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Performance Improvement that
      Makes a Difference

       Presented by:
   Michael Peterson, PHR
Today’s Agenda
• Introduction to Sharp
• Are you ready for a process improvement
  initiative?
• Introduction to Six Sigma
• What is LEAN vs. Six Sigma
• Results
• Questions
Sharp HealthCare
• San Diego’s Health Care Leader
• Not-for-profit
• Largest health care system in San Diego
  –   4 Acute Care Hospitals
  –   3 Specialty Hospitals
  –   2 Affiliated Medical Groups
  –   Full range of programs and services
• Largest private employer in San Diego
  – 15,000 Employees
  – 2,600 Affiliated Physicians
  – 2,000 Volunteers
Are you ready?
Are you ready?

• Foundational elements of process
  improvement
  – Often overlooked
  – Leads to the failure of many, if not most, process
    improvement initiatives
Are you ready?

• Define
  – What is the true problem? Baseline measures
  – What does success look like?
  – How will it be measured?
• Assess
  – What is the driver for improvement?
     •   Internal to the department
     •   External, but within the company
     •   External from the company
     •   A mix?
Are you ready?

• Assess
  – How will you sustain the gains/improvements?
    • Policy and procedural changes
    • Audits
        – How
        – What resources
        – Who
    • Incentives
        – What kind?
        – Unintended consequences
Are you ready?


• Assess
  – Are your processes stable?
     • It is impossible to improve any process that is not
       consistent – The Toyota Way
  – Is anything “hiding” problems
     • The Toyota Way
        – Batch manufacturing
Are you ready?

• Assess
  – Is anything “hiding” problems (continued)
     • What may be hiding problems in Recruiting?
        – Success
        – Brand
        – Lack of competition
        – Lack of need
        – Candidate database
        – Apathy
        – Unrealized problem(s)
        – Lack of knowledge of a better state
Are you ready?

• Assess
  – Do you have the resources?
    • People- everyone is accountable
    • Money
    • Time
  – What are the obstacles?
    • Can we mitigate them?
Six Sigma and LEAN
What is Six Sigma?
• A methodology that focuses on data-driven
  decisions

• Reduction in variation

• A statistical term that represents near-perfection

• A philosophy of driving results to levels never
  before expected
Define                            DMAIC Methodology
• The context of the process
• The customer
• The right metrics and targets

Measure
• Input requirements
                                              D
• Output requirements
• In-process requirements             C      Lean M
Analyze
• Cause and effects
                                          Six Sigma
• Determine the gap
Improve                                   I       A
• Ideal state
• Apply innovation
• Future state
Control
• Sustain the gains!
What is Six Sigma?
                                            Defects Per

                                     σ
                                             Defects Per
• Sigma level (1-6) refers to
  the number of defects per          σ        Million
                                               Million
                                           Opportunities
                                           Opportunities   %
                                                           %
  million opportunities. The
                                     1
                                     1      697,672
                                            697,672    30
                                                       30
  higher the number, the
  fewer the defects.                 2
                                     2      308,770
                                            308,770    69
                                                       69
                                     3
                                     3      66,810
                                             66,810  93.3
                                                      93.3
• Most organizations
  operate around 3 to 4              4
                                     4       6,209
                                              6,209  99.37
                                                     99.37
  Sigma.                             5
                                     5        232
                                               232   99.97
                                                     99.97
 From 3σ to 6σ represents a 20,000   6
                                     6         3.7
                                               3.7  99.9997
                                                    99.9997
   times improvement in quality.
                    Is 99% Good Enough?
                     Is 99% Good Enough?
The Classical View of              The Six Sigma View of
      Quality                             Quality
 “99% Good” (3.8σ )                 “99.99966% Good”
                                           (6σ )
20,000 lost articles of mail per    Seven lost articles of mail per
hour                                hour

5,000 incorrect surgical            1.7 incorrect surgical
operations per week                 operations per week

2 short or long landings at         One short or long landing at
most major airports daily           most major airports every five
                                    years

200,000 wrong drug                  68 wrong drug prescriptions
prescriptions each year             each year
WHAT IS “LEAN”?
• A Methodology That Focuses On
   – Improving Workflow
   – Eliminating Waste
   – Delivering Value

