How Do We Know Where, What & How to Improve?

1. How Do We Know Where, What & How to Improve? Jennifer Hooks MBA Manager, Performance Improvement Six Sigma Master Black Belt Lean Sensei Chris Rees, MHSA, MBA Director of Quality and Safety Six Sigma Master Black Belt

2. Objectives • Overview of Performance Improvement • Introduction to LEAN thinking • Learn How to Pick a Successful Project • Define What Makes a Good Problem Statement • Illustrate the Importance of Measurement • Group Work - Define a Project to Address Your Business Problem

3. How To Improve? There is no magic answer Despite What the Book Sellers will Tell you

4. How to Improve? No Magic Answer, but some basic must haves: • Use a Standard, Disciplined Approach. • Focus on: • Reducing Waste and Inefficiencies, • Reducing Variation and Eliminating defects.

5. Basics of All Approaches • Use a team – Trust the Group • Clearly identify what it is you are trying to improve – Define your process & metrics • Measure and analyze data, both Quantitative and Qualitative • Focus only on the important issues • Validate that the results met your objectives • Have a plan to sustain results

6. Going LeanCan it work for theMedical University?

7. What is Lean? • The relentless pursuit of the perfect process through waste elimination… We Spend 75-95% of Our Time Doing Things That Increase Our Costs and Create No Value for the Customer! In healthcare, Lean is about shortening the time between the patient entering and leaving a care facility by eliminating all non-value added time, motion, and steps.

8. What Lean is not • Layoffs • Customers = widgets • Making people work faster • Short term cost reduction program

9. Origins of Lean • Henry Ford, 1920s • Continuous Flow Assembly • Reduce wasted time • 1913-1914: doubled production with no increase in workforce • 1920-1926: Cycle time from 21 days to 2 days

10. Origins of Lean • Taiichi Ohno (1912-1990) • 1950’s: Toyota Production System • Continuous Flow Production • Just-in-Time (JIT) • Eliminate defects • Eliminate “MUDA” • Top management commitment • Employee participation

11. Lean Thinking Process The 5 steps to Lean Thinking … 2 Map the Value Stream Map all of the steps…value added, non-value added and…non-value added required that bring a product of service to the customer Specify value from the customer’s perspective and express value in terms of a specific product 1 Specify Value 3 Establish Flow The complete elimination of waste so all activities create value for the customer 5 Work to Perfection The continuous movement of products, services and information from end to end through the process 4 Implement Pull Nothing is done by the upstream process until the downstream customer signals the need What are your customers willing to pay for?

12. Who Is the Customer? Parents The Student Academics Government Bodies Professional Bodies Employers Local Business Community Health Trusts Research Institutes The University Funding Providers

13. VA NVA-R NVA

14. 1 Specify Value • Value is determined by the customer • The customer must be willing to pay for the activity • The activity must change the form, fit or function of the service or product • The activity must be done right the first time

15. 2 Map the Value Stream

16. 3 Implement Pull • Produce work when initiated by customer demand • Smooth communication between process steps • http://www.youtube.com/watch?v=0YGF5R9i53A&feature=related

17. 4 Establish Flow • Remove non-value-added activities (wastes) from the process • Keep work moving at all times • Eliminate congestion

18. Identifying Wastes

19. 5S Philosophy: Organize the WorkplaceSort, Set, Shine, Standardize, Sustain • A visually-oriented system for organizing the workplace to minimize the waste of time. • Clears the clouds • Eliminates the waste of motion/ looking for things • Makes the abnormal visually obvious

20. Step 1: Sort Before After Separate the needed from the not needed

21. Step 2: Set BEFORE AFTER A place for everything & everything in its place!

22. Step 3: Shine “Shine” and inspect equipment to ensure it is in perfect working condition... Add inspecting equipment into your work routine. Daily housekeeping is important. Regularly “shine” to ensure everything is in perfect working condition and clean

23. Step 4: Standardize Note: Blue taped outlines and labels ensure equipment is quickly found and returned to the same spot every time. Standard Work requires determining the best method then following that method every time.

24. Step 5: Sustain Develop a method for sustaining your gains

27. 5 Work to Perfection • A continual, never-ending journey • Constantly work on shortening work cycle • Quality and Quantity • Focus on what the customer values

28. Lean Goals • Build trust by removing fear • Initiate long-term cultural change • Communicate the vision to all staff • Active commitment of leadership is a must, in both words and action

29. How to Pick a Project

30. CriticalityCritical to the Customer*Customer Satisfaction*

32. Voice of the Customer • Identify the customer. Who is the recipient of the output? • Is the customer internal or external? Understand that internal customer satisfaction impacts external customer satisfaction. • Identify customer decision criteria. CQFA – cost, quality, features, availability. Is anybody listening?

33. CriticalityCritical to the Business*Revenue Growth, Economic and Market Value*

34. Voice of the Business • Strategic • Identify and prioritize improvement initiatives to achieve strategic goals and objectives • Operations • Risk management internal enabling processes that can affect overall performance • Reporting • Corporate dashboards/balanced scorecards measure efficiency and effectiveness • Compliance • Regulatory compliance Listen to Mission, Vision, Goals

35. Mission Improve health and maximize quality of life through education, research and patient care GOALS • Interprofessional/Interdisciplinary Practices • Technology/Innovation • Entrepreneurialism • Globalization

36. Root Cause Solution Unknown Pick a problem that does not already have a known root cause or solution

37. Well Managed Scope Large enough to significantly improve the process, but still small enough to be manageable Project should be within your control to make the recommended changes in order to improve the process Select a project that can be completed in a reasonable period of time (3 months to 6 months max)

38. Select a problem that happens oftenIt is not worth the time and effort to develop a solution for a problem if it is unlikely to happen againDifficult to collect past data to analyze the causes because the problem occurred only once in the past Chronic Issue

39. Good Leadership Support Essential support from MUSC leadership goes beyond providing teams with the needed resources (time, money, people, etc.) Ensures ongoing comprehensive communication throughout the entire organization for the life of the project—beginning to end

40. Execute the IMPROVE MethodologyIMPROVE Roadmap

41. Important to YOU!! Passionate, Interesting and Exciting

42. Exercise Group Work - Define a Project to Address Your Business Problem

43. Define the Problem • Initial Questions to Ask: • What is the problem? • What is the benefit of reducing the impact of this problem? • What is the Measurement? • Who is my customer? • What matters to them? • How do they define quality • What is the scope? • You can’t solve World Hunger! • What is a reasonable goal, a definition of success? • Remember your goal should be S.M.A.R.T. • Specific, Measurable, Achievable, Relevant, and Time bound

44. Exercise • Work at your tables to answer the questions from the last slide and create a problem statement for this case study • A problem statement has the form: • WHAT is wrong • WHERE it happened • WHEN it occurred • Why is this a problem • A problem statement: • Does not include causes of the problem. • Does not include likely actions or solutions. • Is clear, concise, and specific. A good problem statement is essential to a good start.