1. Lean 6S Training Mercy Medical Center Welcome to Lean 6S Training.
5046 LDLEAN6S - Version 8/20/2009
Welcome to Lean 6S Training.

2. What are the 8 Forms of Waste? What is 6S? How do I conduct a 6S?
Examples of Mercy 6S results
Most people think Lean means a formal week-long facilitated event
Q: But did you know that not everything requires a formal week-long event?
Today you are going to learn about one of the Lean tools called 6S:

3. 8 Forms of Waste WASTED HUMAN TALENT DEFECTS INVENTORY OVERPRODUCTION
WAITING TIME
MOTION
TRANSPORTATION
PROCESSING WASTE
Ask participants to provide an example of each
WASTED HUMAN TALENT – Staff members using their talent and skill to follow a broken process, instead of using the talent and skill to improve the process.
DEFECTS – Hospital Acquired Infection
INVENTORY – Items expire, cost associated with storage and handling
OVERPRODUCTION – We need 3 IV Bags, but I have time so I will make up 10 (that may never get used).
WAITING TIME – We need a bigger waiting room, we need scripting on why they are waiting, we need to update our magazines….Do we? Or do we need to find out why they are waiting.
MOTION – Radiology would walk past each room to see if one was available. Now they have a light that lets them know a room is in use.
TRANSPORTATION – Birthplace Facilities use to have a labor room, delivery room and a room for the hospital stay. New Moms were transported from room to room. Now they labor, deliver and stay all in the same room.
PROCESSING - Marking through all of the patient names on the Well mark Report, except for the patient specific to the set of medical records

4. 1. Wasted Human Talent
I’ve made a few changes to the process.
I wish someone would ask OUR opinion…!
Staff
Staff
Staff
Manager
Staff
Staff
Not asking the staff that works the process how to improve it

5. A negative outcome from process failure
2. Defects
Another defect!!
@*&#!!
A negative outcome from process failure

6. 3. Inventory
Did I really order this much??
Items in greater quantities than can be immediately processed or used.

7. 4. Over Production Generating more work than is really required
I didn’t get my order yet… I’ll send another fax.
Hey…are these multiple orders for the same
Pharmacist
Staff
Generating more work than is really required

8. 5. Waiting
People waiting for items (patients, supplies, specimens, etc.) to process

9. Why can’t I get anything done? Unnecessary human movement
6. Motion
Why can’t I get anything done?
Unnecessary human movement

10. 7. Transportation Unnecessary movement or relocation of items
Waiting Area
I have orders to run some tests.
I’ll bring the patient right over.
Sigh…..!!
Unnecessary movement or relocation of items

11. 8. Over Processing Please approve. Please approve. Please approve.

12. Applying effort to activities that are not required in the process
8. Over Processing
I’m the final approval.
Please approve. +
???
The final approval?!!
Applying effort to activities that are not required in the process

13. What is 6S? Sort Straighten Scrub Standardize Sustain Safety
The 6th S, Safety, is not a separate step. Safety should be a consideration as we do all of the other steps.
Each of these steps will be explained in further detail in following slides.

14. Separate the needed from the not needed
Step 1: Sort
Before
After
The first step is sorting…
separating all the things you need from the things that you don’t.
Q: How will this help the organization?
A: Removes obsolete items and reduces excess inventory.
It costs Mercy to store and manage inventory.
If we have too many of anything, they may expire/become obsolete….costs $$$
Separate the needed from the not needed

15. A place for everything & everything in its place!
Step 2: Straighten
AFTER
BEFORE
Now that you have sorted the needed from not needed items, designate a place for everything and move your sorted items into their new location.
Tip: Prioritize where you place items by putting the items that are used most often in the most readily accessible spots.
Heaviest on the bottom (safety)
Most used – most readily accessible location
Consider height requirements - shortest & tallest users
Place supplies next to equipment – where they will be used.
A place for everything & everything in its place!

