1. Lecture 3 Green Belt DEFINE: Training –Introduction
Introduction to Six Sigma
Presented by Harry H. Holdorf

2. Green Belt Training Objectives
To equip you with the Six Sigma methodology and tools so you can:
Lead and complete Six Sigma projects
Assist Champions and Process Owners in Project Selection (Vice Presidents and Department Heads)
Help Line Management ensure that improvements are sustained (CONTROL)
Be advocates of Culture Change & Six Sigma Principles
To teach you how to apply Six Sigma tools on your job.

3. Six Sigma Introduction
Green Belt Training
Six Sigma Introduction
Define
Measure
Analyze
Improve
Control

4. Introduction

5. Six Sigma is….
Six Sigma
Data Driven Methodology
Business Management Strategy
Measure of Quality
Way of Thinking
Improves the quality of a process by identifying and removing defects (errors) and minimizing variability
How well is a process performing? Is there variability?

6. What is Sigma?
Sigma (σ) is the Greek letter that is used to define the standard deviation of a population
It measures the variability or spread of the results of a process
The Sigma Value is a measure of process quality
Defined in terms of ‘Defects per Million Opportunities’ (DPMO)
Indicate how much of the data falls within the customers’ requirements
A higher sigma value yields greater process outputs, products or services meeting customers’ requirements or fewer defects
2σ ~ yield = % ~ 308,538 DPMO
4σ ~ yield = % ~ 6,210 DPMO
6σ ~ yield = % ~ just 3.4 DPMO!

7. Sigma Values Sigma Value Yield % DPMO 1.5 Sigma 50% 500,000 2 Sigma
(Also Called Z)
Yield %
DPMO
1.5 Sigma
50%
500,000
2 Sigma
308,538
3 Sigma
66,800
4 Sigma %
6,210
5 Sigma %
233
6 Sigma %
3.4
Average Hospital
Today

8. 99% Defect-Free Examples
12 newborns given to the wrong parents each day
103,260 income tax returns processed incorrectly each year
291 pacemaker operations performed incorrectly each year
Bad drinking water from your tap at home for 15 minutes each day
20,000 incorrect drug prescriptions each year
1 wrong medication every hour at a typical hospital

9. Why Are Most Companies at 3-4 Sigma?
BAR R I E R
Rewarding fire-fighting behavior
Little focus on quality measurements
Functional silos inhibit collaboration
Past success has bred false confidence
Dependence on inspection and rework
Reliance on trial and error
Most Companies
3 sigma
4 sigma
5 sigma
6 sigma

10. Taking the Operational Excellence Leap
What is needed to make the leap?
BAR R I E R
Conviction in the opportunity
Belief in the methodology
Openness to challenge ‘status quo’
New skills, tools, and information
Project Alignment with Business Objectives
New behaviors for management and staff
Most Companies
3 sigma
4 sigma
5 sigma
6 sigma

11. Statistical Tools to Improve Process Competitive Advantage
The Six Sigma Journey …
Statistical Tools to Improve Process
$$$$$
DMAIC
$$$
World Class
Multi - CTQ
DMAIC
Optimization
Competitive Advantage
Process Design
(DFSS)
Basic Quality Tools
Process Maps & Procedures
Baselining
Relative Defect Level $
2 sigma
3 sigma
4 sigma
5 sigma
6 sigma

12. The use of Six Sigma continues to evolve
History of Six Sigma :
Motorola begins using Six Sigma Quality Improvement Process. Other companies, such as Texas Instrument also use Six sigma :
Allied Signal- Intro of Black Belt structure
Jack Welch, CEO of GE adopts Six Sigma as part of company’s culture :
Six Sigma spreads based on Allied and GE’s success to company such as Nokia, DuPont, McKesson
1999:2001:
American Society for Quality (ASQ) begins offering Six Sigma certification
Six Sigma ‘arrives’ in Healthcare industry
The use of Six Sigma continues to evolve

13. History of PI at JFK PDCA Six Sigma Lean Sigma
House wide all Directors
Six Sigma
McKesson
Green Belt Training GE
Lean Sigma
Work Out
CAP
Lean
Pre-2005

14. Building a Process Improvement Culture
2012-Present
Create a culture of continuous improvement based on Six Sigma methodology, which allows us to do more for our patients and employees
Building a Process Improvement Culture

