LEAN

1. http://vimeo.com/24784020

2. An Introduction to Lean Six
Sigma
“We don’t know what we don’t know.
We can’t act on what we don’t know.
We won’t know until we search.
We won’t search for what we don’t question.
We don’t question what we don’t measure.
Hence, we just don’t know.”
Dr. Mikel Harry

3. Process Improvement
1. Initial Perception of problem
2. Clarify Problem
3. Locate Point of Cause
4. Root Cause Analysis
5. Design Solutions
6. Measure Effectiveness
7. Standardize

4. Lean Six Sigma Process Improvement
• Lean Six Sigma Seeks to improve the quality
of manufacturing and business process by:
– identifying and removing the causes of defects
(errors) and variation.
– Identifying and removing sources of waste
within the process
– Focusing on outputs that are critical to
customers Define
Measure
AnalyzeImprove
Control

5. Lean Six Sigma Process Improvement
• LSS is a management philosophy that seeks to drive a
quality culture change through a multi-level based
program
Level Training
Green Belt LSS Methodology and basic tool
set
Black Belt Green Belt content plus
advanced data analysis
Master Black Belt Black belt content plus program
management, leadership skills,
some advanced tools

6. 1930 19501900
Ford
Assembly Line
Guinness
Brewery
Shewhart
Introduces SPC
Gilbreth, Inc.
•Management
Theory
•Industrial
Engineering
Deming
•14 Points
•7 Deadly Diseases
Toyota Production
System
Lean Six Sigma Timeline

7. 1990 20001980
Motorola
Introduces Six
Sigma
Just – in–Time
SPC
Lean Mfg.
TQM
AlliedSIgnal
GE Adapt LSS to
Business Processes
Lean Six Sigma Timeline

8. Background on Lean
• Lean comes out of the industrial engineering world
• Taiichi Ohno – Toyota Production System.
– 1940s-1950s company was on verge of bankruptcy
– Dynamics of industry were changing – moving from mass
production to more flexible, shorter, varied batch runs (people
wanted more colors, different features, more models, etc).
• Ohno was inspired by 3 observations on a trip to America
– Henry Ford’s assembly line inspired the principle of flow (keep
products moving because no value is added while it is sitting
still)
– The Indy 500 – Rapid Changeover
– The American Grocery Store – led to the Pull system – material
use signals when and how stock needs to be replenished

9. Path To Lean
Theory Waste is Deadly
Application 1. Define Value – act on what is
important to the customer
2. Identify Value Stream – understand
what steps in the process add value
and which don’t
3. Make it flow – keep the work moving
at all times and eliminate waste that
creates delay
4. Let customer pull -- Avoid making more
or ordering more inputs for customer
demand you don’t have
5. Pursue perfection -- there is no
optimum level of performance
Focus Flow Focused
Assumptions Non-Value added steps exit
Results Reduced cycle time

10. Waste Defined
Wastes Healthcare Examples
Transport 1. Moving patients from room to room
2. Poor workplace layouts, for patient services
3. Moving equipment in and out of procedure room or operating room
Inventory 1. Overstocked medications on units/floors or in pharmacy
2. Physician orders building up to be entered
3. Unnecessary instruments contained in operating kits
Motion 1. Leaving patient rooms to:
• Get supplies or record
• Documents care provided
2. Large reach/walk distance to complete a process step
Waiting 1. Idle equipment/people
2. Early admissions for procedures later in the day
3. Waiting for internal transport between departments
Over-Production 1. Multiple signature requirements
2. Extra copies of forms
3. Multiple information systems entries
4. Printing hard copy of report when digital is sufficient
Over-Processing 1. Asking the patient the same questions multiple times
2. Unnecessary carbon copying
3. Batch printing patient labels
Defects 1. Hospital-acquired illness
2. Wrong-site surgeries
3. Medication errors
4. Dealing with service complaints
5. Illegible, handwritten information
6. Collection of incorrect patient information
Skills 1. Not using people’s mental, creative, and physical abilities
2. Staff not involved in redesigning processes in their workplace
3. Nurses and Doctors spending time locating equipment and supplies
4. Staff rework due to system failures

11. Lean Foundations
• Standardized Work – people should analyze their work
and define the way that best meets the needs of all
stakeholders.
– “The current one best way to safely complete an activity
with the proper outcome and the highest quality, using the
fewest possible resources”
– Standardized not Identical – mindless conformity and the
thoughtful setting of standards should not be confused
– Written by those who do the work.
• Level loading – smoothing the workflow and patient
flow throughout the hospital.
• Kaizen – continuous improvement

12. Lean Methods
• Kaizen Events (or SCORE events)
– Planned and structured process that enables a small group of people
to improve some aspect of their business in a quick, focused manner.
• Select
• Clarify
• Organize
• Run
• Evaluate
• 5S – this methodology reduces waste through improved workplace
organization and visual management
– Sort, Store, Shine, Standardize and Sustain
• Kanban – a Japanese term that can be translated as “signal,” “card,”
or “sign.”
– Most often a physical signal (paper card of plastic bin), that indicates
when it is time to order more, from whom, and in what quantity.

