WHITE BELT TRAINING JANELLE SEENATH UPDATED 2/6/18 1 OBJECTIVES - - PowerPoint PPT Presentation

INTRODUCTION TO PROCESS IMPROVEMENT AND LEAN SIX SIGMA WHITE BELT TRAINING

JANELLE SEENATH UPDATED 2/6/18

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OBJECTIVES

• 1. What is Process Improvement
• 2. Understand Common Improvement Methodologies
• 3. What is Lean and Why Lean
• 4. What is a Lean Project
• 5. Who is doing Lean
• 6. Common lean terms: muda, gemba, kaizen, yokoten
• 7. 8 Basic Improvement Tools
• 8. Understand the roles and responsibilities of the

members on a project team

• 9. Know how to select a project and identify your project

stakeholders 10.Understand the importance of teaming

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12 BREAKTH KTHROUGH OUGH PRIORITIE ORITIES

Increase rease Access ess to He Health h Care re Veteran facing VA internal facing Imp mplem emen ent t Care re in the Commu muni nity ty Deliv iver er a Un Unifie ied d Vet eterans ans Experi erien ence ce Impr mprove e the Comp p & Pension ion exam Impr mprove e the Vet eteran an Experi erien ence ce Modern ernize ize our Conta tact ct Center ers s

(to include de Vet eter erans s Crisi isis s Line) e)

Devel elop

• p a simplif

ifie ied d Appeal als s process ess Conti tinue nue to reduce e Vet eteran n homeles elessness ess Staff f critical cal posit ition ions Transf sform m OIT Impr mprove e Emp mployee ee Experie ience nce

(to include de leade adersh ship ip developm lopment) t)

Transf sform m Supply Chain 1 9 10 11 12 4 2 5 3 6 7 8

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WHAT IS PROCESS IMPROVEMENT (PI)?

Definition: It is the proactive task of identifying, analyzing and improving upon existing processes within an organization for elimination of causes of poor quality, process variation, and non-value- adding activities for optimization and to meet new metrics or standards of quality.

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TYPES OF PROCESS IMPROVEMENT

Process Improvement Projects Come in Different Sizes:

• Process Reengineering involves wiping out the current

process and creating a brand new one from the ground up.

• Process Redesign projects are a little smaller in scope and

involve maintaining the basic framework of the process while improving significant components. Sometimes, there is a fine line between process redesign and reengineering projects. Stellar results are possible in a process redesign project. This basic methodology, with a few modifications, can be used to improve processes of various sizes and scopes, from the largest reengineering project to a small quick-hit fix.

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• Healthcare/System Redesign involves

making systematic changes to practices and health systems to improve the quality, efficiency, and effectiveness of patient care

• Goal: To improve healthcare quality,

reliability and access to care for Veterans SYSTEM REDESIGN

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WHAT IS LEAN?

What is Lean?

• Continued focus on providing customer value
• Drive continuous incremental improvement
• Provide the customer exactly what’s needed at the right time
• Daily focus to eliminate all forms of waste
• Long term vision out weighs short term gain
• Speeding up the operation by eliminating idle time created by paperwork and

bureaucracy

• A way of thinking

“LEAN provides a way to specify value, line up value creating actions in the best sequence, conduct these activities without interruption whenever someone requests them, and perform them more and more effectively.” by James Womack and Daniel Jones (1996)

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Changing the Way We Do Business

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Why LEAN?

• There is an urgent need for business, process and cultural transformation. System

redesign and it’s LEAN components have been chosen to achieve this goal. LEAN has proven to:

• Effectively reduce organizational costs
• Increase process efficiency
• Improve customer value

Lean is:

• Committing to not accepting defects, not creating defects, & not passing defects on
• Never forgetting why we are here
• Committing to making a positive difference!

CUSTOMER’S PERSPECTIVE

Every step in the process should be perceived as adding value (no waste): “It does what I require and expect it to do, when and where I want it done.” The perfect process:

• Creates value for the patient
• Produces a good result every time
• Does not cause delay
• Is flexible
• Is linked by continuous flow
• Is satisfying
• for staff to perform
• for managers to manage
• for patients to experience

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The “lean” perspective is the customer’s perspective. Your project reflects your understanding of the customer, their circumstances, and their perception of value.