15. Multi- Level Process Training
Black
Belt
Conduct the white, yellow and green belt training
Mentors others in Process Improvement projects
Lead Cross Functional Projects
Training: Not offered
Green Belt
Trained in Six Sigma Methodology
Linked to Thompson Reuter financial data
Audience: One GB per Department (limit to 6-8)
Training: 10 days GB Training
Yellow Belt
Utilization of Process Improvement tools (process mapping, root cause analysis, etc.)
Create more impactful metrics
Audience: MDR Department heads
Training: 1 day
(Executive and General)
White Belt
General understanding of Process Improvement methodologies
Able to Identify Projects
Audience: Executives and Process Improvement team members
Training: Few Hours
General Orientation & E-Learning

16. PI Promotes JFK Values
Perfect Performance Exhibiting our highest level of skill, ready to provide expert care and service. Excelling at our jobs as individuals and teams. Doing it right the first time, assuring the safest, highest quality of care
Visionary Spirit Creative and innovative. Eager to generate new ideas. Open and receptive to learning, changing and improving. Continually advancing to new frontiers of healthcare delivery.
Business Best Using our resources with discipline and integrity. Assuring value and efficiency in every action that we take. Recognizing that each one of us has the power to make a difference.
Human Touch Treating everyone with care concern and passion. Being sensitive, always promoting a warm and welcoming environment. Embracing our diverse community.
Best Self Bringing our best to work. Being positive, encouraging, professional and productive. Doing the right thing regardless of the inconvenience we face.

17. Critical Strategic Initiatives
Budget Drivers
Strategic Drivers
Benchmarking and ongoing labor management
Competitive Compensation Program
LOS/Capacity Management
Start Relocation process for SED on campus
Muhlenberg Campus Operations
Reimbursement tied to quality (effective 10/1/12)
Value-Based Purchasing
Benchmarking through Thomson Reuters
Supply Reductions
OB Practice Acquisition
Cardiac Physician & Outpatient Center Acquisitions
Physician Integration
LOS
Utilization / Intensity
Gainsharing (Medicare/Horizon)
Capacity Management
Women’s Services
Pediatrics
Emergency Room (Peds & Adult)
Ambulance/MICU
Branding
Targeted Volume Growth
Generate System savings/revenue (Lab, X-ray, Ambulance, Pharmacy)
Hartwyck Ancillary Service
The goal of all Six Sigma Projects will be to impact Strategic Initiatives

18. Benefits of Process Improvement (Financial and Operational)

19. PI Promotes JFK Values
Perfect Performance Exhibiting our highest level of skill, ready to provide expert care and service. Excelling at our jobs as individuals and teams. Doing it right the first time, assuring the safest, highest quality of care
Visionary Spirit Creative and innovative. Eager to generate new ideas. Open and receptive to learning, changing and improving. Continually advancing to new frontiers of healthcare delivery.
Business Best Using our resources with discipline and integrity. Assuring value and efficiency in every action that we take. Recognizing that each one of us has the power to make a difference.
Human Touch Treating everyone with care concern and passion. Being sensitive, always promoting a warm and welcoming environment. Embracing our diverse community.
Best Self Bringing our best to work. Being positive, encouraging, professional and productive. Doing the right thing regardless of the inconvenience we face.

20. Types of benefits – Hard & Soft Savings
Hard Savings (= cash)
Soft Savings (= non-cash)
$$ Financial Benefits $$
Revenue Enhancement
Higher prices for services
New products/ services
Cost reduction
Lower cost of products and services
Lower Cost of Non Quality
Reducing Working Capital
Capital tied up in:
Inventory
Late Receivables
Early Payments
Opportunity Savings
Freeing up resources to work on other items
Cost Avoidance
Cost would have appeared if project not done
Soft Capacity Increase
Capital tied up in inventory, late receivables, early payments
Patient satisfaction
Improved reputation
Brand image
Employee motivation
Technology improvement
Conformance to law & regulations
Risk management & business controls

21. Statistics are the tools to “torture” data into telling the TRUTH.
Knowledge is the Foundation “ “
When you can
measure
what you are speaking about,
and
express it in numbers
, you know something about it;
but when you cannot express it in numbers, your
knowledge is of a meager and unsatisfactory kind.”
Lord Kelvin
The Need For Knowledge
You don’t know what you don’t know
You can’t act on what you don’t know
You won’t know until you search
You won’t search for what you don’t question
You don’t question what you don’t measure. Hence, you just don’t know
Data allows us to make “correct” decisions and implement the “needed” changes.
Statistics are the tools to “torture” data into telling the TRUTH.

