Simplifying Process Improvement/Lean/Six Sigma Programs for Healthcare IIE Engineering Lean and Six Sigma Conference 2013 September 23-25, 2013 Crowne Plaza at Ravinia Atlanta
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craigastevens@westbrookstevens.com
The Most Efficient Doctor Visit What does excellent look like?
Doctor Lucy Treatments
5 C
Agenda Creating a Team Focused Improvement Program
✓
1
Our Foundations of CPI
2
TQM, Lean, Six-Sigma, Strategic Project Management
3
This an example text. Go Phases ahead and replace it Threeis Easy To Understand
4
Levels of Resources
5
Training Levels, Tools, and Big Rocks
6
Summary of PI Program Approach
3
People and Team Building
Westbrook Stevens, Seven Attributes of Excellent Management Model, 1990 Š
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Our Foundations of CPI The Seven Attributes of Excellent Management
1. Excellent Leadership = Leadership Throughout the Organization, Everyone is Empowered to Lead Their Own Work – What Does Excellent Leadership Look Like? – What Does Our Leadership Look Like? • Are Leaders On Board and Do we have a Leader for the CPI Project?
– Where are the Gaps? – Fix the Gaps! 1/7/2013
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Adapted from Palma Buttles-Valdez, Carnegie Mellon ,Process improvement Briefing to Software Engineering Institute, 2008 – who adapted it from and Dr. Mary Lippitt, Enterprise Management, LTD., 1987, ttp://www.jcse.org.za/upload/events/37/organisational_culture_and_people_issues_in_process_improvementdrpalma_ buttlesvaldez.pdf 2/13 2013
Improvement Efforts and Missing Elements of Change Vision
Resources
Capable Workforce
Capable Processes
Organizational Culture
Incentives
Action Plan
Change
Resources
Capable Workforce
Capable Processes
Organizational Culture
Incentives
Action Plan
Confusion
Capable Workforce
Capable Processes
Organizational Culture
Incentives
Action Plan
Anxiety and Frustration
Capable Processes
Organizational Culture
Incentives
Action Plan
Slow or Little Progress
Organizational Culture
Incentives
Action Plan Action Plan
Reinventing the Wheel
Vision Vision
Resources
Vision
Resources
Vision
Resources
Vision
Resources
Vision
Leadership
Capable Workforce Capable Workforce Capable Workforce
Capable Processes Capable Processes
Organizational Culture
Resources
Capable Workforce
Capable Processes
Organizational Culture
Systems and People
Problem Solving / Skills
Systems and Processes
Incentives
Culture
Action Plan
Incentives
People
Barriers to Change Sporadic Change
False Starts Problem Solving/Skills Tools
Our Foundations of CPI The Seven Attributes of Excellent Management
2. Excellent Culture = The Culture of the Organization, The Culture of the Group – What Does Excellent Organizational Culture Look Like? – What Does Our Culture Look Like? • Are All Stakeholders On Board and Do we have a Willing Culture for the CPI Project?
– Where are the Gaps? – Fix the Gaps! 1/7/2013
7
Adapted from Palma Buttles-Valdez, Carnegie Mellon ,Process improvement Briefing to Software Engineering Institute, 2008 – who adapted it from and Dr. Mary Lippitt, Enterprise Management, LTD., 1987, ttp://www.jcse.org.za/upload/events/37/organisational_culture_and_people_issues_in_process_improvementdrpalma_ buttlesvaldez.pdf 2/13 2013
Improvement Efforts and Missing Elements of Change Vision
Resources
Capable Workforce
Capable Processes
Organizational Culture
Incentives
Action Plan
Change
Resources
Capable Workforce
Capable Processes
Organizational Culture
Incentives
Action Plan
Confusion
Capable Workforce
Capable Processes
Organizational Culture
Incentives
Action Plan
Anxiety and Frustration
Capable Processes
Organizational Culture
Incentives
Action Plan
Slow or Little Progress
Organizational Culture
Incentives
Action Plan Action Plan
Reinventing the Wheel
Vision Vision
Resources
Vision
Resources
Vision
Resources
Vision
Resources
Vision
Leadership
Capable Workforce Capable Workforce Capable Workforce
Capable Processes Capable Processes
Organizational Culture
Resources
Capable Workforce
Capable Processes
Organizational Culture
Systems and People
Problem Solving / Skills
Systems and Processes
Incentives
Culture
Action Plan
Incentives
People
Barriers to Change Sporadic Change
False Starts Problem Solving/Skills Tools
Our Foundations of CPI The Seven Attributes of Excellent Management
3. Excellent Customer Focus – – – –
What Does Excellent Customer Focus Look Like? What Does Our Customer Focus Look Like? Where are the Gaps? Fix the Gaps!