       On-Demand, Defect-Free,
     One-By-One at the Lowest Cost
‘Lean’ Thinking Complements Six Sigma
  • Lean           • Six Sigma
    – Waste is the enemy          – Variation is the enemy
    – Focus on process            – Focus on process
      velocity                      quality and eliminating
    – Tools provide                 defects
      analysis of process
                                  – Tools provide analysis
      flow and value-
      added vs. non-                of contributing causes
      value added                   to identify the ‘vital
                                    few’
Synergy: Variation is much easier to see with a ‘lean’ process
Lean Six Sigma Compared to
 Traditional Problem Solving
• Strong focus on the customer

• Eliminating defects

• Focus on process (velocity)

• Intolerance to process ‘waste’
Results
Recruitment’s Six Sigma Project

              • Baseline data for
                3/2005:
                – Openings: 765
                – New candidates: 1883
                – Applicants per
                  position: 2.5
                – Time to fill: 53 days*

                *all of CY 2005
Results
• Measurable
  improvements
  – Number of open
    positions
     • March 2005: 765
     • March 2010: 343
     • Reduction: 55%
Results
• Measurable
  improvements
     – Time to fill
           • CY 2005: 53 days
           • CY 2009*: 36 days
           • Reduction: 32%




*Through June 2009
Results
• Measurable
  improvements
  – New applicants
     •   March 2005: 1883
     •   March 2010: 2578
     •   Increase: 36.9%
     •   Peaked September
         2010: 3925 or a
         108.4% increase
Results
• Measurable
  improvements
  – Applicants per posting
     •   March 2005: 2.5
     •   April 2010: 5.2
     •   Increase: 108%
     •   Peaked January
         2010: 9.6 or a 284%
         increase
Results
• Measurable
  improvements
  – Reduced expenses on
    interim staffing
     • FY 2004 Registry:
       $6,103,294
     • FY 2008 Registry:
       $2,875,774
     • Reduction:
       $3,227,520 or 52.9%
Results
• Measurable
  improvements
  – Reduced expenses on
    interim staffing
     • FY 2004 Registry
       Hours: 114,989
     • FY 2008 Registry
       Hours: 52,157
     • Reduction: 54.6%
Results
• Measurable
  improvements
  – Reduced expenses on
    interim staffing
     • FY 2004 Traveler
       Hours: 292,273
     • FY 2008 Traveler
       Hours: 190,137
     • Reduction: 34.9%
Results
• Measurable
  improvements
  – New hire performance
    improvements*
     • FY 2004 vs. FY 2005:
       15.3% increase
     • FY 2004 vs. FY 2006:
       23.1% increase
     • FY 2004 vs. FY 2007:
       20.5% increase
     • FY 2004 vs. FY 2008:
       23.1% increase
Results
• Non-measurable
  improvements
  – Improved approach to
    managing expenses
     • Media
     • Events
     • Other
  – Improved approach to
    investigating new
    media, technologies
    and practices
Results
• Non-measurable
  improvements
  – More confidence
    working with the hiring
    managers
     • Improved
       relationships
     • More comfortable
       “providing input”
     • More comfortable
       innovating
Results
• Non-measurable
  improvements
  – Expedited a culture of
    more accountability
     • Within Recruitment
     • Outside of
       Recruitment
Questions?



Contact Information:
E-mail: michael.peterson@sharp.com
Social Media- Opinions expressed are my own
LinkedIn: http://www.linkedin.com/in/michaelkpeterson
Twitter: @SoCalRecruiting
Blog: SoCalRecruiting.wordpress.com

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Process Improvement Presentation V1