22. Process Improvement Methodologies

23. Process Improvement Methodologies
PDCA
Plan, Do, Check, Act
Used for the control and continuous improvement of processes
Iterative method
DMAIC
Define Measure Analyze Improve Control
Improving existing processes
Root Cause Unknown
Lean
Kaizen,
Work Out
Eliminates waste and maintain the gains
Improve cycle times
DFSS
Design for Six Sigma
To create business gains by designing new processes or products or services
Change Management (CAP)

24. PDCA is your everyday Process Improvement.
Review the actual results
Compare against the expected results (targets or goals from the "PLAN")
Create action plans on significant differences between actual and planned results.
Analyze the differences to determine their root causes.
Implement the plan
Execute the process
Collect data for charting and analysis in the following "CHECK" and "ACT" steps
Establish the objectives and processes necessary to achieve your results goals
Pilot to test possible effects
Plan (P)
Do (D)
Check (C)
Act (A)
PDCA is your everyday Process Improvement.
“Just Do It”

25. Examples?

26. DMAIC DMAIC is a structured methodology
To improve processes
Using data to make decisions
DMAIC is an acronym for the Six Sigma data-based process-improvement methodology
The ultimate objective is to achieve business results using a data-based improvement methodology

27. Six Sigma Principles
To accomplish our BUSINESS strategy, Six Sigma says….
Customer Focus
The Customer Defines Quality
Focus on what the CUSTOMER values and will pay for
Variability is the Enemy!
Be excellent in these things by REDUCING VARIATION (with a side benefit of lower cost).
Act on Fact!
This is accomplished by DATA DRIVEN DECISIONS (we know the root causes)
Measurement is the Key!
This requires Valid MEASUREMENT (which also drives Behavior)
Employee Brainpower
Then Solve the problem and CONTROL the process
(which utilizes TEAM brainpower)

28. Deliverables Define Measure Analyze Improve Control
Fully trained team is formed & supported
Customers identified
High impact characteristics defined
Team charter developed
Business process mapped
Measure
Key measures identified
Data collection planned and executed
Process variation displayed and communicated
Performance baselined
Sigma level calculated
Analyze
Data & process analysis
Root cause analysis
Quantifying the gap / opportunity
Improve
Generate & test possible solutions
Select the best solutions
Design implementation plan
Control
Standardized process and procedures documented
Monitoring plan documented & implemented
Response plan established & deployed
Transfer of ownership (project closure)

29. Family Medicine Scheduling Example
Define
Scope-Patient calls/arrives to schedule appointment through next visit is scheduled
Measure
CTQ-Patients can schedule their next appointment when leaving their current appointment
Analyze
15% of patients are able to make their next appointment when they leave their current appointment
Improve
Re-assign appointment lengths per patient type
Outline new process to schedule OB patients
Outline new process to schedule Sick Visits
Control
Outline SOP for new processes
Regular audits of identified metrics
Visible performance metrics

30. Lean
Lean…
…the relentless pursuit of the perfect process through waste elimination…

31. Benefits of Lean … Lean attacks waste here Higher customer
. . . Any process or value stream
Higher customer
satisfaction
Lead Time / Cycle Time
Before
Reduced cycles
Better delivery
More capacity
Better quality
Productivity
Work . . .
Value Add Time
After
Wait / Waste . . .
Non Value Add Time
Lean attacks waste here
Increased process velocity, reduced
waste, improved customer experience

32. Cardiac Catheterization
Lean Examples
Emergency Department
Dispo to IP Bed
Family Medicine
In Door to Out Door
Cardiac Catheterization
Door to Balloon

33. How lean and DMAIC fit together
Lean and Six Sigma have a strong overlap in terms of optimizing value creation

34. DFSS
Design for Six Sigma (DFSS) is an improvement system used to develop new processes or products at Six Sigma quality levels.
Define
Define the goals of the project and that of the customers
Measure
Quantify the customer needs as well as the goals of the management
Analyze
Analyze the options, existing process to determine the cause of error origination and evaluate corrective measures
Design
Design a new process or a corrective step to the existing one to eliminate the error origination that meets the target specification
Verify
Verify, by simulation or otherwise, the performance of thus developed design and its ability to meet the target needs