1/7/2013
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Our Foundations of CPI The Seven Attributes of Excellent Management
4. Excellent Team Building = All Things People, Team Issues, and Motivational Theories – – – –
What Does Excellent People Management Look Like? What Does Our People Management Look Like? Where are the Gaps? Fix the Gaps!
1/7/2013
10
Adapted from Palma Buttles-Valdez, Carnegie Mellon ,Process improvement Briefing to Software Engineering Institute, 2008 – who adapted it from and Dr. Mary Lippitt, Enterprise Management, LTD., 1987, ttp://www.jcse.org.za/upload/events/37/organisational_culture_and_people_issues_in_process_improvementdrpalma_ buttlesvaldez.pdf 2/13 2013
Improvement Efforts and Missing Elements of Change Vision
Resources
Capable Workforce
Capable Processes
Organizational Culture
Incentives
Action Plan
Change
Resources
Capable Workforce
Capable Processes
Organizational Culture
Incentives
Action Plan
Confusion
Capable Workforce
Capable Processes
Organizational Culture
Incentives
Action Plan
Anxiety and Frustration
Capable Processes
Organizational Culture
Incentives
Action Plan
Slow or Little Progress
Organizational Culture
Incentives
Action Plan Action Plan
Reinventing the Wheel
Vision Vision
Resources
Vision
Resources
Vision
Resources
Vision
Resources
Vision
Leadership
Capable Workforce Capable Workforce Capable Workforce
Capable Processes Capable Processes
Organizational Culture
Resources
Capable Workforce
Capable Processes
Organizational Culture
Systems and People
Problem Solving / Skills
Systems and Processes
Incentives
Culture
Action Plan
Incentives
People
Barriers to Change Sporadic Change
False Starts Problem Solving/Skills Tools
Our Foundations of CPI The Seven Attributes of Excellent Management
5. Excellent Problem Solving = All Things Skills, Core Competencies, and Problem Solving Tools (Project Management, Six Sigma, Lean, Accounting, Etc.) – – – –
What Does Excellent Skills and Tools Look Like? What Does Our Skills and Tools Look Like? Where are the Gaps? Fix the Gaps!
1/7/2013
12
Adapted from Palma Buttles-Valdez, Carnegie Mellon ,Process improvement Briefing to Software Engineering Institute, 2008 – who adapted it from and Dr. Mary Lippitt, Enterprise Management, LTD., 1987, ttp://www.jcse.org.za/upload/events/37/organisational_culture_and_people_issues_in_process_improvementdrpalma_ buttlesvaldez.pdf 2/13 2013
Improvement Efforts and Missing Elements of Change Vision
Resources
Capable Workforce
Capable Processes
Organizational Culture
Incentives
Action Plan
Change
Resources
Capable Workforce
Capable Processes
Organizational Culture
Incentives
Action Plan
Confusion
Capable Workforce
Capable Processes
Organizational Culture
Incentives
Action Plan
Anxiety and Frustration
Capable Processes
Organizational Culture
Incentives
Action Plan
Slow or Little Progress
Organizational Culture
Incentives
Action Plan Action Plan
Reinventing the Wheel
Vision Vision
Resources
Vision
Resources
Vision
Resources
Vision
Resources
Vision
Leadership
Capable Workforce Capable Workforce Capable Workforce
Capable Processes Capable Processes
Organizational Culture
Resources
Capable Workforce
Capable Processes
Organizational Culture
Systems and People
Problem Solving / Skills
Systems and Processes
Incentives
Culture
Action Plan
Incentives
People
Barriers to Change Sporadic Change
False Starts Problem Solving/Skills Tools
Our Foundations of CPI The Seven Attributes of Excellent Management
6. Excellent Continuous Improvement = All Things Change Related, Continuous Improvement, Systems, and Processes (Systems Thinking, CPI) – What Does Excellent Change Management (Systems and Process Improvement) Look Like? – What Does Our Change Management (Systems and Process Improvement) Look Like? – Where are the Gaps? – Fix the Gaps! 1/7/2013 14