  • 1. Performance Improvement that Makes a Difference Presented by: Michael Peterson, PHR
  • 2. Today’s Agenda • Introduction to Sharp • Are you ready for a process improvement initiative? • Introduction to Six Sigma • What is LEAN vs. Six Sigma • Results • Questions
  • 3. Sharp HealthCare • San Diego’s Health Care Leader • Not-for-profit • Largest health care system in San Diego – 4 Acute Care Hospitals – 3 Specialty Hospitals – 2 Affiliated Medical Groups – Full range of programs and services • Largest private employer in San Diego – 15,000 Employees – 2,600 Affiliated Physicians – 2,000 Volunteers
  • 5. Are you ready? • Foundational elements of process improvement – Often overlooked – Leads to the failure of many, if not most, process improvement initiatives
  • 6. Are you ready? • Define – What is the true problem? Baseline measures – What does success look like? – How will it be measured? • Assess – What is the driver for improvement? • Internal to the department • External, but within the company • External from the company • A mix?
  • 7. Are you ready? • Assess – How will you sustain the gains/improvements? • Policy and procedural changes • Audits – How – What resources – Who • Incentives – What kind? – Unintended consequences
  • 8. Are you ready? • Assess – Are your processes stable? • It is impossible to improve any process that is not consistent – The Toyota Way – Is anything “hiding” problems • The Toyota Way – Batch manufacturing
  • 9. Are you ready? • Assess – Is anything “hiding” problems (continued) • What may be hiding problems in Recruiting? – Success – Brand – Lack of competition – Lack of need – Candidate database – Apathy – Unrealized problem(s) – Lack of knowledge of a better state
  • 10. Are you ready? • Assess – Do you have the resources? • People- everyone is accountable • Money • Time – What are the obstacles? • Can we mitigate them?
  • 12. What is Six Sigma? • A methodology that focuses on data-driven decisions • Reduction in variation • A statistical term that represents near-perfection • A philosophy of driving results to levels never before expected
  • 13. Define DMAIC Methodology • The context of the process • The customer • The right metrics and targets Measure • Input requirements D • Output requirements • In-process requirements C Lean M Analyze • Cause and effects Six Sigma • Determine the gap Improve I A • Ideal state • Apply innovation • Future state Control • Sustain the gains!
  • 14. What is Six Sigma? Defects Per σ Defects Per • Sigma level (1-6) refers to the number of defects per σ Million Million Opportunities Opportunities % % million opportunities. The 1 1 697,672 697,672 30 30 higher the number, the fewer the defects. 2 2 308,770 308,770 69 69 3 3 66,810 66,810 93.3 93.3 • Most organizations operate around 3 to 4 4 4 6,209 6,209 99.37 99.37 Sigma. 5 5 232 232 99.97 99.97 From 3σ to 6σ represents a 20,000 6 6 3.7 3.7 99.9997 99.9997 times improvement in quality. Is 99% Good Enough? Is 99% Good Enough?
  • 15. The Classical View of The Six Sigma View of Quality Quality “99% Good” (3.8σ ) “99.99966% Good” (6σ ) 20,000 lost articles of mail per Seven lost articles of mail per hour hour 5,000 incorrect surgical 1.7 incorrect surgical operations per week operations per week 2 short or long landings at One short or long landing at most major airports daily most major airports every five years 200,000 wrong drug 68 wrong drug prescriptions prescriptions each year each year
  • 16. WHAT IS “LEAN”? • A Methodology That Focuses On – Improving Workflow – Eliminating Waste – Delivering Value On-Demand, Defect-Free, One-By-One at the Lowest Cost
  • 17. ‘Lean’ Thinking Complements Six Sigma • Lean • Six Sigma – Waste is the enemy – Variation is the enemy – Focus on process – Focus on process velocity quality and eliminating – Tools provide defects analysis of process – Tools provide analysis flow and value- added vs. non- of contributing causes value added to identify the ‘vital few’ Synergy: Variation is much easier to see with a ‘lean’ process
  • 18. Lean Six Sigma Compared to Traditional Problem Solving • Strong focus on the customer • Eliminating defects • Focus on process (velocity) • Intolerance to process ‘waste’
  • 20. Recruitment’s Six Sigma Project • Baseline data for 3/2005: – Openings: 765 – New candidates: 1883 – Applicants per position: 2.5 – Time to fill: 53 days* *all of CY 2005
  • 21. Results • Measurable improvements – Number of open positions • March 2005: 765 • March 2010: 343 • Reduction: 55%
  • 22. Results • Measurable improvements – Time to fill • CY 2005: 53 days • CY 2009*: 36 days • Reduction: 32% *Through June 2009
  • 23. Results • Measurable improvements – New applicants • March 2005: 1883 • March 2010: 2578 • Increase: 36.9% • Peaked September 2010: 3925 or a 108.4% increase
  • 24. Results • Measurable improvements – Applicants per posting • March 2005: 2.5 • April 2010: 5.2 • Increase: 108% • Peaked January 2010: 9.6 or a 284% increase
  • 25. Results • Measurable improvements – Reduced expenses on interim staffing • FY 2004 Registry: $6,103,294 • FY 2008 Registry: $2,875,774 • Reduction: $3,227,520 or 52.9%
  • 26. Results • Measurable improvements – Reduced expenses on interim staffing • FY 2004 Registry Hours: 114,989 • FY 2008 Registry Hours: 52,157 • Reduction: 54.6%
  • 27. Results • Measurable improvements – Reduced expenses on interim staffing • FY 2004 Traveler Hours: 292,273 • FY 2008 Traveler Hours: 190,137 • Reduction: 34.9%
  • 28. Results • Measurable improvements – New hire performance improvements* • FY 2004 vs. FY 2005: 15.3% increase • FY 2004 vs. FY 2006: 23.1% increase • FY 2004 vs. FY 2007: 20.5% increase • FY 2004 vs. FY 2008: 23.1% increase
  • 29. Results • Non-measurable improvements – Improved approach to managing expenses • Media • Events • Other – Improved approach to investigating new media, technologies and practices
  • 30. Results • Non-measurable improvements – More confidence working with the hiring managers • Improved relationships • More comfortable “providing input” • More comfortable innovating
  • 31. Results • Non-measurable improvements – Expedited a culture of more accountability • Within Recruitment • Outside of Recruitment
  • 32. Questions? Contact Information: E-mail: michael.peterson@sharp.com Social Media- Opinions expressed are my own LinkedIn: http://www.linkedin.com/in/michaelkpeterson Twitter: @SoCalRecruiting Blog: SoCalRecruiting.wordpress.com

