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Lean Healthcare Training Now Available for Local Healthcare Professionals in Georgia and Northern Florida

Lean Healthcare Training Now Available for Local Healthcare Professionals in Georgia and Northern Florida 150 150 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense

Aug 17, 2012

Lean Healthcare Training Now Available for Local Healthcare Professionals in Georgia and Northern Florida

The Lean Green Belt Training Offered By NOVACES is Being Held September 24-28 in Valdosta, Georgia. It is a Certification Course Aimed at Providing Healthcare Professionals With Proven Tools for Improving Performance and Quality of Care.

August 17, 2012 Valdosta, GA — NOVACES will host a Lean Healthcare Training in Valdosta on September 24 thru 28. Rising pressure for medical facilities to become more efficient and to control costs is creating a need for professionals who can implement Lean Healthcare, a process improvement methodology that has proven to speed up the adoption of new ideas and change to create the best place for patients and their families to receive care.

Local healthcare leaders in Georgia and Northern Florida, such as Lou Strickland, Practice Administrator for the Shaw Center for Women’s Health in Thomasville, GA, agree that a training course like this one responds to the increased demand for process improvement and change management skills for today’s professionals. “Lean process improvement has been a quality and efficiency focus in other industries for years, bringing that culture to healthcare is a strategy for improving service and clinical quality as well as cost containment. Process improvement is a big focus for the Shaw Practice as we pursue certification as a Patient-Centered Medical Home,” said Ms. Strickland.

Physician involvement is a key to so many of the improvements being implemented during Lean healthcare workshops. It is no surprise that physicians are getting trained to support these improvement initiatives. A recent training at St. Alexius Medical Center included Dr. Shiraz Hyder MD, who is a neurologist at the medical center’s specialty clinic. Dr. Hyder recognized an interesting parallel from the physician’s perspective, “Finding solutions to patient problems is second nature to a physician as they have been trained accordingly; finding solutions to systems and operational issues requires a different set of skills. Having a Lean Green Belt certification is like having an ACLS or ATLS certification, it is a proof that you have acquired necessary skills to rally a team, analyze and fix a problem.”

The Lean Healthcare training requires an instructor that understands hospitals and private practices, and course materials that are designed for teaching the concepts for application in a healthcare setting. NOVACES, a firm that specializes in teaching performance improvement to healthcare organizations, will be hosting the course at the Valdosta Hilton Garden Inn. Those who attend the course will have an opportunity to receive a Green Belt certification, a much sought after distinction for healthcare professionals looking to enhance their careers and improve the industry.

The training is a hands-on learning experience with a special healthcare simulation to help participants really understand how to apply Lean in healthcare. “This is a opportunity to learn some of the most effective tools to solve healthcare challenges. Investing in continuous improvement is a must for those who are serious about healthcare excellence,” said Deborah Smith, Senior Vice President of Healthcare Services for NOVACES.

Registration is now open for the course, and is available at http://www.novaces.com/georgia-lean-healthcare-training or by contacting Noel Huston at 504-544-6888 x203. A portion of the proceeds from the training will go to benefit the Physicians’ Institute for Excellence in Medicine, a foundation of the Medical Association of Georgia.

NOVACES will be making a Special Breakfast Presentation at the 24th IHI

NOVACES will be making a Special Breakfast Presentation at the 24th IHI 150 150 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense

Intermediate Objectives Map – A Great Planning and Execution Tool

Submitted By: Bob Sproull

Many people who have gone through a TOC Jonah training session have come away overwhelmed and sometimes feeling like they are unable to apply what they’ve learned.  Let’s face it, the TOC Thinking Process tools are just not easy for some people to grasp and apply, so they kind of put them on the back-burner rather than taking a chance of doing something wrong.  Well, for everyone who fits into this category, I have hope for you.  What if I told you there was a logic diagram that is actually simple to construct  and one that you would feel confident using?  Would that be of interest to you?  There is such a tool and it’s called an Intermediate Objectives Map.  Yes, I’ve had other posts about this tool in the past, but I want to show you a different way to use the IO Map.  But before I do, let’s review the basics of the IO Map.