35. Examples New Emergency Department
Moving Interventional Radiology beds to a new location
System Implementations

36. Choosing a Process Improvement Methodology

37. PM vs. PI
The discipline of planning, organizing, securing, and managing resources to achieve specific goals
A project is a temporary endeavor with a defined beginning and end, undertaken to meet unique goals and objectives
The primary challenge of project management is to achieve all of the project goals and objectives while honoring the preconceived constraints
Project Management
A series of actions taken by a process owner to identify, analyze and improve existing business processes to meet new goals and objectives
Business processes are repetitive, permanent or semi permanent functional activities to produce products or services
Uses specific methodology or strategy to improve quality, reduce costs, or accelerate schedules
Process Improvement

38. Use the methodology appropriate for the situation
Which project methodology?
Use the methodology appropriate for the situation

39. Define the problem to create a focused project plan

40. Define Phase Deliverables
Determine VOC, translate to CTQ’s & link project to business strategy
Establish Process Boundaries & Scope
Recognize Inputs and Outputs
Gather the “Correct” Team
Determine where data is gathered (measured)
Quantify the impact
Define the problem to create a focused Project Charter
Verify Process Maps by Observation

41. Introduction to Six Sigma
Define
Introduction to Six Sigma
Project Selection
Project Definition
Process Mapping
Change Management

42. Project Selection Define Deliverables Developing CTQs
Project Characteristics
Customers & VOC
Sources for projects
VOC  CTQ
Just Do It
Decision Trees
Project Selection
KANO

43. Characteristics of Good Process Improvement Projects
High priority objective
Focused on a critical success factor
Linked to an upper level strategy
Aggressive target
Important: a significant improvement is required
Urgent: target must be reached in 3-6 months
Six Sigma projects should have a significant financial benefit for the business

44. Sources for Project Selection
Strategic Plan
Customer Requirements
Business Metrics
Costs Associated with Errors and Rework
‘Low Hanging Fruit’

45. Just Do It…

46. Brainstorming Approach
Approaches to Project Selection
There are three basic approaches to Project Selection…
Blatantly Obvious
Things that clearly occur on a repetitive basis and present problems in delivering our service(s) or product(s).
Brainstorming Approach
Identifies projects based on individual’s “experience” and “tribal knowledge” of areas that may be creating problems in delivering our service(s) / product(s) and hopefully tie to bottom-line business impact.
Structured Approach
Identifies projects based on organizational data, provides a direct plan to effect core business metrics that have bottom-line impact.
All three approaches work….Structured is the best.

47. Questions to think about…
What are the organization’s goals?
Who are your customers?
Internal vs. External
What are your:
Critical to Quality (CTQ’s)
Key Process Indicators (KPI’s)
Where are your pain points?
Where are your bottlenecks?
You need to determine what you are trying to accomplish before you determine what to measure

48. Step 1 Step 2 Step 3 Developing CTQ’s Identify Customers Listing
Capture VOC
Review existing performance
Determine gaps in what you need to know
Select tools that provide data on gaps
Collect data on the gaps
Validate CTQ’s
Translate VOC to CTQ’s
Prioritize the CTQ’s
Set Specified Requirements
Confirm CTQ’s with customer
Identify Customers
Listing
Segmentation
Prioritization
Step 2
Step 3

49. Start with your customers!
How to Start?
Start with your customers!
Identify who they are:
Patients
Patient Families
Community members
Dr’s/Surgeons
CMS
JHACO
Board Members

50. How do our customers communicate with us?
Types of Customer Voices
Compliments
Complaints
Patient Surveys
HCAPS
Repeat visits
Feedback boxes
Friend referrals

51. Both External and Internal Customers are Important
Types of Customers
External (Voice of Customer)
Direct: those who receive the output of your services, they generally are the source of your revenue
Indirect: those who do not receive or pay for the output of your services but have a vested interest in what you do (government agencies)
Internal (Voice of the Business)
Those within your organization who receive the output of your work (other departments)
Both External and Internal Customers are Important

52. Listen to what is being said!
What our patients say to us:
“I have been waiting for hours”
“I want to see a Dr. now”
“This room is dirty”
“The food is gross”
What our co-workers say to us:
“We need to cut expenses”
“We need to reduce our LOS”
“Terminal cleans are not happening”
“Pharmacy takes too long to profile orders”
“We need to improve the way we run MDR”
“I don’t get the right information when you give report”
Voice of the Customer
Voice of the
Business

53. Voice of the Customer
Voice of the Customer (VOC) may seem obvious but do we really know what our customers want???

54. Voice of the Customer Ask Yourself?
Does the process provide what the patient expects? How do we know?
Do we meet our patients time frame? How do we know?
Are we providing the care our patients (and family) want? How do we know?