Notas del editor

  1. MP TO PUT OUR STORY INTO PERSPECTIVE, LET ME TAKE A MOMENT TO PROVIDE YOU A VERY BRIEF OVERVIEW OF THE SHARP HEALTHCARE ORGANIZATION. SHARP IS A NOT-FOR-PROFIT, FULLY INTEGRATED HEALTH CARE SYSTEM SERVING THE ENTIRE COUNTY OF SAN DIEGO FOR OVER FIFTY YEARS…….. And for our last polling question, please let us know what industry you work in
  2. MP TO PUT OUR STORY INTO PERSPECTIVE, LET ME TAKE A MOMENT TO PROVIDE YOU A VERY BRIEF OVERVIEW OF THE SHARP HEALTHCARE ORGANIZATION. SHARP IS A NOT-FOR-PROFIT, FULLY INTEGRATED HEALTH CARE SYSTEM SERVING THE ENTIRE COUNTY OF SAN DIEGO FOR OVER FIFTY YEARS…….. And for our last polling question, please let us know what industry you work in
  3. MP Start of many process improvement initiatives: Things “need to be better, or improve” But this critical step is often overlooked and leads to failure How many times have you been part of a “process improvement initiative” only to see all those efforts either: Result in improvement that is short lived Or drift to a state of marginal improvement This is because of our eagerness to get the work done without thinking of where we are and where we are going Would you start a long journey with no idea where you are and where you are headed?
  4. MP How to determine where you are and where you are headed: Define where you are by: Looking at what the problems are, accept that you may not know the causes yet Determine how things will be measured, again accept that you may add to these measures Conduct baseline measures, this will later help you measure effectiveness Determine what success looks like by: Listening to the voice of the customer, what you want usually doesn’t matter, what they want does Job seeker example GM example Defining what successful measures will be: Better time measures (be careful) Better cost measures (be careful) Better quality measures Better outcomes Anecdotal measures The definition of success may be partially defined by the driver for improvement For example, if your customers are saying quality is too low, you wouldn’t necessarily focus on cost savings
  5. MP Sustaining the gains/improvements are one of the areas that many projects fail: We all have examples from our experience of those projects that improve performance for a short time, but them everyone slowly returns to their old ways Early on or in some cases before starting the project, look at the tools that you have to make the improvement sustainable and review any “infrastructure” like policies and procedures that may need to be changed. If policies and procedures need to be changed, you will need to build into your plan the necessary steps based on your organization. Approvals from sr. leadership, committees, etc. Impact on other departments that utilize/are governed by the same policy/procedure Input and buy in from customers For example: if you are changing the service delivery model, you want input from those that receive the service Do you use audits? (how, what resources do you have, who would do it, what is the enforcement mechanism) Incentives? (what kind, how do you fund?) Watch for unintended consequences
  6. MP It is impossible to improve any process that is not consistent from the Toyota Way Process improvement is difficult enough with one process, let alone 5 processes that are inconsistent and vary from person to person So ask your self, are your processes stable? If they are, then you can proceed with the initiative If they are not, this makes things very difficult How do you do a baseline measure? Are the variable processes the cause of the issue? Work to create one process and see what the impact is You may still be able to measure a baseline, but it would probably need to be something like customer satisfaction Also be prepared to accept that part of your processes/infrastructure may be hiding problems In Toyota Way one manufacturing process that hides problems is traditional “batch” manufacturing where a large supply of parts is made, but that has an unintended consequence of hiding inefficiencies in planning and production
  7. MP Here are some examples of things within Recruiting that would potentially hide problems
  8. MP Finally before starting: Assess if you have the resources necessary, this is another point of failure or at least delay for projects Identify other obstacles and proactively try to find a way to mitigate them Buy in from someone that is hard to convince Cooperation from another department Systems and processes that would not support change or need to be worked around