13. Lean vs. Six Sigma
• Lean tends to be used for shorter, less complex problems. Often
time driven. Focus is on eliminating wasteful steps and practices.
• Six Sigma is a bigger more analytical approach – often quality driven
– it tends to have a statistical approach. Focus on optimizing the
important steps – reducing defects.
• Some argue Lean moves the mean, SixSigma moves the variance.
But they are often used together and should not be viewed as
having different objectives.
– Waste elimination eliminates an opportunity to make a defect
– Less rework means faster cycle times
• Six Sigma training might be specialized to the “quality” department,
but everyone in the organization should be trained in Lean

14. VOC vs. VOP
Voice of Customer
Voice of Process
The Voice of the Process is independent of
the Voice of the Customer
Sigma
Capability
Defects per
Million
Opportunities
% Yield
2 308,537 69.15%
3 66,807 93.32%
4 6,210 99.38%
5 233 99.98%
6 3.4 99.99966%

15. What’s good enough?
99% Good (3.8 Sigma) 99.99966% Good (6 Sigma)
20,000 lost articles of mail per hour
(based on 2,000,000/hr)
7 articles lost per hour
Unsafe drinking water for almost 15
minutes each day
1 unsafe minute every 7 months
5,000 incorrect surgical operations per
week
1.7 incorrect operations per week
2 short or long landings daily at an
airport with 200 flights/day
1 short or long landing every 5 years
2,000,000 wrong drug prescriptions
each year
680 wrong prescriptions per year
No electricity for almost 7 hours each
month
1 hour without electricity every 34
years

16. Goals of Lean Six Sigma
LSL USL
Customer Target
DefectsDefects
Prevent Defects by
Reducing Variation
LSL USL
Customer Target
Defects
Prevent Defects by
Centering ProcessLSL USL
Customer Target
Meet Customer
Requirements

17. What Makes a Good Lean Six Sigma
Project?
• There is no known solution
• The root cause is not known
• The problem is complex and needs statistical
analysis
• The problem is part of a process
• The process is repeatable
• A defect can be defined
• Project will take 3-6 months
• There are data available

18. The DMAIC Methodology
• Define – describe the problem quantifiably and the
underlying process to determine how performance will
be measured.
• Measure – use measures or metrics to understand
performance and the improvement opportunity.
• Analyze – identify the true root cause(s) of the
underlying problem.
• Improve – identify and test the best improvements that
address the root causes.
• Control – identify sustainment strategies that ensure
process performance maintains the improved state.

19. Define
• Define Scope of the Problem
– Document the Process
– Collect and Translate the Voice of the Customer
• Determine Project Objective and Benefits
– Define Metrics and Defects
– Establish Preliminary Baseline
– Develop Problem & Objective Statements
– Estimate Financial Benefit

20. Define (continued)
• Create Project Charter
– Confirm Improvement Methodology
– Define Project Roles and Responsibilities
– Identify Risks
– Establish Timeline
– Managerial Buy-in
• Focus here is on the problem

21. Measure
Measure what is measurable, and make measurable what is not so” – Galileo
• Define “As Is” process
– Value stream map/process flow diagram
• Validate Measurement System for Outputs
– Don’t assume your measurements are accurate –
measuring system must accurately tell what is
happening
• Quantify Process Performance
– Collect data (Y’s)
– Examine process stability/capability analysis

22. Analyze
• Identify Potential Causes (X’s)
• Investigate Significance of X’s
– Collect data on x’s
– Graphical/Quantitative analysis
• Pareto Chart
• Fishbone Diagram (cause and effect)
• Chi Square Test
• Regression Analysis
• Failure Mode Effects Analysis
• Identify Significant Causes to focus on (y=f(X))
– Evaluate the impact of x’s on y
• Here you identify the critical factors of a “good” output and
the root causes of defects or “bad” output.

23. Improve
• Generate Potential Solutions
• Select & Test Solution
• Develop Implementation Plan

24. Control
• Create Control & Monitoring Plan
– Mistake proof the process
– Determine the x’s to control and methods
– Determine Y’s to monitor
• Implement Full Scale Solution
– Revise/develop process
– Implement and evaluate solution
• Finalize Transition
– Develop transition plan
– Handoff process to owner