LEAN PERSPECTIVE ABOUT PROCESSES

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LEAN is a methodology that shortens the time between start and finish of any given process by eliminating unnecessary and non-value adding sources of waste.

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HOW LEAN IS DONE?

Through:

• Team work
• Critical thinking
• Transparency
• Courage
• Committing to having a roadmap for each project and using it
• Continuous learning
• Committing to not accepting defects, not creating defects &

passing defects on to other steps in the process

• Committing to making a positive difference!

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We can’t solve problems by using the same kind of thinking we used when we created them. - Albert Einstein Can you solve: https://www.youtube.com/watch?v=vKA4w2O61Xo

WHAT IS A LEAN PROJECT

A Lean project is any effort that embraces Lean thinking and adheres to a

• methodology. There are six core VISN2 South Lean methodologies:
• 1. A3 Problem-Solving (9 steps or boxes) for process improvements where

barriers or muda are evident.

• 2. 5S / 6S for disorganized work spaces (sort, set in order, safety, shine/simplify,

standardized, and sustain.

• 3. Lean (pull systems, flow, 5S / 6S, value stream mapping) for cycle time and

wait time issues

• 4. The scientific method for improving processes when causes of problems are

simply not known.

• 5. Six Sigma DMAIC which mirrors the scientific method, and used where

unacceptable variation or defects exist, or root causes of problems or issues are unknown or not well understood. Teams proceed through Define, Measure, Analyze, Improve, and Control phases.

• 6. Project Management for implementing and managing projects and changes.
• 7. Others

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METHODOLOGY CROSS WALK

VA-TAMMCS VISION ANALYSIS TEAM AIM MAP MEASURE CHANGE SUSTAIN SIX SIGMA DMAIC DEFINE MEASURE ANALYZE IMPROVE CONTROL PDSA PLAN DO STUDY ACT PROJECT MANAGEMENT INITIATE PLAN EXECUTE MONITOR & CONTROL CLOSE

A3 9BOX

• 1. REASON FOR ACTION
• 2. INITIAL STATE
• 3. TARGET STATE
• 4. GAP ANALYSIS
• 5. SOLUTION APPROACH
• 6. RAPID EXPERIMENTS

7.IMPLEMENTATION/ COMPLETION PLANS

• 8. CONFIRMED STATE
• 9. INSIGHTS

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Define Measure Analyze Improve Control

DMAIC

• Brainstorming
• VOC/Interviews
• Stakeholder

Analysis

• Pareto Analysis
• Cause and Effect
• Process

Documentation

• Process Map
• SIPOC
• FMEA/FMECA
• POA&M
• Define Project

statement

• VOC/Interviews
• Specifications
• Requirements
• Process/Product

Data Collection

• Process Maps
• Control Chart
• MSA
• FMEA/FMECA
• Defect and

Defective Product/Process

• First past Yield

(FPY)

• Descriptive

Statistics

• Descriptive

Analysis

• SIPOC
• RASCI
• Pareto Chart
• Cause & Effect

Diagram

• Affinity Diagram
• Process Map
• FMEA/FMECA
• Capability

Analysis

• Process/Product

Analysis

• 5 Whys
• Process Map
• Brainstorming
• FMEA/FMECA

update

• PDSA
• Pareto Analysis
• Solution

selection matrix

• MSA
• Process

Capability Analysis

• Implementation

Plan

• Final Process Map
• Final

FMEA/FMECA

• Implementation

Plan

• Control Plan
• SIPOC
• RASCI
• SPC Plan
• Audit Plan
• Training/transition

plan

• Project Notebook

Well Defined Project Scope & Metric PDSA

• f Improved

Process List of Proposed Improvements to Process Measure of Process/Product Effectiveness More Effective Process

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PLAN, DO, STUDY, ACT (PDSA)

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A3 9BOX METHODOLOGY

What is the A3 problem-solving process? What are the 9 steps?