55. Translating the VOC into CTQs
VOC’s and VOB’s
Verbatums from your customers and the business
Drivers
An understanding of the needs
CTQ’s (Critical to Quality)
A measurable form of the driver or need

56. VOC  CTQ’s Example Verbatum’s from your customers and the business
VOC’s and VOB’s
Verbatum’s from your customers and the business
I want good Customer Service
Drivers
An understanding of the needs
What does the customer mean by “good”?
-Fast Response time when calling the 800#
-One phone call Solution
CTQ’s (Critical to Quality)
A measurable form of the driver or need
-The time for a customer service representative to answer the phone
-% of resolutions in one phone call

57. More VOC to CTQ examples
Driver
CTQ’s
Correct Answers
Knowledgeable Reps
Information Available
One Call Resolution
I want good Customer Service
Friendly Reps
Friendly Greeting
Greeted by Name
Timeliness
Short Hold Time
Answer call within 30 seconds

58. More about CTQ’s
Critical to Quality (CTQ ’s) are measures that we use to capture VOC properly. (also referred to in some literature as CTC’s – Critical to Customer)
CTQ ’s can be vague and difficult to define.
The customer may identify a requirement that is difficult to measure directly so it will be necessary to break down what is meant by the customer into identifiable and measurable terms
Performance
Features
Conformance
Timeliness
Reliability
Serviceability
Durability
Aesthetics
Reputation
Completeness
Competence
Accuracy
Responsiveness
Access
Courtesy
Communication
Credibility
Security
Understanding
Product:
Product:

59. Exercise “I want a good cup of coffee”
In small groups, identify the drivers and CTQ from the VOC statement.
“I want a good cup of coffee”

60. Decision Trees Decision trees are….
A tool for capturing team’s problem solving approach
Explain the logic that a project team used to find Project Y’s or critical x’s
Show how the initial problem was split to create the problem statement
For example, a decision tree shows the logic of going
From this statement: “We must improve our overall operating expenses by 5%”
To this one: “The project team will work on reducing overtime hours in Radiology from 200 hours per pay period to 50 hours per pay period”

61. Project Definition Tree
Project definition trees explain the logic the team uses to select a problem statement

62. Decision trees to Help you Focus
Voice of Customer
Project Selection
CTQ
CTQ
CTQ Y Y Y
Process
Measure y
Sub- Process
Analyze
Improve
Control
Process
Variables x x x x x

63. Decision Tree Example VOC: I want a good ER experience. Project
Selection
Human Touch
Meeting JCAHO Req.
Time Spent in ER
Y: Overall ER Length of Stay
Process
Y: Friendliness of Staff
Y: Proper Documentation
Measure
y: Door to Doc
y: Time from disposition to discharge
Sub- Process
Process
Variables
Analyze
Improve
Control
X: Staff to patient ratio
x: individual staff
x: ER Dr.
x: Acuity
x: Day of Week
x: Time of Day

64. KANO analysis
Purpose
An approach to sort customer needs into categories. The categories will allow you to make decisions on features and functions that are most important to your customers.
Risks
If you are designing a new process or product- everything the old process/product had must fall into the “Must Have” Category
Trying to include too many “Delighters” in a new process / product

65. KANO model A delighted customer is your best salesperson! Satisfaction+
Satisfiers
(more is better)
Delighters (latent desires)
Product / service fully functional
Product / service dysfunctional
Must have
(Dissatisfiers) -
Dissatisfaction
A delighted customer is your best salesperson!

