Lean Six Sigma in the Lab Kansas City CLMA Friday, March 1, 2013

1. Lean Six Sigma in the LabKansas City CLMAFriday, March 1, 2013 Scott Bolen Master Black Belt Quest Diagnostics – Midwest Region

2. Agenda Leadership LEAN versus Six Sigma Waste Flow Continuous Improvement

3. LEAN Leadership LEAN Leaders Your experience?

4. Lean Six Sigma Leadership LEAN versus Six Sigma Waste Flow Continuous Improvement

5. LEAN versus Six Sigma Six Sigma is about meeting the customer demand for accuracy (Quality) LEAN is about meeting the customer demand for timeliness (Speed) LEAN and Six Sigma complement each other. Each drives continuous improvement through the DMAIC methodology

6. Six Sigma Quality LEAN Six Sigma Method: Improvement (DMAI2C) – Reduce variation and defects in an existing process Define the project, process, and customer requirements. Measurethe process to set baseline and quantify factors. Analyzethe data to determine root cause. Innovate Improvements that address root cause. Controlimproved process and determine effect.

7. 2.8s Low Quality 10% Error Rate 100,000 DPMO 6 s High Quality 0.00037% Error Rate 3.4 DPMO Good Bad Good Bad Customer Spec Customer Spec Target Target Many Defects Virtually No Defects 1s 1s 2s 2s 3s 3s 4s 4s 5s 6s 5s 6s Improving Operational Efficiencies Six Sigma is about decreasing variation. Lean is about decreasing waste.

8. Six Sigma is “S..t..r..e..t..c..h Thinking” Sigma Yield Errors per million opportunities 6 Sigma 5 Sigma 4 Sigma 3 Sigma 2 Sigma 1 Sigma 3 Sigma 6 Sigma 3.4 233 6,210 66,807 308,538 691,462 66,807 3.4 99.9997% 99.977% 99.38% 93.3% 69.1% 30.9% 99.9997% 93.3% Six Sigma Quality Most good companies are here

9. 50 newborns harmed at delivery, every day 5,000 incorrect surgical operations a week 200,000 wrong drug prescriptions a year No electricity for almost 7 hours a month 20,000 lost articles of mail per hour Unsafe drinking water almost 15 min. a day 528,000 checks deducted from the wrong bank accounts every day At Quest Diagnostics, we perform nearly 350 million tests a year.   If we did 99% of them right: 3.5 Million Tests would have an error! We want Six Sigma Quality: 99.9997% of tests done correctly! Less than 1200 would have an error Six Sigma Quality Six Sigma: The Highest Quality 99% Good Means: Quest Diagnostics Quality:

10. How do we control Processes? Off Target & Inconsistent Consistent but Off Target Consistent & On Target Control Chart

11. What the Customer Wants Average = 13 Minutes

12. Which is Better? The average wait time is decreased by 2 min. The # of patients waiting >15 min. has increased from zero to ~20 But…. Average = 13 Minutes Average = 11 Minutes Most customers don’t experience the average!

13. LEAN Six Sigma Leadership LEAN versus Six Sigma Waste Flow Continuous Improvement

14. Six Sigma Quality Reduce or eliminate waste DOTWIMP • Defects • Overproduction • Transport • Waiting • Inventory • Motion • Extra Processing DOWNTIME • Defects • Overproduction • Waiting • Non-Utilized Employees • Transport • Inventory • Motion • Extra Processing

15. Six Sigma Quality Perspective • From the Function/Provider: Everyone is very busy • From the patient: Hurry up and wait • From the specimen: Sit, Sit, Sit, Test, Sit

16. Six Sigma Quality What is Value?

17. Value Added: Definition • Must Physically Change the product / information • Must be Done Right the First Time (no rework) • Customer is Willing to Pay For It

18. Lean Toolkit – 5S Six Sigma Quality 5S Parody • What is it ?? • A systematic way to improve your workplace and processes • Focuses on creating and maintaining a clean, well organized workplace • Easily distinguish between normal and abnormal conditions • Highly dependent on employee involvement • Promotes defect reduction, cost reduction and a safe work environment • Goal: • A self-explaining, self-ordering, self-regulating, and self-improving workplace where what is supposed to happen does happen on time, every time, day or night.

19. Current State 5S Exercise Before Warehouse Before Supply Cart

20. Current State 5S Exercise 5S - Circle the numbers in order from 1-50 You have 60 Seconds 60 55 50 45 40 35 30 25 20 15 10 5 Time’s Up

21. Implementation and Benefits of 5S 5S Exercise Set in Order Sort Shine Standardize Sustain Sort: “When in doubt throw it out” Sort necessary from unnecessary items • Remove all unneeded items such as racks, tools, equipment, and excess inventory • Red tag method • Attach red tags to unneeded items and remove them to a red tag area • Evaluate and properly dispose of items in the red tag area Sort - Benefits • Work area less crowded • Less time needed to find things • Fewer part selection errors • Improved process flow • Reduced maintenance costs • Improved communication among employees