16. Regularly “scrub” to ensure everything is in perfect working condition
Step 3: Scrub (inspect)
“Scrub” and inspect equipment to ensure it is in perfect working condition...
Add inspecting equipment into your work routine.
Use scrubbing and cleaning to make certain equipment is in perfect working order.
Add equipment inspection into you regular work routine.
Again, making certain everything is in working order allows you to reduce your inventory levels to a few good working units.
Regularly “scrub” to ensure everything is in perfect working condition

17. Step 4: Standardize
Note: Blue taped outlines and labels ensure equipment is quickly found and returned to the same spot every time.
Before the 6S, equipment was just shoved into this room.
One of the Radiologists talks about being sent here to locate equipment, searching for 15 minutes and still not finding what he needed.
Note the labeling on the floor, now there is a place for everything and everything is in its place…every time.
e can tell at a glance when something is missing.
Q: What would this labeling do for a new employee?
Don’t need to ask for help from someone else who is busy.
Standard Work requires determining the best method then following that method every time.

18. Note labels and instructions
Step 4: Standardize
Note labels and instructions
Standardization applies to files, supply cupboards, forms, or even websites.
Q: What if standard visual controls & labeling were used and everything was placed in the same location on every floor of the hospital?
You can be assigned to a different floor and still find what you need without searching!
Visual Controls ensure that anyone can find what they need in a matter of moments.

19. Develop a method for sustaining your gains
Step 5: Sustain
The team will need to find a method for ensuring things don’t go back to the way they were prior to the 6S.
Create diagrams like the ones above as guides
Determine inventory par levels to indicate when items should be reordered
Use maintenance checklists to have the team share responsibility for keeping the area in order
Develop a method for sustaining your gains

20. Safety is a top priority in all that you do!
Step 6: Safety
Safety first when determining where items are to be located:
Keep fire hydrants clear
Electrical a safe distance from plumbing
All items accessible - Not too high, not too low
Uncluttered traffic areas - no tripping hazards
Emergency phone numbers and procedures prominently posted
This chart is self explanatory
Safety is a top priority in all that you do!

21. How do I Conduct a 6S?

22. Good preparation is the key to successful results!
Observe the process first hand (Gemba walk)
Create a spaghetti diagram - a hand drawn map of your process including:
Tasks in the sequence they are done
Location of supplies and equipment
Measure distance traveled and time spent searching or waiting
In a Gemba walk it is important to observe:
Movement of things
Movement of staff
Movement of patients
Time spent searching
Distance traveled between tasks or locating things.
Good preparation is the key to successful results!

23. Spaghetti Diagram Time & Distance Traveled - Before
Dedicated
Staff
Time & Distance Traveled - Before
15 min – searching
For supplies
Supply
Room
Chart
Rack
Printer
20 min – searching
For printer paper
Ancillary
Testing
200 feet
100 feet
150 feet
250 feet
300 feet
1,550 Feet
108 min
16 min
11 min
21 min
1 min
31 min
Patient’s
Room
15 min – searching
for meds
10 min – searching
for PT chart
Med
Room
Have someone walk the process as it would normally be done.
Observe:
The number of steps that are taken (the average step is 30” in length)
Time the person to see how long it takes to complete all tasks
Be certain to note:
When the person is spending excess time in any given area
The location of equipment and supplies
Tip: One of the best ways to analyze a process is by observation…watch the team during their normal work routine. Look for unnecessary steps and ways to creatively improve things for the workers.
Nurse’s
Station
Tube
Station
Report
Room
10 min – waiting for
meds tube system
What forms of “Waste” can you identify?

24. Applying 6S eliminates waste!
How Can We Improve?
What would you do to improve?
Sort out the need from the not needed
Have a place for everything so there is no searching
Move supplies or equipment closer to where they are needed
Co-locate tasks or people
Change the sequence in which tasks are done
Be creative with your solutions – you, after all, are the expert!
Applying 6S eliminates waste!

25. Spaghetti Diagram No Searching or Waiting - After
Dedicated
Staff
I’ve found my “dream” job!
30 sec – 6S on
supply room
Supply
Room
400 ft
50 feet
40 min
1.5 min
2 min
1 min
30 min
60 sec – 6S on
Med room
Med
Room
Report
Room
Chart
Rack
Tube
Station
Ancillary
Testing
Patient’s
Room
Nurse’s
Station
Printer
Conducting a 6S on the areas that took up excessive time allows us to save time in the process…
Note: We want to continue to spend time in the patient’s room, so that wasn’t touched (value added time)
Now, we not only saved 1,150 feet of travel but also reduced our time by over an hour.
What will these improvements do to our time at the bedside?
30 sec – 6S on
chart rack
30 sec – Indicator light
installed on tube system
30 sec – Paper checked
@ end of each shift
Reduced travel by 1150 ft & search time by 68 min.