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CORE IDEAS OF LEAN

Pull vs. Push: Let the patient pull the product or service No delay versus delay (eliminate delays) Parallel versus sequential process flow (do more things in parallel) No action versus action (eliminate unnecessary processing) No movement versus movement (eliminate unnecessary movement) Determine value using the VOC (what does the veteran want?) Use the “pull” system to avoid overproduction (batching of lab tests) One-piece flow make the process flow with out interruptions or wasted time Level out the workload to the rate of customer demand Stop and fix problems immediately when they appear Standardize processes to support improvement Use visual control so no problem remain hidden Only use reliable technology that supports the people and the process

From Lean Six Sigma for Hospitals by. J Arthur

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WHO IS DOING LEAN

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Mayo Clinic CEO John Noseworthy: https://www.youtube.com/watch?v=nO_7HyQ1X2k

WHAT IS “LEAN” THINKING?

• The Toyota Production System (TPS)
• The Toyota Way – Jeffrey Liker

Outlines 14 principles of the Toyota Way; i.e., “LEAN Thinking”

• Philosophy
• Process
• People and Partners
• Problem Solving

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PHILOSOPHY

Base your management decisions on a long-term philosophy, even at the expense of short term goals.

Most difficult is most important

Leaders must take responsibility Start with goal of generating value for customers, society, and the economy – NOT an endpoint

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PROCESS

Bring problems to the surface. Use “pull” systems to avoid overproduction. Level the workload (tortoise) Culture of stopping to fix problems. Quality right 1st time. Foundation of Standardized Tasks. Visual controls, no hidden problems. Use only reliable, tested technology.

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PEOPLE AND PARTNERS

Grow leaders who thoroughly understand the work, live the philosophy, and teach it to others. Develop exceptional people and teams who follow company philosophy. Respect your extended network of partners and suppliers by challenging them and helping them improve.

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PROBLEM SOLVING

Go and see for yourself to thoroughly understand the situation - GEMBA Make decisions slowly by consensus, thoroughly considering all options; implement decisions rapidly. Become a learning

• rganization through

relentless reflection and continuous improvement.

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Kaizen – “continuous improvement”. Many use the term Kaizen to mean short duration improvement projects, 1 to 2 days. Sometimes, these are called, “kaizen events”. We in the VA tend to use the term to mean Rapid Process Improvement Workshops (RPIW) that may take from 3 to 5 days. Gemba – “the scene”. We use the term Gemba to mean the area under study; or the place where the process lives and where the action takes place! “Gemba walk” or “walking the Gemba” refers to walking around and observing a process for the purpose of understanding, and documenting the current “as is” process. Muda – an activity that is wasteful and doesn’t add value as defined from the customer’s point of view Yokoten - is copying and improving on proven solutions.

COMMON LEAN TERMS

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LEAN = Eliminating the Muda or waste; i.e. unnecessary burden of non-value added work, tasks, things

Typically 95% of Health Care Process Time is non-value added!!!

Eight t Forms s of Waste

1. Defects 2. Overproduction/Overprocessing 3. Waiting 4. Not Utilizing People/Resources 5. Transport 6. Inventory 7. Motion 8. Extra Processing

Non-value added

Value added

WHAT IS WASTE?

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DEADLY WASTES: DOWNTIME

Defects

Errors or mistakes causing rework to correct the problem Wrong-site surgeries Medication errors Label on the wrong tube Patient complaints/decreased satisfaction scores

Over-

Production/ Processing

Creating too much material or information To many approval steps in the process Batching, delivering set number of items at one time Pre-printing documents

Waiting

Waiting for material or information, or material

• r information waiting to be processed

Patients waiting to make appointments Patients waiting to be seen for an appointment Waiting for labs, ancillary tests

Not utilizing

People/ Resources

Not utilizing or underutilizing the talent (scope)

• f employees or use of resources, staff not

involved in improvement projects Top down improvement approach No Voice of the Customer

Transport

Moving material, information, patients Moving patients from room to room Charts not centrally located Poor layouts, lab located a long distance from the ED

Inventory

Having more material or information than you need Overstocked medications on units/floors Overflowing supply bins, racks, shelves, excessive stock

Motion

Staff motion to get material or information Excessive bending, reaching, walking to get supplies Heavy items on top shelf, light items on bottom

Extra-

Processing

Processing more than necessary to achieve the desired output Multiple copies (paper and electronic) Multiple steps for approval, multiple signatures Multiple blood specimen collections

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8 BASIC PROCESS IMPROVEMENT TOOLS

Voice ce Of the Custome

• mer Table

e capture

re the custom

• mer

er need eds s and helps s transl slate e it into

• actiona
• nabl

ble e mea easu surea reabl ble e perf rform

• rmance step

eps

Control

• l Charts to measu

sure re and mon

• nitor
• r the

perf rform

• rmance of any process

rocess.

