An overview about Lean Six Sigma in Healthcare by Dr.Parag Rindani

1. LEAN SIX SIGMA – AN OVERVIEW
Dr. Parag R Rindani MD MBA
Head Medical Strategy & Clinical Excellence
Wockhardt Hospitals Ltd

2. Quality in Healthcare

3. Safety
Appropriateness
Access
Consumer centeredness
Effectiveness
Efficiency

4. Strategy
“Would you tell me, please, – asked Alice, Which
way I ought to Walk from here?”
That depends a good deal on where you want to
get to,” said the Cat.
“I don’t much care where…” said Alice
“Then it doesn’t matter which way you walk,” said
the Cat.
- From 'Alice in Wonderland’ - Lewis Carroll

5. • Better management through reduction in turn
around time – OPD waiting times, discharge
times, ambulance dispatch times
• Increase in clinical efficiency – Emergency room
assessment and triage, standardization of
protocols for stroke, myocardial infarction,
trauma
• Decrease in negative outcomes – infections, falls,
injuries

6. What is a Process??

7.  Any sequence of activities that use a set of
INPUTS to produce an OUTPUT is called a
PROCESS
 A Process is a means for doing work
 Every Process has a CUSTOMER. A Customer is
the immediate recipient of the Output from the
Process
7

8. Supplier: The provider of inputs to your process
Input: Materials, resources or data required to
execute your process
Process: A collection of activities that takes one or
more kinds of input and creates output
that is of value to the customer
Output: The products or services that result from
the process
Customer: The recipient of the process output – may
be internal or external
8

9. Process
Outputs
Input
Variables
Process Variables
9

10. What can go wrong??

11.  A Process may not produce the desired output leading to
CUSTOMER DISSATISFACTION.
 The output from a process may have defects or errors in
it and this leads to REWORK or REJECTION. This leads to
the generation of WASTE.
 The produced output may be unpredictable in its ability
to meet customer requirements and this is caused due
to high VARIATION in a Process.
 The process may be unstable and this leads to
generation of WASTE in the process itself
11

12. The key deficiencies of any Process include:
 VARIATION
 WASTE
12

13. How to prevent variation and waste??

14.  Identify Chronic Problems (diseases) in the Process
 Ensure that adequate Measurement Systems have been
defined to accurately measure the damage i.e. Rework,
Rejections, Variation, etc caused by these problems
 Use structured Problem Solving Methodologies to
permanently eliminate or minimize the Waste and
Variation
 Improve the Capability of the Process to meet customer
requirements Consistently at Optimized Costs
14

15.  Process Deficiencies are solved by a Project by Project approach.
 Each Project needs to address a specific PAIN (deficiency) in the
process
 Each Project is a structured approach to Problem Solving involving
the five steps;
 Defining the Problem
 Measuring the Problem
 Analyzing the Root Causes
 Implementing the Improvements
 Sustaining the gains
15

16.  Each Project needs to have a specific GOAL for
improvement in terms of either eliminating or minimizing
the deficiency.
 Each Project needs to be conducted by a
CROSSFUNCTIONAL TEAM consisting of members from
the functions most affected by the pain.
 Each Project needs to be TIMEBOUND
16

17.  Each Project must have a goal to generate
savings as ELIMINATING OR MINIMIZING
DEFICIENCIES will always REDUCE COSTS. This
reduction in costs translates to SAVINGS TO THE
BOTTOMLINE
17

18. What is Six Sigma??

19. “The real problem at Motorola is that our quality stinks”
……1979, Art Sundry
“A product found defective and corrected during
manufacturing had high probability of failing during
early use by customer”
……1985, Bill Smith
19

20. What does Quality Mean…….
 Detecting and correcting mistakes in the product such
that it meets compliance standards.
OR
 Preventing defects in the first place through process
controls and product design such that it meets
performance standards.
20

21. Motorola believed….
“Highest Quality Producer was the Lowest Cost
Producer”
In 1987, a new approach to quality came out of
Motorola’s Communication Sector –
6
Six Sigma
21

22. Sigma Level PPM/DPMO 3 - Historical Standard
93.32% yield
1 691,462 10 Times
Improvement
2 308,538
4 - Current Standard
3 66,807 99.38% yield
4 6,210 1800 Times
Improvement
5 233
6 – New Standard
6 3.4 99.99966% yield
22