66. KANO model: automotive example
Satisfaction + -
Dissatisfaction
Product / service dysfunctional
Product / service fully functional
Satisfiers
(more is better)
Delighters (latent desires)
Must have
(Dissatisfiers)
Car that parks itself
Heated Steering Wheel
CD player/radio
Air bags
Power brakes
Power steering
Reverse gear
Horsepower
Mpg
Leg room

67. Project Selection Define Deliverables Developing CTQs
Project Characteristics
Customers & VOC
Sources for projects
VOC  CTQ
Just Do It
Decision Trees
Project Selection
KANO

68. Introduction to Six Sigma
Define
Introduction to Six Sigma
Project Selection
Project Definition
Process Mapping
Change Management

69. Project Definition Problem Statements Operational Definition
Business Case
Project Scope
SMART metrics
Project Charter

70. Defining the Problem & Business Case

71. Problem Statements Problem: Something Which Upsets the Customer!
Problem Statement: Description & Content
An Overall, then Detailed Description of the Problem - clear definition!!
Should begin with the Customer and CTQ being identified.
The Problem is stated in Terms of the undesired attributes or “Defects”…. affecting the CTQ’s. Be as specific as possible, and update as understanding of the problem increases throughout the Measure and Analyze phases.
Roughly quantifies the current status or performance relative to customer CTQs.
Clarifies “Units of Measurement” and source of measured (quantified) data.
Should NOT include causes or solutions!!!

72. Problem Statement Components
CTQ-what is important to the Customer
Background/history
Actual data
Operational Definition

73. Problem Statements
First Pass
It takes too long to schedule an MRI for an Inpatient
First Revision
45% of patients on our Med Surg units take more than 8 hours to be scheduled for an MRI
Second Revision
75% of patients on the Med Surg units take more than 5 hours from the time the order is received to send a completed checklist to the MRI department so procedure can be scheduled.

74. What’s the Problem?
The Surgical Services Director sent out notification that,
“Patients are unhappy with OR Scheduling. Let’s get out there and fix it!”
Energized and motivated by such a dynamic charge, each of five employees
said, “I know what the problem is!” and marched off to take (what they each
thought was) appropriate corrective actions.
Here’s what they did:
The Office Manager in the Physician Office immediately issued a new procedure to schedule PAT at the same time as they schedule the procedure
OR Scheduler #1 told all her colleagues to schedule more patient at the Surgi-
Center instead of JFK OR
OR Scheduler #2 immediately began requiring physician offices to provide
patient insurance information in order to schedule the procedure
The OR Nurse Manager began calling patients on the day of their procedure to come in 2 hours earlier than was planned
The Director of Admitting created a process to register patients in the Same Day Surgery area.

75. Problem Statement Worksheet
Unit of Measure
Data Type & Source
“Definition” of the Problem
According to . . .
Office Manager
Physician Office
OR Scheduler #1
OR Scheduler #2
OR Nurse
Manager
Admitting
Office
Sample answers on next page

76. Problem Statement Worksheet
Unit of
Data Type
According to . . .
“Definition” of the Problem
Measure
& Source
The patient wants their PAT appointment scheduled at the same time they scheduler the OR
% scheduled
for PAT
Numeric
HSM
Office Manager
Physician Office
The patient would like surgery to be at Mediplex instead of JFK
OR Scheduler #1
% scheduled
At MSC
Numeric
HSM
The patient doesn’t want anyone calling them for insurance information
% cases
MD provides
insurance
Numeric
Excel
OR Scheduler #2
The patient wants their procedure to be done earlier in the day
hours
Count
OR Desk
OR Nurse
Manager
# cases
Registered in SDS
Count
Star
Admitting
Office
The patient wants to get registered in the OR

77. Typical Issues with Problem Statements
CTQ or process output poorly defined, or not quantifiable.
CTQ or process output does not link to customer CTQ.
Quantification based on anecdotal information
Data source
measurement method,
not indicated
Scale of measure and specifications not supported by
customer data
Stated as a
predetermined solution
instead of problem.
Unclear “Defect” Definitions - operational definitions
can help solve this issue.

78. Operational definition of a project
An operational definition is:
A precise description of the criteria being measured (the what)
The method used to obtain the characteristic you are trying to measure (the how)
Operational definitions:
Provide everybody with the same meaning
Used to remove ambiguity
Describe the scope of the measure (what is included and what is not included)
Before collecting data you need to clarify your operational definition.
© 2002 IBM Corporation (unpublished). All rights reserved. Version 1.0.

79. How do you define OR Scheduling? The definition makes it
Operational Definitions
How do you define OR Scheduling?
The definition makes it
measurable!!!!!!

