Six Sigma and Lean Chapter 6

Outline Learning Objectives Lean Six Sigma Benefits of Lean and Six Sigma Summary Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.2

Learning Objectives Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.3

After reading the chapter, you will be able to: Describe the types of waste found in healthcare processes List the 5 Lean principles and explain briefly how each is used to examine a process Learn how to map the value stream Investigate the root cause of a problem Understand the importance of flow in Lean Explain the basis for Six Sigma Describe the steps in DMAIC Elucidate how culture is important for organizations that adopt Lean or Six Sigma methodologies Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.4

Lean Definition Waste elimination principles Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.5

Definition of Lean “A set of concepts, principles, and tools used to create and deliver the most value from the customers’ perspective while consuming the fewest resources and fully utilizing the knowledge and skill of the people performing the work” (Graban, 2012, p.17) Core idea: 根除【浪費】 Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.6

Waste Elimination Types of waste (non–value-added) Overproduction Inventory Defects, errors Motion Extra processing Waiting Transport Underutilization Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.7

Figure 6.1 – Principles of Lean 2. Map the Value Stream 3. Create Flow 4. Establish Pull 5. Seek Perfection 1. Identify Value Source: Lean Enterprise Institute, 2015, Principles of Lean. Reproduced with permission. Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.8

Lean Principles Identify Value 改善的起點：確認顧客價值 降低批量大小，會增加配送的次數 不是【根除浪費】 根除浪費是改善的「結果」 電商消費者 (顧客) 24小時隔日取貨 免運費 電商 (服務提供者) 小批量、密集運送 【物流中心】 降低批量大小，會增加配送的次數 (消除一項浪費，可能產生另一項浪費) Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.9

Map the Value Stream a flowchart depicting a process flow from a Lean perspective For each process step, designate whether the step creates value, does not create value (waste) but cannot be eliminated at this time, or is waste and can be eliminated Use the 5 Whys methodology to get to the root causes of the problems

Figure 6.2 – Value Stream Map: Medication Ordering and Administration Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.10

5 whys 病人抱怨等候時間超過一小時 why why 因為沒有任何(人工、電腦)系 統，可以處理醫師臨時變更行 程 醫生在看掛號在他之前的病人 因為門診開始的時間被延遲 因為醫師去處理一位住院病人 的緊急狀況 門診的人員沒有被通知 why 因為沒有任何(人工、電腦)系 統，可以處理醫師臨時變更行 程

To scrub or not to scrub 大理石剝落日益嚴重 why 經常清洗 沾汙嚴重 鴿屎累積 鴿子來覓食，牆面有微生物 燈光營造出微氣候，適合微生物

Lean Principles (cont.) Create Flow Rethink the workflow, physical layout, and efficiency of environment waits bottlenecks Work in processes Use 5S methodology Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.11

5S Methodology Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.12

Lean Principles (cont.) Establish Pull Push—goods/services are provided without waiting for customer demand Pull—goods/services are provided in response to actual customer demand Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.14

Push: end products inventory 單一、同質的產品

Pull: production when needed Supermarkets Material Handling Personnel

Lean Principles (cont.) Seek perfection Mistake-proof system (Poka-yoke) 顏色的應用 形狀的應用 聲音的應用 公車刷卡 老人票 全自動化 Bar codes 開刀房排程系統 (病人編號) 病人手環 (病人編號) Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.15

Continuous improvement (Kaizen) 混線生產 生產線邊物料架 處理種類較少時 線邊撿貨 (套件物料包) 型號過多 車款顏色多元 內裝顏色多元

Six Sigma Definition DMAIC Key players Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.16

Definition Process improvement methodology focused on eliminating defects and reducing variation Six Sigma = 6 standard deviations from a target value Mean of the process distribution is 6 standard deviations away from the lower specification limit (LSL) and 6 standard deviations away from the upper specification limit (USL) 3.4 ppm DPMO (defects per million opportunities) Low variation decreases the chances of introducing errors Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.17

Principles of Six Sigma Define Measure Analyze Improve Control Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.18

Figure 6.5 – Steps in DMAIC and Tools Used at Each Step Brainstorming Focus Group Surveys Project Charter Define Value stream mapping Interviewing Observing Measure Pareto Chart Fishbone Diagram Process Capability 5 Whys FEMA Analyze Checklist Gantt Chart Before and after Pareto and Control Charts Improve Statistical Process Control Control Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.19

Symptoms Versus Root Causes

(Project Participant) Key Players Executive Sponsor or Champion Master Black Belts Black Belts Green Belts Yellow Belts Master Black Belt (Mentor) (Project Leader) Green Belt (Project Team Member) Yellow Belt (Project Participant) Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.20

Benefits of Lean and Six Sigma Improved quality Reduction in the process cycle time Improved communication Cost savings Improved skill training Reduced waste and variation Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.21

Summary Connecting concepts Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.22

Figure 6.7 – Revised Mind Map Linking Indicators to Delivery (Chapter 7) Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6.23