22. Sort • Get rid of what you do not need. Keep only what is needed. • (Remove higher numbers) 5S Exercise 5S - Circle the numbers in order from 1-50 You have 60 Seconds 60 55 50 45 40 35 30 25 20 15 10 5 Time’s Up

23. Implementation and Benefits of 5S 5S Exercise Sort Shine Standardize Sustain Set in Order Set in Order : “A place for everything and everything in its place” Arrange items so that they can be found quickly by anyone • Everything that is movable should have a designated place when not in use • Arrange things so they are easy to find, easy to use and easy to put away • Most frequently used items should be close-at-hand • Items should always be in the same place Set in Order - Benefits • The proper amount of space is designated to store items • Reduces time needed to find things, less searching • Everything is in its place and not on the floor – improved safety • Elimination of excess motion • Increased space / capacity

24. Implementation and Benefits of 5S 5S Exercise Set in Order Sort Shine Standardize Sustain Shine: “A clean systematic organization results in increased safety and efficiency” Create a spotless workplace • Keep what is left CLEAN and in good working condition • Perform a major cleanup • Assign daily housekeeping tasks at least 5 min./day Shine - Benefits • Less equipment breakdown. • Defects are easy to see • Improved efficiency • Safer work environment • Improved morale

25. 2. Set in Order Put needed items in the proper place (No sequential numbers in the same quadrant) 3. Shine Keep workplace neat and clean (Clean up fonts) 5S Exercise 5S - Circle the numbers in order from 1-50 You have 60 Seconds 60 55 50 45 40 35 30 25 20 15 10 5 Time’s Up

26. Implementation and Benefits of 5S 5S Exercise Set in Order Sort Shine Standardize Sustain • Standardize:“Do the right things the right way, every time” Maintain the previous changes and continuously improve • Standardize your processes • Incorporate sorting, storage, and shining activities into daily routines • Use aids to control what happens and when it happens Standardize - Benefits • Increased equipment life • Clean environment • Increased visibility of normal and abnormal conditions • Consistent delivery • Improved quality • Training of new employees is easier

27. Standardized Taping Scheme 5S Exercise

28. 4. Standardize Implement, train and maintain best practices (Define a standard order) 5S Exercise 5S - Circle the numbers in order from 1-50 You have 60 Seconds 60 55 50 45 40 35 30 25 20 15 10 5 Time’s Up

29. Implementation and Benefits of 5S 5S Exercise Set in Order Sort Shine Standardize Sustain Sustain: “5S Ingrained in everyday work life” Ensure the systematic organization, visual placement and cleanliness are maintained • Follow the rules you set • Involve workers in every aspect of the 5S process including checklists and job charts • Practice and repeat until it becomes a way of life • Continuously improve through regular assessments (audits) • Fully train existing and new employees on 5S and your expectation Sustain - Benefits • Higher employee pride and ownership • Work place is maintained in an organized fashion without clutter • Detailed tasks are documented to make the process more efficient • Customer appeal / boosts professional image • Saves time, money on over orders & reduces out of stocks

30. Warehouse Before / After 5S Photos 5S Exercise Before: After:

31. Supply Cart Before / After 5S Photos 5S Exercise Before: After:

32. LEAN Six Sigma Leadership LEAN versus Six Sigma Waste Flow Continuous Improvement

33. Flow Video What are the attributes of good process flow?

34. Six Sigma Quality Lean in the Lab – Optimizing Flow “Before” Spaghetti Map of Molecular

35. Six Sigma Quality Lean in the Lab – Optimizing Flow “After” Spaghetti Map of Molecular Optimizing Cells helped reduced “Transportation Waste” by 46% (1709’ vs 930’)

36. Value Stream Map

37. Takt time Takt time = (time available)/(customer demand) Example: 480 specimens arrive to the lab at 9 pm, are processed and delivered to toxicology at 10 pm. All results are due for release by 8 am. If an AU2700 can do 1 rack of 10. How long should 1 rack take to meet the 8 am TAT? Available time = 9 hours – 30 minutes for lunch – 2 x 15 minutes for breaks = (9*60) – 30 – 30 = 480 minutes Customer demand = 480 specimens (assume no splits) Takt time = 480/480 = 1 minute = 60 seconds 1 rack = 10 specimens 1 rack = 10 * 1 = 10 minutes What is the practicality of this?

38. Work Elements for the Histology Project Operator Balance Chart Takt time = 11.36 sec. What do you notice about this picture?

39. Operator Balance Chart with Improvement Takt time = 11.36 sec. Planned Cycle Time = 9.66 sec. Note: We need to plan 85% - 95% of takt time to allow for variability in the process 11.36 X 85% = 9.66

40. Lean Six Sigma Leadership LEAN versus Six Sigma Waste Flow Continuous Improvement

41. Kaizen: the philosophy that continuous improvement takes place through small, incremental process improvements, repeated over and over again What is Kaizen? Workshop: • A means of implementing process improvements • Short, 3-5 day events with intensive focus on one area and problem (for example cycle time or rework) • A cross-functional, participative implementation approach • Focus on substantial improvement (30-40%) Workshop Objectives: • Achieve results • Bring new problem solving skills to the workforce

42. PDCA (Plan-Do-Check-Act? Video

43. Questions? Thank You!