WELCOME!!!!!

1. WELCOME!!!!! DMAIC in a Day Kate Isaacsen

2. Agenda • Change Management • DAMIC familiarization • OEE • Single Piece Flow • Practical Tools • Q & A

3. Change Management

4. Change Management • IT’S TOUGH TO CHANGE!!! • Invasion Of Privacy • A Little Change Is Fun • A Little More Is Stressful • Too Much And They Give Up

5. Change Management Shocking lessons • #1: Most people do not think in terms of processes. They would rather think in terms of isolated events. • #2: When convinced of the value of thinking in terms of processes, most people still don’t think in terms of processes. • #3:The word “process” generates fear and resistance.

6. Change Management • Increased understanding  decreased confusion • Increased commitment  decreased resistance • Increased capability  decreased fear of failure

7. DMAIC Familiarization

8. DAMIC • Define • Measure • Analyze • Improve • Control

9. Define

10. Measure

11. Analyze

12. Improve

13. Control

14. OPE/OAE/OEE

15. Overall Process Effectiveness NumberOPE = %Availability X %Performance X % QualityAvailability = Time the process is working correctlyPerformance = Rate at which the process is performedQuality = How well the process meets specificationsOverall Activity Effectiveness NumberOAE = %Availability X %Performance X % QualityAvailability = Time the activity is working correctlyPerformance = Rate at which the activity is performQuality = How well activity meets specifications OEE = %Availability X %Performance X % QualityOperational Equipment Effectiveness NumberAvailability = Time the equipment is working correctlyPerformance = Rate at which equipment is operatingQuality = How well equipment meets specifications OPE/OAE/OEE

16. OPE/OAE/OEE Max Time Available = 24 hr * 7 days/wk = 168 hrs/wk Operational Asset Utilization Unscheduled Time Business Decision = Cost Impact Total Time Available as Scheduled => Could be 168 hrs Operational Availability = Gross Operating Time = Labor Utilization Breaks Lunch Weekends Holidays Unplanned Downtime Planned Downtime Availability Rate Speed Losses Inefficiency Learning Performance Rate Net Operating Time = Performance Rate = Performance Against Standards Quality Operating Time = First Pass Yield/Other Yield Defect Losses Scrap/Rework OEE Benchmark is Equipment Specific Quality Rate OEE % Operational Equipment Effectiveness = Availability * Performance * Quality OEE = 95% * 95% * 95% = 85%

17. Single Piece Flow

18. When items are produced and moved from one processing step to the next, one-at-a-time, without stoppages, scrap, or backflow Single Piece Flow • Consistent flow rate • Drumbeat: regular, linear, even capacity utilization • Synchronized with the customer Quest Diagnostics Confidential & Proprietary

19. Practical Exercises • Round About • Candy Cups

20. Charter

21. Cytology Processing Kaizen Event Define: Team Charter Scope Business Case • All business units are challenged to improve overall productivity in specimen processing. This project is directly linked to the Blue Print objective of improving cost per requisition, possible FTE savings and increased revenue per day. Start:When Thin Preps and SurePaths are delivered to Cytology Processing Stop:When slides are placed on slide cart for further processing Exclude:Conventional slides Problem Statement Goal • On a daily basis Cytology Processing handles an average of 1,560 specimens. The current workflow requires additional steps throughout the process. Eliminating redundant movement will maximize efficiency and throughput. • To reduce the distance traveled while processing Thin Preps and SurePaths by a minimum of 50%.

22. SIPOC

23. SIPOC

24. Define: SIPOC lass lass Cytology Processing Kaizen Event Suppliers Process Outputs Customers Inputs Slides ready for cytology reading Requisitions ready for keying into Copath. Ready for transport to Sendouts Patients Drs Offices Vendors IT Logistics Accessioning HC requisitions Specimen vials Electronic demographics and test request Patients Drs Offices Insurance Companies Cytologists Billing Client Services Cytology Processing High level process Start Stop Transport To cytology Prep specimens Stain slides Image specimens Gather

25. SIPOC Inputs/Suppliers • Where does the information or material you work on come from? Who are your suppliers? • What do they supply? • How do our suppliers affect what we do? • What effect do they have on our job and on the outcome? Process steps • What happens to each input? • What conversion activities take place? Purpose • What do we do? • What is the purpose? • What is the outcome? Outputs • What product do we make? • What are the outputs? • At what point are we done? Customers • Who uses the products? • Who are the customers?

26. Stakeholder Analysis

27. Stakeholder Analysis for Change Used for: Identifying stakeholders and their position on a particular Six Sigma change initiative. Names Strongly Against Moderately Against Neutral Moderately Supportive Strongly Supportive Stakeholder Analysis People resist or support change for a variety of reasons

28. Stakeholder Analysis Change = reducing number of suppliers Moderately Supportive (+1) Strongly Supportive (+2) Strongly Against (-2) Moderately Against (-1) Names Neutral (0) X Ref. Physicians File Clerks X X IT Department EquipmentVendors Techs CFO X X • Who will care? • What commitment level now; minimum needed? Critical attention? • Who influences whom? Solid Line = Critical To Move Dotted Line = Important But Not Urgent = Okay Where They Are

29. I. STAKEHOLDER II. MAJOR CONCERNS/INTERESTS III. OUR STRATEGY Stakeholder Analysis • A STAKEHOLDER IS ANY PERSON OR GROUP OF PEOPLE THAT IS: • Responsible for the final decision. • Likely to be affected, positively or negatively, by the outcomes you want. • In a position to assist or block achievement of the outcomes. • Has expertise or special resources that could substantially affect the quality of your end product/service.