Adapted from Palma Buttles-Valdez, Carnegie Mellon ,Process improvement Briefing to Software Engineering Institute, 2008 – who adapted it from and Dr. Mary Lippitt, Enterprise Management, LTD., 1987, ttp://www.jcse.org.za/upload/events/37/organisational_culture_and_people_issues_in_process_improvementdrpalma_ buttlesvaldez.pdf 2/13 2013
Improvement Efforts and Missing Elements of Change Vision
Resources
Capable Workforce
Capable Processes
Organizational Culture
Incentives
Action Plan
Change
Resources
Capable Workforce
Capable Processes
Organizational Culture
Incentives
Action Plan
Confusion
Capable Workforce
Capable Processes
Organizational Culture
Incentives
Action Plan
Anxiety and Frustration
Capable Processes
Organizational Culture
Incentives
Action Plan
Slow or Little Progress
Organizational Culture
Incentives
Action Plan Action Plan
Reinventing the Wheel
Vision Vision
Resources
Vision
Resources
Vision
Resources
Vision
Resources
Vision
Leadership
Capable Workforce Capable Workforce Capable Workforce
Capable Processes Capable Processes
Organizational Culture
Resources
Capable Workforce
Capable Processes
Organizational Culture
Systems and People
Problem Solving / Skills
Systems and Processes
Incentives
Culture
Action Plan
Incentives
People
Barriers to Change Sporadic Change
False Starts Problem Solving/Skills Tools
Our Foundations of CPI The Seven Attributes of Excellent Management
7. Excellent Performance Measures – What Do Excellent Performance Measures Look Like? • Seven Steps (1. Know the Rules, 2. Know the Goals, 3. Know the Criterion for the Goals, 4. Know the Indicators of the Criterion, 5. Collect the Data, 6. Analyze the Data, and 7. Use the Data)
– What Does Our Performance Measures Look Like? – Where are the Gaps? – Fix the Gaps! 16
1/7/2013
Agenda Creating a Team Focused Improvement Program
✓
1
Our Foundations of CPI
✓
2
TQM, Lean, Six-Sigma, Strategic Project Management
3
This an example text. Go Phases ahead and replace it Threeis Easy To Understand
4
Levels of Resources
5
Training Levels, Tools, and Big Rocks
6
Summary of PI Program Approach
7
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Lean Improvement Focused Teams
Lean Focuses on reducing waste and improving cycle time through continuous quality improvement Impact – Improves process flow and efficiency
Six Sigma Improvement Focused Teams
Six Sigma Focuses on reducing errors through rigorous data analysis and statistical controls Impact – Improves quality and reduces process variation Example From the HCA PI Teams
craigastevens@westbrookstevens.com
1st Order Changes or Continuous Improvement Adapt
1st
Some Order Changes become 2nd Order Changes
Adapt
Adapt
Start
1/7/2013 1/7/2013
Copyright Š 2007, www.WestbrookStevens.Com 20 20
craigastevens@westbrookstevens.com
Project Management is Required for 2nd Order Changes (or A Major Step Change)
Before the Change
1/7/2013 1/7/2013
During the Change
After the Change
21 Copyright Š 2007, www.WestbrookStevens.Com
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Project Management Improvement Focused Teams
Project Management ďƒ˜Major Changes Require Mastering Project Management
Example From the HCA PI Teams
Strategic Project Management
Strategic Project Management ďƒ˜Considers the overall value of the project related to desired strategic and tactical results
Example From the HCA PI Teams
Strategic Planning
Industrial/Systems Engineering
Process Improvement
Lean
Productivity Improvement
Project Selection Portfolio Management
Project Management Program Management
Agenda Creating a Team Focused Improvement Program
✓
1
Our Foundations of CPI
✓
2
TQM, Lean, Six-Sigma, Strategic Project Management
✓
3
Three Easy To Understand Phases
4
Levels of Resources
5
Training Levels, Tools, and Big Rocks
6
Summary of PI Program Approach