23. 99% GOOD (3)
(3 99.99966% GOOD (6)
(6
20,000 LOST ARTICLES OF MAIL SEVEN LOST ARTICLES OF MAIL
PER HR. PER HR.
UNSAFE DRINKING WATER 15 UNSAFE DRINKING WATER FOR
MIN. PER DAY ONE MINUTE EVERY SEVEN
MONTHS
5,000 INCORRECT SURGICAL 1.7 INCORRECT SURGICAL
OPERATIONS PER WEEK OPERATIONS PER WEEK
23

24. 99% GOOD (3)
(3 99.99966% GOOD (6)
(6
2 SHORT OR LONG LANDINGS AT ONE SHORT OR LONG LANDING
MOST MAJOR AIRPORTS EACH EVERY FIVE YEARS
DAY
200,000 WRONG DRUG 68 WRONG DRUG
PRESCRIPTIONS EACH YEAR PRESCRIPTIONS EACH YEAR
NO ELECTRICITY FOR ALMOST 7 NO ELECTRICITY FOR ONE
HOURS PER MONTH HOUR EVERY 34 YEARS
24

25. What is Sigma?
• Sigma is used in statistics to denote standard
deviation.
• A sigma value is used to relate the ability of a process
to perform defect free work.
• The higher the sigma value the better the process is
performing and the lower the probability that a defect
will occur.
25

26. Standard Deviation:
Metric that displays variation from it’s “target”.
1 Std. Dev.
(“Sigma”)
One standard deviation around the mean is about 68% of the total
“opportunities” for meeting customer requirements!
26

27. If we can squeeze six standard deviations in between
our target and the customer’s requirements...
6 5 4 3 2 1 1 2 3 4 5 6
…….99.99966% of “opportunities” to meet customer requirements
are included!
27

28. What is Lean??

29. "Lean", is a practice that considers the expenditure
of resources for any goal other than the creation of
value for the end customer to be wasteful, and thus
a target for elimination.
Working from the perspective of the customer who
consumes a product or service, "value" is defined as
any action or process that a customer would be
willing to pay for
29

30. Lean is a generic process management philosophy derived
mostly from the Toyota Production System (TPS)
Lean is renowned for its focus on reduction of the seven
wastes in order to improve overall customer value.
“All we’re trying to do is shorten the time line…. from
order receipt to collecting cash for the goods or services
provided.” …….1975, Taiichi Ohno
30

31. SEVEN
CLASSICAL
WASTES
31

32. 1. Waste of over production
2. Waste of inventory
3. Waste of correction (rework)
4. Waste of motion
5. Waste of over processing
6. Waste of transportation
7. Waste of waiting
32

33. Overproduction
This is the waste of producing too much at a particular
point in time. This waste is generally characterized by:
 Producing more than is needed by the next
process or customer
 Producing earlier than is needed by the next
process or customer
 Producing faster than is needed by the next
process or customer
33

34. Inventory
• This is the waste of having excess inventory at all
stages of the service delivery process.
• Inventory is considered waste as it does not add
value and only increases the cost of service delivery.
• High inventory only means high costs of storage,
handing, preservation and movement.
• Economic Order Quantity – Healthcare !!
34

35. Correction (Repair/Reject)
• Repair This is the waste of reworking on a process
output that should have been delivered right the first
time and added value to the customer.
• Any repair or rework reduces the value of the
output and also increases the cost of delivery.
• Reject This is the waste of scrapping the output of a
process.
• Rejections nullify the purpose of the value creation
process and double the cost of service delivery
35

36. Motion
• This is the waste of excessive motion of the human
body such as lifting heavy loads, bending awkwardly,
repeatedly climbing staircases, stretching too far, etc.
• Such work environments create plenty of safety
hazards and may lead to injuries and lost time or
resources.
• This leads to increase in time and cost of service
delivery.
36

37. Over Processing
• This is the waste of unnecessary inspection in a
process.
• Over processing loads a process with additional steps
that do not add any value to the process output, but
are included because the team has low confidence in
the capability of the process.
• Over processing only helps to slow the process speed
and increase cost.
37

38. Transport
• This is the waste of transportation of materials /
people from one part of the process to another.
• This leads to long cycle times and also increases the
cost of service delivery.
• The waste of transportation promotes the practice of
working in batch mode.
38