80. Problem Statement Homework
Review and/or write a problem statement for your project and compare it to what you were just taught.
Modify it, with blanks if needed for further data.
Is there anything vague that needs an operational definition? Write one
Review with the person beside you.
Be prepared to share these

81. Business Case Why is this ‘problem’ important to us?
What impact does it have?
What are the customer requirements?

82. Example Problem statement Business Case
55% of patients move from the ED to their Inpatient bed in less then 60 minutes of a bed assignment.
Business Case
Medicare is tracking this metric and using it to compare us to other hospitals
It is the right thing to do

83. Project Scope What is project scope?
The work that needs to be completed to deliver the service or result with the required specifications.
Defines what is “in or out” of your project
Why is scoping a project important?
Aligns stakeholders and project lead
Prevents scope creep

84. Focusing the scope helps protect the project team
Scope Considerations
What authority does the project team have?
What is “in scope” and “out of scope”?
What businesses/departments are in and out of scope?
What patient types are in and out of scope?
What days of week are in and out of scope?
Which procedures are in and out of scope?
What potential solutions are out of scope?
Focusing the scope helps protect the project team

85. Defines where your process Starts and where it Stops
Scope
Defines where your process Starts and where it Stops
Door to Doctor
Patient Out of Bed to New Patient in Bed
Order Written to Bed Assigned

86. Scope
In 2013, the Edison McDonalds had an increase in complaints about the time it takes from ordering a meal to picking it up at the drive through window. Complaints are up 8% from McDonalds leadership is scoping a project to improve speed through the drive through window. Write the scope for this project.
Start:
Stop:
Includes?
Excludes?

87. Quantifying the Problem
Data Collection
Delays, Defects and other Waste
Financials
Labor
Supplies
Unitization

88. Six Sigma Principle
Act on
Fact !!
Persuasion by RATIONAL THOUGHT !!!

89. SMART Metrics Specific Measurable Attainable Relevant Time Bound
Goal is clear and unambiguous
Measurable
Criteria to measure progress
Attainable
Setting realistic goals
Use stretch goals not extreme goals
Relevant
Setting worthwhile goals
Time Bound
Setting and reaching target dates

90. Examples of SMART Metrics
Increase the number of patients seen in the breast center by 10% from 1650 to 1815 by 12/31/14
Reduce the amount of time it takes to assign a bed by 23% from 78 minutes to 60 minutes by 12/31/14
Increase patient satisfaction scores by 5% from 91% to 95.5% by 12/31/14
Reduce the number of billing errors by 20% from 47 to 42 by 12/31/14
(Increase/Decrease) the (Project Goal) by X% from X to X by x/x/xx.

91. Primary and Secondary Metrics
Defines the primary goal of the project
Primary Metric
Measures the side effects of the project.
Can be used to ensure there is not a negative effect of the project.
Example:
Primary Metric: Increase the number of Work Orders by 10% from 1000 to 1100 by 12/31/12.
Secondary Metric: Maintain the average number of hours worked within +/- 5%.
Secondary Metric

92. Exercise
Create a metric for your project in the SMART format. Include operational definition(s) for things you have not already defined
Identify potential secondary metrics for your project.

93. Project Charter

94. Project Charter Purpose:
Defines the main purpose or intent of the project
Explicitly states what the project team is going to accomplish and by when
Ensures a common understanding by clearly stating goals and objectives

95. Project Charter Problem Statement/ Business Case:
Provide the background and rationale for the project.
Objectives/Goals (Including SMART metric):
Describe what you are trying to accomplish and by when
Team Members
Name……role
Scope:
Includes:
Excludes:
(What is in/out of the project)

96. Project Charter Example
Problem Statement/
Business Case:
Patients are not able to make follow up appointments for well visits and OB patients do not see the same physician for each of their standard appointment types because of the current schedule structure.
Objectives/Goals (Including SMART metric):
Increase the percentage of patients that can schedule follow up appointments at the time of their current appointment by 200% from 25% to 75% by 6/30/2011
Team Members
Dr. Rogers- Attending Physician
Dr. Jones- Resident
Lisa Smith- Nurse
Don Johnson- Nurse
Jean Roberts- Medical assistant,
Mary Baker- Front Desk staff
Scope: Patient needs appointment to patient scheduled for appointment; Patient feels sick to patient needs are met
Includes: All standard patient visits
Excludes: Procedures

97. Six Sigma Project Charter

98. Project Definition Problem Statements Operational Definition
Business Case
Project Scope
SMART metrics
Project Charter

99. FIN