Pa Paret eto Charts identify

fy the most

• st freq

equen ent types es of defec fects, s, mistakes es and erro rors. rs.

5 Why’s or Ishikawa (fish

shbone) bone) diagra rams identify fy the potential root

• t causes

es of the e prob

• blem

em.

Check sheet ets to quantify

fy & understa rstand d the magn gnitude de

• r freq

equen ency y of the e prob

• blem

em

Flow Charts identify

fy curren rent process

• cess step

eps

Run n Charts show

• ws

s data process

• cess over

er time

Box Plot

• ts display

y differ feren ences es bet etwee een pop

• pulations
• ns withou

hout making any assumpt ption

• ns

s

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Control chart Pareto chart

Chec eck Sheet

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ROLES AND RESPONSIBILITIES

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ROLES & RESPONSIBILITIES

Team:

Share the workload and support the team lead in the successful execution of the project. Should possess the following skills and abilities, data gathering, data analysis, focus, commitment to the project and team, ability to use MS word, MS. Excel, MS. PowerPoint.

Project Leader:

The individual who is responsible for keeping the project team on task and on schedule towards achieving the project teams goal. Key: Courageous, leader, follower, focused on results, & timely completion.

LEAN Coach/Facilitator:

Not the project leader, but advisor and coach regarding appropriate methodology, tools, and application, investigator, team builder, communicator, problem solver. Must demonstrate competencies, learning, & growth. Must facilitate curriculums. Key: knowledge transfer

Financial Rep:

Validator of cost and revenue calculations, evaluator of benefit categories and translation into financial/budget terms as avoided costs and actual project savings and new revenues.

Process Owner/Champion:

Co-owner of projects, roadblock remover, strategist, communicator, alliance builder, reality checker, identifies/assists in getting resources, identifies and ensures alignment of projects to strategic objectives; focuses on meaningful, measureable, scalable, sustainable results. Responsible for progress. Key: Authority & availability.

Project Sponsor:

Provide guidance relative to the selection and application of the project benefits, effort and risk evaluation criteria. Recommend project candidates. Approve and fund the project.

Supervisor:

Assess the resourcing (funding, man-hours, facilities, equipment) that will be required to execute the project. Concur in the approval of the project.

VISN Network Office Coach:

Consultant, technical advisor, mentor, strategist focused on facility and team support, high reliability, sustainability, and transformation; continuous learner, change agent, curriculum design, improvement practices, and standards. Coach the coaches and sometimes teams and team leads.

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PROJECT SELECTION PROCESS (SCOPE)

Initial Project:

• Local-level project (i.e., usually within individual’s office/team).
• Must have an impact on the operation of a specific unit

(process/team/office/department) of the organization, in terms of one or more

• f the following areas: Quality, Cost, Schedule and/or Risk
• The scope of the project should be narrow as it affects a single process or unit
• f the organization

Advance Project:

• Strategic-level project (i.e., cross-departmental, leverage-able/replicable,

multi-command or cross-agency type).

• Must have an impact on the operation of more than one organizational unit

(multiple teams/offices/departments) in terms of one or more of the following areas: Quality, Cost, Schedule and/or Risk 35

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BEN ENEFIT EFITS S – EF EFFORT RT/RIS /RISK K EV EVALUATION TION MATRIX RIX EX EXAMP MPLE LE

Pot

• tenti

ntial Projects cts

(Priorit rity (9) x Criteria Score (9) = 81)

Prior

• rit

ity (weig eight ht)

Reduce LOS Inventory Process Maintenance Process

Benef efit its

Support Organization Strategy

9 81 27 9

Attract New Business

3 3 3 9

Reduce Operating Cost

9 81 27 81

Improve Ease of Use

3 27 3 3

Tot

• tal Benefits

ts Ranki king ng

192 60 102

Effor

• rt/Ri

t/Risk sk

Project Cost

3 9 9

Project Resources

3 9

Internal Resistance

1 9 9

Tot

• tal

l Effort/ t/Ri Risk k Ranki king ng

4 21 27

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STAKEHOLDER ANALYSIS

What is a Stakeholder Analysis?

