
128
130. 130
Key Deliverables for Improve
• Main elements of Define, Measure, and
Analyze completed
• “Obvious Xs” identified and confirmed
• Potential Xs identified, data collected and
confirmed (Root Causes)
• Improvement solutions generated and
prioritized upon investigation of root causes
and supported with data
Improve – Review & Key Deliverables
131. 131
Key Deliverables for Improve
• Improvement solutions tested (pilot) and
benefits estimated
• Implementation plan for solution(s) drafted
with input from process owners
• Champion approval of the key solution(s)
implementation
Improve – Review & Key Deliverables
132. 132
Improve Phase Review:
Key Steps
In alignment with our project goal statement, and
given what we have learned in the Define, Measure,
and Analyze Phases of our project, during the
Improve phase our team will complete:
•Generating and prioritizing Solutions (Improvement actions)
•Risk assessment
•Evaluation of Solutions and Benefits
•Approach for Implementation
•Translating and communicating learnings to Champion and
Process Owner(s) as appropriate
We will define and implement GREAT improvement solutions!
Improve – Review & Key Deliverables
133. 133
Start Date: Enter Date
End Date: Enter Date
Benchmark Analysis
Project Charter
Formal Champion
Approval of Charter
(signed)
SIPOC - High Level
Process Map
Customer CTQs
Initial Team meeting
(kickoff)
Start Date: Enter Date
End Date: Enter Date
Identify Project Y(s)
Identify Possible Xs
(possible cause and
effect relationships)
Develop & Execute
Data Collection Plan
Measurement
System Analysis
Establish Baseline
Performance
Start Date: Enter Date
End Date: Enter Date
Identify Vital Few
Root Causes of
Variation Sources &
Improvement
Opportunities
Define Performance
Objective(s) for Key
Xs
Quantify potential $
Benefit
Start Date: Enter Date
End Date: Enter Date
Generate Solutions
Prioritize Solutions
Assess Risks
Test Solutions
Cost Benefit
Analysis
Develop &
Implement
Execution Plan
Formal Champion
Approval
Start Date: Enter Date
End Date: Enter Date
Implement
Sustainable Process
Controls – Validate:
Control System
Monitoring Plan
Response Plan
System Integration
Plan
$ Benefits Validated
Formal Champion
Approval and Report
Out
Author: Enter Name
Date: June 5, 2013
Project Name:
Problem Statement:
Mislabeled example
Project Scope:
Enter scope description
Champion: Name
Process Owner: Name
Black Belt: Name
Green Belts:
Names
Customer(s):
CTQ(s):
Defect(s):
Beginning DPMO:
Target DPMO:
Estimated Benefits:
Actual Benefits:
Not Complete
Complete
Not Applicable
MeasureDefine
Directions:
•Replace All Of The Italicized, Black Text With Your Project’s Information
•Change the blank box into a check mark by clicking on Format>Bullets and
•Numbering and changing the bullet.
Analyze Improve Control