30. FMEA

31. FMEA 1. For each Process Step, list ways that it can vary or go wrong (Failure Modes) 2. Identify Effects associated with each Failure Mode 3. List all Causes for each Failure Mode (These could be outputs from a previous process step or additional inputs to this step). 4. List the Current Controls for each Cause 5. Create Severity, Occurrence, and Detection rating scales 6. Assign Severity, Occurrence and Detection ratings to each Cause 7.Calculate the risk priority number for each potential Failure mode scenario 8. Determine recommended actions, with responsible parties assigned and estimated date of completion, to reduce High RPNs - Estimate effect of Actions on RPN (SEV, OCC, DET). 9.Take appropriate actions and re-calculate all RPNs

32. FMEA • Process Step/Function - simple description of the process step or function being analyzed. • Failure Mode- the manner in which a specific Process Step could potentially fail to meet process requirements or intent. • It is a description of malfunction at the process step under consideration. • can be an Effect(Output) of a failure in a previous operation or • can be a Cause (Input) of a failure in a subsequent operation. • Failure Effect - impact on the customer. • The effect is described in terms of what the customer might notice or experience (outputs on process map). • Cause • Sources of process variation that causes the Failure Mode to occur. • Causes are things that could be corrected or controlled (inputs on process map). • Current Controls • systematized methods/devices in place to prevent or detect Failure Modes or Causes (before causing effects).

33. FMEA What is the process step being analyzed? What is the Effect on the Outputs? What can go wrong with the Input? How can this be found? In what way could the process step fail to meet requirements? How Bad? How Often? How well can we detect?

34. RPN = Severity X Occurrence X Detection Effects Causes Controls FMEA • The output of an FMEA is the Risk Priority Number • The RPN is a calculated number based on information you provide regarding • the potential failure modes, • the effects, and • the current ability of the process to detect the failures before reaching the customer • The severity of the effects x rating on how often it occurs * ability to detect

35. Spaghetti Map

36. Spaghetti Map After Before

37. Spaghetti Map An Illustration of a System’s Inefficiency Quest Diagnostics Confidential & Proprietary

38. Benefits of Spaghetti Charting • Identifies Inefficiencies in Area/Plant Layout • Identifies Opportunities For Less Handling • Identifies Opportunities For Better Workforce Communication • Identifies Resource Allocation Opportunities • Identifies Opportunities For Safety Improvements

39. Spaghetti Map • Sketch or Obtain “Facility Layout, Map” • “Become the Product” • Walk the Process As if Your Where the Product (A Requisition, Specimen Tube, etc.) • Mark the Process Locations and Steps on the Layout • Connect the Dots in Accordance With the Actual ‘Travel or Walk Patterns’ • Calculate the Distance Where is There Excessive or Unnecessary Movement?

40. Value Add Analysis

41. Value Add Analysis Quest Diagnostics Confidential & Proprietary

42. Value Add Analysis Seven Types of Waste: • Defects • Overproduction • Transport • Waiting • Inventory • Motion • Extra Processing Quest Diagnostics Confidential & Proprietary

43. Value Added Non-Value Added Value Add Analyses

44. Control Plan

45. PROCESS CONTROL PLAN Notify Customer of Resolution in 48 hours 9.0 Managing Customer Relationships Core Process: Implemented Process: Project Goal:: Critical To Quality: Client Problem Resolution Timely Notification of Resolution. Date: 12/03/01 Comments If Indicators out of Control... Indicators Action Plan Responsible Party Frequency Item to Review Control Limits Measure UCL= LCL= UCL= LCL= UCL= LCL= UCL = LCL = UCL= LCL= Spec = Spec = Spec= MSE Gauge R&R on CSR & Problem Res. Group data input accuracy Quarterly Functional Mgr w/ assistance of GB/BB Key Xs: X1= % Problems Requiring Investigation Review Criteria for CIR and give Feedback to Originators # CIR vs Problem Tracking from Database Service Solutions Monthly • OPS • Service Solutions Review Criteria for CIR and give Feedback to Originators • Sample of CIR’s (dept • code) • CIR Database • Daily • Monthly X2 =% Priority 1 vs Priority 2 X3= % CIR’s Received Incomplete Sample of CIR’s • OPS • Daily X4= % CIR’s Rerouted to Another Dept • Daily • Monthly • OPS • Service Solutions Review individual CIR’s as to reason for reroute. Address drivers CIR Database X5 = Cycle Time for Client Notification Service Solution & Customer Satisfaction Team Investigate if X > 48 hrs and address drivers Bi-Weekly CIR Database Key Ys: Service Solution & Customer Satisfaction Team Y1 =% Customers Notified After 48 Hours Bi-Weekly Investigate if X > 3.5% and Address drivers CIR Database Y2 = % CIR’s closed After 120 Hours Investigate if X> 5% and address drivers CIR Database Bi-Weekly Service Solutions & Customer Satisfaction Team Y3 =% Customer Satisfied with Priority 1 Investigate if Y < 97%. CIR Database Service Solutions & Customer Satisfaction Team Monthly T.Pate 12/04/01 Page 2 of 2 ProcessControlPlan.pp.

46. PROCESS CONTROL PLAN Notify Customer of Resolution in 48 hours 9.0 Managing Customer Relationships Core Process: Implemented Process: Project Goal:: Critical To Quality: Client Problem Resolution Timely Notification of Resolution. Date: 12/03/01 Process Flowchart Indicators Client Service Service Solution Sales Other Depts Client Measure Page 1 of 2 ProcessControlPlan.pp.

47. ARMI

48. ARMI

49. Process Maps

50. Process Maps • There are many types of process maps. • Flow Chart • Functional Deployment Map • Value Stream Map • SOP • List of Steps