• A disciplined project risk management method for identifying the

stakeholders, assessing potential stakeholder impact and planning for stakeholder involvement Why perform a Stakeholder Analysis?

• To assure that all of the stakeholders are identified
• To identify the stakeholders’ interest in and expectations of the project
• To assess the stakeholders’ attitude toward the project
• To plan for the stakeholders’ involvement in the project
• To plan for the communication of the core project team with the

stakeholders

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STAKEHOLDER ANALYSIS

Who are your Stakeholders?

• Any individual who can have an effect on a improvement project or

will be affected by the improvement project team recommendation

• All of the stakeholders are to be included as a project team member

(either full time or ad-hoc) When to perform a Stakeholder Analysis?

• Early in the initial phase of the project

Who performs a Stakeholder Analysis?

• The core project team members perform the analysis and

coordinate the results with the project sponsor, process owner and coach/mentor

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STAKEHOLDER ANALYSIS WORKSHEET

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SUCCESSFUL TEAM INGREDIENTS

• Clearly defined goals
• Clearly defined roles
• Interpersonal and Team Skills
• Cooperative
• Balanced Participation
• Ground Rules
• Team Tools
• Face-to-Face Interaction
• Trust
• Communication

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TEAM DEVELOPMENT MODEL

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• Expert knowledge & Experience
• Improvement Advisors, lead teams and advise

coaches, facilitate trainings

Black ck

• Knowledge & experience in advanced

tools & leading projects

• May lead projects and coach and facilitate

for improvement teams

Gr Green

• Knowledge of basic tools & some

experience applying them

• Active participant on improvement

teams

Yellow w Belt

• Basic understanding of

Lean Principles, define value, Identify Waste

• All Staff

White e Belt

4 Levels of Lean Mastery

See your lean coach about training & certification opportunities You are here

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REVIEW

1) What is Process Improvement? 2) What is Lean? 3) What are the Lean methodologies? 4) What are the common lean terms? 5) What are the 8 basic process improvement tools? 6) What are 8 forms of waste? 7) Why is project selection important? 8) Why is stakeholder analysis important?

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QUESTIONS

Janelle Seenath, System Redesign Coordinator/Supervisor x4755

▪ Janelle.Seenath@va.gov

Barbara Carralero, System Redesign Health System Specialist X3087

▪ Barbara.Carralero@va.gov

LOCAL PROCESS IMPROVEMENT EXPERTS AND GOOD PEOPLE TO KNOW…

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Project Title:

Project Start Date: Project Origin/Alignment breakthrough priorities: Process Owner: Team Lead: Team Coach: Project Champion: Team Members: Key Metric or Deliverable:

Aim - 1. Reason For Improvement

Problem Statement: Scope: Trigger: ▪ Process Start – ▪ Process Stop – Limitations:

Box 1 – Reason for Action

Map - 2. Current State

List of Current State Attributes: Box 2 – Current State

Baseline Data

Metric Current (Dates)

Box 2 – Current State

Map - 3. Target State

Box 3 – Target State List of Target State Attributes:

Measure - 4. Gap Analysis

Note: Show the gap between the Current State versus Target State, for example:

• Waste difference (i.e. comparison of Value-Added, Non Value-Added But

Necessary, and Non Value-Added and Unnecessary process steps)

• Metrics comparison
• Process step comparison (i.e. difference in the total number of process steps)
• Gap Analysis Tools Used (i.e. 5 Whys, Fishbone Diagram, etc…)
• Identified Problems and corresponding Root Cause(s)

Box 4 – Gap Analysis

Measure - 5. Solution Approach

If we do this… …then we will achieve this….

Box 5 – Solution Approach

Change - 6. Rapid Experiments

Plan Do Study Act

Box 6 – Rapid Experiments

Change - 7. Completion Plan

What Who When Status

Box 7 – Completion Plan

Sustain - 8. Confirmed State

Metric Baseline Goal Actual

Countermeasures

[Please describe control/sustain tools, like dashboards, control charts, visual controls, etc.]

Baseline or below Above Baseline, trending to goal Goal or better

Box 8 – Confirmed State

Sustain - 9. Insights

What went well?

• What did not go well?
• Lessons Learned
• Box 9 – Insights