Making Lean Six Sigma Work For You

In October 2019, I presented a workshop on applying Lean Six Sigma in Hospitals to a group of 25 Health Information Managers at the 2019 HIMAA/NCCH National Conference held in Paramatta, NSW, Australia. HIMAA is the Health Information Management Association of Australia while NCCH is the National Centre for Classification in Health, The University of Sydney. The workshop was designed to help participants to:

1. Assess a problem or area for improvement.
2. Identify possible routes to dealing with it.
3. Evaluate potential solutions.
4. Choose an approach that has a reasonable chance of success.
5. Select tools and methods suited to the problem and the approach chosen.
6. Use the tools and methods to address the problem.

Background

While Lean is now regarded as synonymous with the Toyota Production System (TPS), pure lean is concerned with the elimination of waste (“muda”). Lean methodologies “allow an organisation to efficiently and effectively design workflow processes by eliminating mudas (or wastes).”(1) The seven original “muda” are transport, inventory, motion, waiting, over-production, over￾processing and defects. The TPS has two fundamental pillars, Just-in-Time and Automation, is concerned with the improvement of flow and focuses on three key forms of waste: • “muda” is work which adds no value; • “muri” is work which is too complicated or uncontrolled; and • “mura” is work which lacks uniformity or consistency. Six Sigma, developed and applied in manufacturing industry, is a “process-focused, statistically based approach to business improvement…” (2) The structured method used is to Define, Measure, Analyse, Improve and Control (DMAIC) and the core performance metric is the number of defects per million opportunities (DPMO).(3) Lean Six Sigma is an amalgam of aspects of each, balancing the qualitative, value driven 'doing the right thing' of Lean with Six Sigma’s empirical quantitative measurement of 'doing things right'. The framework introduced in this workshop was developed in an attempt to answer the apparent failure of Lean Six Sigma in healthcare. While the framework is focused on Lean Six Sigma, it is not necessary to adopt the philosophy as the tools and methods can be, and have been, utilised in many different settings.

In the first part of the workshop we explored and discussed:

(i) The topic of Lean Six Sigma, including the philosophy, strengths, weaknesses and critical success factors; and some of the most widely used methods and tools; (ii) What makes healthcare different from other settings, especially key characteristics unique to healthcare, including individual patient variation and clinical independence; (iii) The concept of simplification as an alternative to complexity and intensification.

The second part of the session considered:

(iv) the potential usefulness and transferability of a decision support framework designed for the acute hospital setting; (v A new decision support framework designed for the acute hospital setting; and (v) The seven basic tools of quality

The final portion of the workshop:

focused on using the framework to examine some real life case studies to better understand the framework, methods and tools proposed.

Please feel free to comment below. For a copy of the workshop slides, just click here

 

References:

1. Kuo, A. M-H., Borycki, E., Kushniruk, A., Lee, T.-S., 2011. A Healthcare Lean Six Sigma System for Postanesthesia Care Unit Workflow Improvement. Quality Management in Health Care, 20(1), pp.4-14
2. Bisgard, S., Hoerl, R.W., Snee, R.D., 2002. Improving Business Processes With Six Sigma. Quality Congress ASQ's Annual Quality Congress Proceedings, pp.701-704
3. Schroeder, R.G., Linderman, K., Liedtke, C., Choo, A.S., 2008. Six Sigma: Definition and underlying theory. Journal of Operations Management, 26(4), pp.536-554

Click here to download a copy of the Workshop Abstract directly from the Conference Proceedings   Proceedings of the HIMAA/NCCH 36th National Conference, Health Information Management: Engaging the Next Generation. 23 - 25 October 2019, Western Sydney Stadium, Parramatta, New South Wales, Australia Copyright 2019 Health Information Management Association of Australia Ltd/National Centre for Classification in Health, The University of Sydney

According to Mark Twain there are three kinds of lies: "lies, damned lies and statistics" while Winston Churchill reportedly said that "the only statistics you can trust are the ones you have falsified yourself".

You might wonder why statistics have such a bad reputation. I guess one basic contributing factor is that a majority of people do not feel comfortable or confident dealing with numbers.  Many suspect that arguments and reasons that include or rely on numbers are deliberately made more complicated than is necessary, that we are being manipulated. Take the term "average", a commonly used word that is not as simple as we may be led to believe. In statistical terms, averages are measures of central tendency and there are three common measures - the mean, median and mode. However, within the mean there are three variations - simple, trimmed and weighted. Simple Average A simple mean is the sum of all the values in the population or sample being measured and is sensitive to extreme values, e.g. I have 100 people in a group: 10 have $10,000 25 have $1,000 15 have $100 40 have $10 10 have $1 The total amount of money they have together is $126,910 and the simple average per person is $1,269.10 Trimmed Average A trimmed mean is calculated by excluding extreme values from the average. The drawback here is that the decision on what should be included or excluded is necessarily arbitrary and may create a misleading impression. If we exclude the top 10 values of $10,000 each and bottom values of $1 each: The total amount of money the remaining 80 people have is $26,900 and the trimmed average is $336.25 Weighted Average A weighted mean is computed by attributing a weight to each value. If the example above were weighted according to the proportion of people at each value (i.e. 10% have $10,000; 25% have $1,000; 10% have $100; 40% have $10, and 10% have $1): The weighted sum is $16,636, the weighted number is 26.5 and the weighted average is $627.77 Median The median value is the middle value in a population or sample. If the population or sample contains an even number of items, the median is the simple average of the two middle values. In the example give above the median is the simple average of the 50th value which is $100 and the 51st value which is $10 = $100 + $10 = $110 / 2 = $55. Mode The mode is the value that occurs with the greatest frequency - in the example given, the mode is $10 because there are 40 people with $10. So now we have five distinct values for the average, depending on how we choose to calculate it: Simple average (mean) $1,269.10 Trimmed average (mean) $   336.25 Weighted average (mean) $  627.77 Median $    55.00 Mode $    10.00 If you intend to use and/or rely on averages in planning your business, it is important to know what those averages actually mean. If I create my marketing plan assuming that the average person has $1,269.10 and am not aware that 50% of this group have $10 or less I am inviting disaster. Key questions to consider when looking at averages are:

1. What kind of average is this? 2. Is it based on a population or on a sample? 3. How is the population or sample defined? 4. How reliable is the data? I will talk about populations and samples in a later post, highlighting some of the main aspects of each as well as the relative advantages and disadvantages.