I remember going through the Jonah course and of all of the TOC Thinking Process tools I learned, the IO Map stood out for me because of its simplicity.  Since then I have used the IO Map in a variety of different settings and in every instance the leadership team not only understood it, but actually embraced it.  The beauty of the IO Map is that everything that must be in place to achieve the goal of the organization is included on a single sheet of paper.

Bill Dettmer tells us of his first exposure to IO Maps back in 1995 during a management skills workshop conducted by Oded Cohen at the Goldratt Institute.  In recent years, Dettmer has recommended that the IO Map, which he now refers to as a Goal Tree, should be the first step in a Thinking Process analysis.  He believes this because it defines the standard for goal attainment and its prerequisites in a much more efficient manner.  I believe that the IO Map is a great focusing tool to better demonstrate why an organization is not meeting its goal.  Other advantages of using an IO Map include a better integration of the rest of the TP tools and will accelerate the completion of Current Reality Trees, Conflict Clouds and Future Reality Trees.  The other thing I like about IO Maps is that they can be used as a stand-alone tool which results in a much faster analysis of the organization’s weak points or in conjunction with the other TOC TP Tools.  In this posting we will discuss the IO Map as a stand-alone tool.

When using the logic based TOC Thinking Process tools there are two distinctly different types of logic at play, sufficiency type logic and necessity type logic.  Sufficiency type logic is quite simply a series of if-then statements.  If I have this, then I have that.  Necessity-based logic trees use the syntax, “in order to have this……I must have that. The IO Map falls into the necessity-based category.  For example, in order to have a fire, I must have a fuel source, a spark and air. If the goal is to have a fire, I must have all three components.  Take away even one of the CSFs and I won’t have a fire.

The hierarchical structure of the IO Map consists of a single Goal, several Critical Success Factors (CSFs) which must be in place to achieve the goal and a series of Necessary Conditions (NCs) which must be in place to achieve each CSF. The Goal and CSFs are written as terminal outcomes that are already in place.  Let’s look at an example of what an IO Map might look like.

Suppose that you were working with an organization who wants to become a highly profitable one.  You assemble the CEO and key members of his staff to develop an effective plan to achieve this goal.  In the IO Map drawing below, after much discussion, you agree on your Goal as “Highly Profitable Company” and place it inside the Goal box. This goal statement is written as a terminal outcome as though it’s already been achieved.  In the IO Map below, the Goal is stated as “Highly Profitable Company” which is the desired end state.  You think to yourself, “What must I have in place for our goal to be realized?” You think, “I know that we must have highly satisfied customers for sure and that our throughput must be high and growing,” so you place both of these in separate CSF boxes.  One-by-one you continue listing those things that must be in place to achieve your goal and place them into separate CSF boxes like the figure below.  In an IO Map you should have no more than 3 to 5 CSF’s.

Because the IO Map uses necessity–based logic, it is read in the following way: “In order to have a highly profitable company, I must have highly satisfied customers as well as the other four CSF’s.  Directly beneath the CSFs are NCs that must also be in place to achieve each of the CSFs. So continuing to read downward, “In order to have highly satisfied customers, I must have three different NCs as described in the IO Map above.  Remember, the CSF’s are written as terminal outcomes, as though they’re already in place.  You continue reading downward, in order to have, for example, high on-time delivery rate, I must have buffer management in place and functioning.  The NC’s represent actions that must be completed to achieve each individual CSF and form the basis for your improvement plan.  In like manner, your team completes all of the NCs until you are satisfied that what you have in place on the IO Map will ultimately deliver the goal of the organization. Typically in an IO Map, there are three-to-five CSFs and no more than two-to-three layers of NCs.  OK, so what happens next?

Here’s where I’ve departed from the traditional TP tools in that the next step would be to use the IO Map to construct a Current Reality Tree.  And although I totally support this approach, when time is a factor, I continue on with the IO Map in this way.  I typically facilitate a critical discussion on the status or current state of the Goal, CSFs and NCs.  I use a simple Green, Yellow and Red coding system to describe how each of the IO Map entities exists in our current reality.  The figure below is a summary of that exercise for our hypothetical company.