39. Waiting
• This is the waste of equipment and people in one
step of the process remaining idle as the previous
step of the process is far too slow in servicing the
next step.
• This leads to low utilization of resources and in turn
increases time and cost of service delivery.
39

40. Why Lean Six Sigma??

41. • The primary focus of Lean has been on maximizing
process velocity and eliminating waste so as to deliver
products and services to customers at the lowest cost
with maximum speed. That is why Lean has been the
primary weapon in the War on Waste.
• Lean Principles help to bring agility in a process by using
a combination of highly effective process speed tools
within a structured framework.
41

42. • The primary focus of Six Sigma has been on reducing
defects and variation in a process so as to deliver near
perfect products and services to customers at lowest
possible cost. That is why Six Sigma has been the primary
weapon in the War on Variation.
• Six Sigma helps to bring stability and consistency in a
process by using a combination of highly effective process
quality tools within a structured framework.
42

43. • Why Lean Six Sigma ? - Because Lean provides the agility and
repeatability in many basic processes. Once repeatability has
taken hold, much of the variation due to human intervention
goes away. The data collected to support Six Sigma activities
thereby becomes much more reliable and accurate.
• Lean Six Sigma’s ability to achieve NEAR PERFECT PRODUCTS
AND SERVICES AT AN ACCELERATED SPEED offers an
organization a powerful tool to achieve their strategic goals with
faster pace.
43

44. Quality is a state in which
value entitlement is realized
by the customer and provider
in every aspect of the
business relationship.
44

45. SIX SIGMA
LEAN
Improvement
Improvement
Improvement
Time Time
LEAN
SIX SIGMA
Time
45

46. • Reduce Variation
• Reduce Waste Focus
• Reduce Defects of
• Delighting Customer Lean Six
• Reduce Cost Sigma
• Reduce Delivery Time
46

47. 1. Genuine Focus on Customer
Six Themes
2. Data and Fact-Driven Management
of
3. Processes are where the Action Is
Lean Six
4. Proactive Management
Sigma
5. Boundary Less Collaboration
6. Drive for Perfection; Tolerate Failure
47

48. Pitfalls in Deployment
• Projects drift away from strategic management priorities
• Scoping projects very broadly - too long, loss of focus
• Undertaking too many projects at the same time
• Inadequate tracking of results
• Little or no sharing of Best Practices
• Forgetting people not directly involved in deployment
48

49. Summary
• Lean Six Sigma reduces waste and variation in a
product / service by improving the process that
delivers the product / service.
• Lean Six Sigma is equally effective on manufacturing
and service processes.
• Effective Lean Six Sigma implementation requires the
allocation of correct resources.
49

50. Summary
• Direct involvement of Top Management is essential.
Lean Six Sigma cannot be delegated.
• Lean Six Sigma is not completely new. It uses the same
tools in a structured manner through the various
phases of problem solving.
50

51. In 2010, Quality Council of India (QCI) conceptualized a National Demonstration Who Should Attend
Project (NDP) on Lean Six Sigma (LSS) in Healthcare. The project was executed by  Hospital management representatives
Qimpro with great success.  Hospital administrators
 Healthcare professionals
Over 50 healthcare professionals and hospital administrators were trained on LSS.  Healthcare management students
 Hospital quality managers
Thereafter they used the LSS methodology to successfully complete improvement
 Everybody from healthcare
projects that resulted in significant change in the efficiency of hospital processes who believe in “change”
and patient experience. This success is proof of confirmation that LSS is equally
effective in improving hospital processes. Course Faculty
Quality in healthcare is a deep concern amongst patients and society at large. The
QCI, recognizing this issue, have underlined the criticality of Continuous Quality
Improvement as a key factor for NABH Accreditation. In this scenario it has
become essential for healthcare professionals and hospital administrators to have
Lean Six Sigma Green Belt (LSSGB) credentials. Dr Parag Rindani Anirudha Chakravarty
Head - Medical Director
Strategy Qimpro Healthcare
& Clinical Excellence Six Sigma Master Black
Wockhardt Hospitals Belt
Contact: Vidhya Unni, Qimpro Consultants Tel: (91-22) 6634 8701 |
Email: healthcare@qimpro.com