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Three Easy to Understand and Use Improvement Phases A= Assessments
P = Problem Solving
I = Implementation Using Project Management Tools/Support
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Assessment Phase
A= Assessments
P = Problem Solving
I = Implementation Using Project Management Tools/Support
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Solve Problems and Apply GFR (Benchmarking) A= Assessments
GFR GFR
GFR P = Problem Solving
I = Implementation Using Project Management Tools/Support
craigastevens@westbrookstevens.com
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Step 6 – Select the Solutions and Build a Project Portfolio A= Assessments
GFR GFR
GFR P = Problem Solving
I = Implementation Using Project Management Tools/Support
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Agenda Creating a Team Focused Improvement Program
✓
1
Our Foundations of CPI
✓
2
TQM, Lean, Six-Sigma, Strategic Project Management
✓
3
Three Easy To Understand Phases
✓
4
Levels of Resources
5
Training Levels, Tools, and Big Rocks
6
Summary of PI Program Approach
30
Three Types of Assessments Level One - SelfAssessments – – – –
Tool Box Available to All Sites PM Driven PI Supported Operations Follow Up
Level Two - Onsite Assessments – – – –
Only a Few DVP/GVP Chosen Sites PI Driven PM Support (and others) Operations Follow Up
Level Three - Third-Party Supported Assessments Level Three (A) – Third-Party Supported Assessment of Current Practices – – – –
For a Few Highly Complicated or Politically Charged Sites PI Driven Contractor Supported Operations Follow Up
Level Three (B) – Third-Party Assessment of New Acquisition –
– – –
For the Critical New Sites Chosen by DVP/GVPs TM Ops/Contractor Driven PI Supported Operations Follow Up
31
Three Types/Levels of Assessments
PM Driven Self-Assessments (Level 1)
PIP Team Onsite Assessments (Level 2) 32
Level One - Self-Assessments •
Materials/Tools – On-line Tool Box • A Menu of Tools • Triggers for When to Use the Tools
– 30 Minutes to an Hour Audios with PowerPoint Presentation – Example Projects (Green Flag Report Lessons Learned) • Scheduling, Staffing/Labor, Patient Flow, Telephones • General Assessing, Problem Solving, and Implementation Tools
•
•
Website, SharePoint Site, Newsletter – Lessons Learned and Materials – Face-to-Face, WebEx, and Online Education and Training Organizational Support Development – “The HCAPS Way” with a Culture of Continuous Improvement – Obtain Resources for Improvement and Sustainability
33
Team Room Link: http://teamrooms.hca.corpad.net/sites/hcapsproject/OPSS/Process%20Improvement/Forms/AllItems.aspx
Create the Tools and Teach How to Find and Use Them
Activity Tiers For Level Two Week 1 = Off-Site Kickoff, Surveys, and Data Gathering Week 2 = Off-Site Data Gathering, Interviews, and Analysis
A= Assessments
Week 3 = Managed Assessment and Problem Solving
Week 4 + = PMs Continue Problem Solving and Implementation Using Project Management
P = Problem Solving
I = Implementation Using Project Management Tools/Support
35
Build a Assessment Candidate Portfolio
Agenda Creating a Team Focused Improvement Program
✓
1
Our Foundations of CPI
✓
2
TQM, Lean, Six-Sigma, Strategic Project Management
✓
3
Three Easy To Understand Phases
✓
4
Levels of Resources
✓
5
Training Levels, Tools, and Big Rocks
6
Summary of PI Program Approach
37
CPI Training Modules
Suggested and Optional Modules Training Modules
Description
Leaders
Tools Only
Master
CPIP Team
Introduction and Orientation T.001.1234 - O.10.S - PI Training Introduction 20130208
This is a 30 Minute orientation to summarize the program.
O
X
X
X
T.001.1234 - O.10.L - PI Training Introduction - Hour 20130313 (one or the other)
More detailed Orientation - This is a 60 Minute summarization of the program for those whom will not take other training.