26. Suggest you insert some before and after pictures/examples of 6S results in the next few slides.

27. Simulation – Round 1

28. Instructions to the Class
Worker
Gather White, Yellow and Blue sheets of paper
Paper clip the sheets together
Place in a folder
Place post-it on the outside of the folder
Place folder and contents on the chair (to be picked up by a delivery person)
Manager
Create a spaghetti diagram:
Draw the room layout, identifying the location of the supplies used in the simulation
As Participant #1 walks the process, trace his/her footsteps on the spaghetti diagram
Facilitator Instructions
Worker
Sheets must be in the following order:
1 Blue Sheet
1 White Sheet
1 Yellow Sheet
Paper clip sheets together (landscape - upper left corner)
Place clipped sheets in a RED folder
Place post-it on outside (upper left corner) of red folder
Place folder and contents on chair

29. Instructions to the Class
Efficiency Expert #1
Count the number of steps Person #1 travels from beginning to end in the process.
Efficiency Expert #2
Track how much time Participant #1 takes to do the entire process
Track how much time is wasted waiting and/or searching
Customer
Do a quality inspection on the finished product against the sample provided to you by the Instructor
Co-workers (Rest of Class)
Identify the 8 Forms of Waste in our process
Identify possible ideas for improvement

30. Quantifying the Results
Capture the Results from Round 1
The placement of the materials is probably the most critical piece of this very simple simulation (the entire simulation takes minutes max). Spread the paper, file folders, post-its, paper clips randomly around the room. Make certain nothing is in the sequence that it will be used. For example, don’t place the pieces of paper together – spread around the room (excess travel).
The red folders are mixed in with other colored folders in a pile (searching). Paper clips are in a box with various other supplies. There are a couple of empty boxes of clips and only one full box on the bottom of the supply box (searching). I also use a stop watch to time the process. After the simulation, I ask the students to use what they've learned to improve the process. I capture the results pre and post on a the board to help students see the change: cycle time, travel (steps), search time , inventory levels, etc.

31. What Are the Results? Manager Efficiency Expert #1
What does the spaghetti diagram show us?
Efficiency Expert #1
How many steps did it take for the worker to do the process?
Efficiency Expert #2
How much time did the entire process take?
How much time was wasted waiting and/or searching?
Customer
Was the customer happy with the service provided (quality inspection)?
Rest of Class
Identify forms of waste in the process
Include possible ideas for improvement

32. What Waste Did You Observe?
Wasted Human Talent
Defects
Inventory
Over Producing
Waiting
Motion
Transportation
Over Processing
Capture measurements and timings on flip chart paper.

33. How Can We Use 6S to Improve?
Sort – Separate the needed from the not needed
Straighten – A place for everything and everything in its place
Scrub – Ensure everything is in perfect working condition
Standardize – Determine the best method – visual queues, labeling, etc.
Sustain – Develop Standard Work
Safety – Safety first at all times

34. Simulation – Round 2

35. Instructions to the Class
Now that you have identified the waste and the opportunities for improvement in the process
Put your recommended improvements in place
We’ll run the simulation a second time
Then we’ll measure the results…
….and celebrate our success!!

36. Quantifying the Results
Capture the Results from Round 2
The placement of the materials is probably the most critical piece of this very simple simulation (the entire simulation takes minutes max). Spread the paper, file folders, post-its, paper clips randomly around the room. Make certain nothing is in the sequence that it will be used. For example, don’t place the pieces of paper together – spread around the room (excess travel).
The red folders are mixed in with other colored folders in a pile (searching). Paper clips are in a box with various other supplies. There are a couple of empty boxes of clips and only one full box on the bottom of the supply box (searching). I also use a stop watch to time the process. After the simulation, I ask the students to use what they've learned to improve the process. I capture the results pre and post on a the board to help students see the change: cycle time, travel (steps), search time , inventory levels, etc.