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An Introduction to Lean Six

Sigma
We dont know what we dont know.
We cant act on what we dont know.
We wont know until we search.
We wont search for what we dont question.
We dont question what we dont measure.
Hence, we just dont know.
Dr. Mikel Harry

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

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

Control

Improve

Measure

Analyze

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

Lean Six Sigma Timeline

Guinness
Brewery

1900
Ford
Assembly Line

Shewhart
Introduces SPC

1930
Gilbreth, Inc.
Management
Theory
Industrial
Engineering

Deming
14 Points
7 Deadly Diseases

1950
Toyota Production
System

Lean Six Sigma Timeline

SPC

TQM

1980
Just inTime

Motorola
Introduces Six
Sigma

1990
Lean Mfg.

AlliedSIgnal
GE Adapt LSS to
Business Processes

2000

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 Fords 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

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 dont
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 dont have
5. Pursue perfection -- there is no
optimum level of performance

Focus

Flow Focused

Assumptions

Non-Value added steps exit

Results

Reduced cycle time

Waste Defined
Wastes
Transport

Inventory
Motion

Waiting
Over-Production
Over-Processing
Defects

Skills

Healthcare Examples
1.
2.
3.
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2.
3.
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2.
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2.
3.
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2.
3.
4.
1.
2.
3.
1.
2.
3.
4.
5.
6.
1.
2.
3.
4.

Moving patients from room to room

Poor workplace layouts, for patient services
Moving equipment in and out of procedure room or operating room
Overstocked medications on units/floors or in pharmacy
Physician orders building up to be entered
Unnecessary instruments contained in operating kits
Leaving patient rooms to:

Get supplies or record

Documents care provided

Large reach/walk distance to complete a process step
Idle equipment/people
Early admissions for procedures later in the day
Waiting for internal transport between departments
Multiple signature requirements
Extra copies of forms
Multiple information systems entries
Printing hard copy of report when digital is sufficient
Asking the patient the same questions multiple times
Unnecessary carbon copying
Batch printing patient labels
Hospital-acquired illness
Wrong-site surgeries
Medication errors
Dealing with service complaints
Illegible, handwritten information
Collection of incorrect patient information
Not using peoples mental, creative, and physical abilities
Staff not involved in redesigning processes in their workplace
Nurses and Doctors spending time locating equipment and supplies
Staff rework due to system failures

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

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.

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

VOC vs. VOP

Sigma
Capability

Voice of Customer

Defects per
Million
Opportunities

% Yield

308,537

69.15%

66,807

93.32%

6,210

99.38%

233

99.98%

3.4

99.99966%

Voice of Process

The Voice of the Process is independent of

the Voice of the Customer

Whats 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

Goals of Lean Six Sigma

LSL

USL

Defects

LSL
Defects

Defects
Customer Target

Prevent Defects by
Reducing Variation

USL

Customer Target

LSL

USL

Customer Target

Meet Customer
Requirements

Prevent Defects by
Centering Process

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

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.

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

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

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

Dont assume your measurements are accurate
measuring system must accurately tell what is
happening

Quantify Process Performance

Collect data (Ys)
Examine process stability/capability analysis

Analyze
Identify Potential Causes (Xs)
Investigate Significance of Xs
Collect data on xs
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 xs on y

Here you identify the critical factors of a good output and

the root causes of defects or bad output.

Improve
Generate Potential Solutions
Select & Test Solution
Develop Implementation Plan

Control
Create Control & Monitoring Plan
Mistake proof the process
Determine the xs to control and methods
Determine Ys to monitor

Implement Full Scale Solution

Revise/develop process
Implement and evaluate solution

Finalize Transition
Develop transition plan
Handoff process to owner