X
O
O
O
X
X
X
White Belt Training (2 hours) T.002.1234 - W-20-X1 - PI White 20 Minutes - General Introduction to Lean/6 Sigma/TQM/Change Management/Project Belt Training 20130208 Management
O
T.002.1234 - W-20-X2 - PI White 20 Minutes - Leadership - Situational Leadership Belt Training 20130208
O
X
X
T.002.1234 - W-20-X3 - PI White 20 Minutes - Leadership - Understanding Empowerment and how to get results Belt Training 20130208
O
X
X
T.002.1234 - W-20-X4 - PI White 30 Minutes - Culture – Understanding culture. Belt Training 20130212
O
O
X
X
T.002.1234 - W-20-X5 - PI White 30 Minutes - General Introduction to Customer Focus, People, Skills/Problem Belt Training 20130214 Solving Tools, Change/Improvement, and Performance Measures
O
O
X
X
Training by Levels of Expertise
120 Min.
For Leaders
Create an Understanding with a focus on Leadership and Empowerment (White Belt)
For Supervisors
1 Day – Mainly Lean Tools with some Culture, Teams, and Motivation
Be Able to Manage and Contribute to Improvements (Yellow Belt)
For Practitioners 2 Weeks Worth of Training, Projects and Tools For CPI Mentors and Facilitators 3 Months Worth of Implementation – Mentoring and Implementation Study
Be Able to Perform Improvement Projects Independently (Green Belt)
Be able to Teach and Facilitate Improvement Projects for Others (Black Belt) 39
White Belt – 120 Minutes of Building Leaders
Element 1 -Leadership 2 - Culture 3 - Customer Focus
% of Introduction Time 50 25 5
Minutes of a 120 Minutes Presentation 60 30 6
Goal: To Create an Understanding
1 -Leadership 2 - Culture
4 - People and Teams 5 - Skills and Tools
5 5
6 6
6 - Processes and Systems
5
6
7 - Performance Measures
5
6
3 - Customer Focus
4 - People and Teams 5 - Skills and Tools 6 - Processes and Systems 7 - Performance Measures
40
Leadership Training - (50% of Time) • Situational Leadership – When and how much to lead
• Incubation of Leaders – About people, Empowerment and – how to motivate and lead people to get results 1/7/2013
41
Organizational Culture Training – (25% of Time) • What is Culture • How to Assess the Culture • How to Create a Cultural Desire to Improve 1/7/2013
42
Training by Levels of Expertise
120 Min.
For Leaders
Create an Understanding with a focus on Leadership and Empowerment (White Belt)
For Supervisors
1 Day – Mainly Lean Tools with some Culture, Teams, and Motivation
Be Able to Manage and Contribute to Improvements (Yellow Belt)
For Practitioners 2 Weeks Worth of Training, Projects and Tools For CPI Mentors and Facilitators 3 Months Worth of Implementation – Mentoring and Implementation Study
Be Able to Perform Improvement Projects Independently (Green Belt)
Be able to Teach and Facilitate Improvement Projects for Others (Black Belt) 43
Yellow Belt – 1 Day – Building Direct Supervisors
Element 1 -Leadership 2 - Culture 3 - Customer Focus
% of Leaders’ Minutes of 1 Time Day 2 10 2 10 4
20
Goal: To Be Able to Manage and Contribute to Improvements
1 -Leadership 2 - Culture
4 - People and Teams
4
20
3 - Customer Focus 4 - People and Teams
5 - Skills and Tools
63
300
5 - Skills and Tools
6 - Processes and Systems
6 - Processes and Systems
13
60
7 - Performance Measures
13
60
7 - Performance Measures
44
Yellow Belt – Problem Solving (Skills and Core Competiveness) (63%of time)
• Highest Impact Tools and Solutions – Doctor Schedule Templates – Patient Throughput – Phones – Room Utilization – Staffing
• Green Flag Reports 1/7/2013
45
craigastevens@westbrookstevens.com
Yellow Belt – Problem Solving (Skills and Core Competiveness) (63%of time)
• Introduce Lean Tools – – – – – – –
In addition to the Big Rocks & GFRs Observations Value Stream Mapping Flow Charting A3 Processing and Reporting Spaghetti Diagram 5 S Events