  9. Many of the elements of Six Sigma and touched upon in The Toyota Way To be honest, I didn’t read Toyota Way until after the Six Sigma Project was complete and realized that some of the concepts in the book were ones that we utilized and explored as part of our project
  10. I have taken you through some of these earlier, specifically Defining and Control To Measuring on this slide I would add a baseline measure to establish a means by which to measure progress
  11. Who functions at a Six Sigma level? Airplane industry…thinking about landings. Six sigma focuses on reducing variability, it does not much matter where – could be very useful in these businesses as well. 3  capability—historical standard 4  capability—current standard 6  capability—new standard We must deliver every project, product, or service with the highest quality. In today’s marketplace, “good” is no longer good enough. The experience of several world class companies which have dramatically improved quality levels using the Six Sigma method has demonstrated that: We can be much better if we take a rigorous approach to quality improvement. Six Sigma means: A 99.99966% probability that we will not pass on a defect to the customer.
  12. March 2005 was as far back as I could go We’re a big organization with a lot of moving parts, so obviously these improvements are the result of many initiatives, some of which were part of or resulted from six sigma, but some were independent or even beyond our control
  13. MP
  14. MP Applicant volume increases started small in July 2005 and kept growing stronger and stronger with some fluctuation
  15. MP We started tracking applicants per posting because we recognized the number of postings declining and felt that this decline would eventually impact the volume of applicants, which is something that we may be seeing today.
  16. MP For those of you outside of healthcare, Registry is something like a last minute temporary employee… they come in to cover for a shorter period of time, usually for unplanned absences Having additional available staff and a strong internal temp pool can mitigate the need for external registry We also implemented an internal system that allows employees to “bid” on available shifts for coverage
  17. MP Dramatic reduction in Registry Hours
  18. MP The reason I did not share cost with you is the number was deceptive. The underlying structure of how we worked with Travelers changed completely since FY 2004 and the per hour rate increased dramatically as a result.
  19. MP So getting to the focus of this presentations title, these are the results we have for quality of hire We measured quality of hire for the purpose of this presentation by comparing average merit increases for individuals hired on or after FY 2004 FY 2004- before the Six Sigma Project This slide reflects the percent increase in average merit increase since the FY 2004, not the actual increase to salary Quality of hire is the result of a process As you can see, Six Sigma is a great tool/methodology for reviewing and improving processes So look at where you are, and where you want to be: The D in DMAIC stands for Define, so define what a high quality hire is. Is it mgr satisfaction, performance, cultural integration, team integration, new hire satisfaction, is it multi-dimensional? What time frames are critical? Then decide if a Six Sigma process is what you need to make the improvements necessary. Look at the variability, determine what is driving it and fix it. Keep asking why throughout the process? The C in DMAIC stands for control and that is the true key- building a sustainable fix.
  20. MP I feel that the non-measurable improvements are the true benefits and the measurements are the outcome of those improvements Being data driven, being more confident in moving forward with new technologies You have a comfort with data going in You have a comfort with data to evaluate efficacy
  21. MP Communication improves relationships Armed with data and experience, we are more comfortable providing input to managers More comfortable innovating
  22. MP Throughout the talent supply chain, more accountability Perfect- no Better- yes
  23. MP My contact information is: [email_address] Also on LinkedIn and Twitter I also have a blog: socalrecruiting.wordpress.com