1/7/2013
46
Training by Levels of Expertise
120 Min.
For Leaders
Create an Understanding with a focus on Leadership and Empowerment (White Belt)
For Supervisors
1/2 Day – Culture, Teams, Motivation
Be Able to Manage and Contribute to Improvements (Yellow Belt)
For Practitioners
2 Weeks Worth of Training, Projects and Tools For CPI Mentors and Facilitators 3 Months Worth of Implementation – Mentoring and Implementation Study
Be Able to Perform Improvement Projects Independently (Green Belt)
Be able to Teach and Facilitate Improvement Projects for Others (Black Belt) 47
Green Belt – 4 Days & Project – Building Practitioners
% of Practitioners’ Time
Hr Training
1 -Leadership
2
1/2
2 - Culture
2
1/2
3 - Customer Focus
6
2
Element
Goal: To Be Able to Perform Improvement Projects Independently
1 -Leadership
4 - People and Teams
10
3
5 - Skills and Tools
60
20
2 - Culture 3 - Customer Focus 4 - People and Teams 5 - Skills and Tools
6 - Processes and Systems
10
3
7 - Performance Measures
10
3
Requires Completion of a Complete Improvement Project
6 - Processes and Systems 7 - Performance Measures
48
craigastevens@westbrookstevens.com
Green Belt – Select a Green Belt Project that Relates to Your Work Area • Use the Three Phases – Assess Using the Seven Attributes • Plant Green and Red Flags • Build Red Flag Portfolio
– Perform Problem Solving On One or More of the Red Flags • Facilitate a Team Problem Solving Effort • Build a Solution Portfolio and Select the Best (May Be a Real Project)
– Implement Solutions • Build a Project Portfolio Based on the Solutions • Implement some Quick Fixes and • Select and Use PM tools to Implement a Real (Larger) Project 1/7/2013
49
Green Belt – Training • Learn the Key Six Sigma Tools – Stats and Use the Lean Tools
• Review and Expand on the Other Subjects • Apply to The Selected Project • Learn Project Management Tools
1/7/2013
50
Training by Levels of Expertise HCAPS Improvement Focused Teams
120 Min.
For Leaders
Create an Understanding with a focus on Leadership and Empowerment (White Belt)
For Supervisors
1/2 Day – Culture, Teams, Motivation
Be Able to Manage and Contribute to Improvements (Yellow Belt)
For Practitioners
2 Weeks Worth of Training, Projects and Tools For CPI Mentors and Facilitators 3 Months Worth of Implementation – Mentoring and Implementation Study
Be Able to Perform Improvement Projects Independently (Green Belt)
Be able to Teach and Facilitate Improvement Projects for Others (Black Belt) 51
Black Belt – 6 Months Experience, Training, & 4 Projects for CPI Facilitators
% of Facilitators' Time
Hours over 6 Months
1 -Leadership
5
2
2 - Culture
5
2
3 - Customer Focus
5
2
Element
Goal: To Be able to Teach and Facilitate Improvement Projects for Others
1 -Leadership 2 - Culture
4 - People and Teams
20
8
5 - Skills and Tools
30
10
3 - Customer Focus 4 - People and Teams 5 - Skills and Tools
6 - Processes and Systems
30
10
7 - Performance Measures
5
2
6 - Processes and Systems
Requires Facilitating the Successful Completion of 4 Complete Improvement Projects for Others
7 - Performance Measures
52
Black Belt – Training • Review and Expand on the Attributes and Tools • Add Systems Thinking Archetypes • Apply to The Selected Projects • Have a Strategic Focus • Focus on Mentoring Others • Focus on Training-the-Trainer
1/7/2013
53
Agenda Creating a Team Focused Improvement Program
✓
1
Our Foundations of CPI
✓
2
TQM, Lean, Six-Sigma, Strategic Project Management
✓
3
Three Easy To Understand Phases
✓
4
Levels of Resources
✓
5
Training Levels, Tools, and Big Rocks
✓
6
Summary of PI Program Approach
54
Results
A= Assessments
GFR GFR
GFR P = Problem Solving
I = Implementation Using Project Management Tools/Support
55