Notice the key on the bottom right hand side of the IO Map and you’ll see that a box shaded in green indicates that the entity is in place and functioning so no changes need to be made.  A yellow box indicates that there is something in place, but that it needs improvement.  A box shaded in red means that the entity is either not in place or that something is in place, but it isn’t functioning.  It should be obvious that any entity shaded in red has a higher priority than one shaded in yellow.

In our example, because the company is at least minimally profitable, but not highly profitable, it is shaded in yellow.  If we look at the CSFs, four of the five CSFs are shaded in red meaning that each is either not in place or simply not functioning well enough to drive higher profitability.  In this hypothetical company it appears as though the only thing this company is doing right is their excellent quality and it’s because they have excellent quality systems in place.  But other than their quality systems, not much else is functioning well.  Let’s look now at several of the NCs that must be worked on to satisfy the CSFs.

For the first CSF, Highly Satisfied Customers, we see that the leadership team believes that three things must be in place to satisfy this CSF:

  1. They must have high on-time delivery rates and because it’s shaded in red, this probably isn’t happening or at least not to the level to highly satisfy their customers.  The team further stated that in order to have high on-time delivery rates, they must have buffer management in place and functioning.
  2. They must also have excellent quality and because this entity is shaded in green, the team believes that their quality is excellent due to their excellent quality systems.
  3. Finally, they must have a high perceived value by the customer and since it’s shaded in yellow, the team doesn’t believe this is the case.  The team believes that this is being driven primarily by the price of their products, but it’s probably also due to their poor on-time delivery rates.

In the second CSF, Throughput High and Growing, the red shading indicates that this company has significant room to grow.  This company had been through TOC training which included a section on Throughput Accounting and they now understand that their throughput is driven by managing the system constraint and by focusing their improvement efforts only on the constraint.  The team now believes that in order for constraints management to function well, they must have work synchronized to meet demand.  Similarly, if we look at each of the remaining CSFs and associated NCs we have a much better understanding of what actions need to take place in order to ultimately drive profitability higher.

The key to creating a focused improvement plan, using the IO Map, is to develop the improvement plan around what the Necessary Conditions are telling us.  If we look at the figure below and scrutinize it, we see that there are four primary improvement projects which, if implemented correctly, will drive improvement to each of the five Critical Success Factors and ultimately achieve our goal.

  1. Implement TOC’s Drum Buffer Rope.  This project will impact two CSFs, Highly Satisfied customer by improving the on-time delivery rate and Throughput High and Growing by synchronizing work to meet demand.
  2. Implement an integrated Lean, Six Sigma and Constraints Management, but only at the system constraint.  In so doing, this will automatically drive throughput higher and will continue to do so when the constraint moves.
  3. Implement Active Listening.  Active listening is the process of soliciting and implementing solutions provided by the subject matter experts, the people building the product or delivering the service.  In my experience, this will also have an immediate, positive impact on the morale of the work force.
  4. Implement Dynamic Replenishment.  One of the keys to profitability is to reduce inventory and avoid part’s stock-outs and by implementing a replenishment system based upon usage rather than a forecast.  In so doing, two dramatic improvements will take place.  Overall inventory will decrease by at least 40% and part’s stock-outs will virtually disappear.  These two benefits occur because part’s replenishment will now be based upon actual consumption and not a forecast.

So here it is, a different way to utilize an Intermediate Objectives Map which is easy both to understand and construct and which permits the development of a very focused improvement plan.  In my experience using this approach, the team that develops it, will embrace it because it is their plan.  And the good news is, from start to finish it only takes less than a day, rather than days or weeks to develop.

Bob Sproull

How a Value Stream Analysis Can Help You Elminate Non-Value Adding Activities

How a Value Stream Analysis Can Help You Elminate Non-Value Adding Activities 150 150 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense

How a Value Stream Analysis Can Help You Elminate Non-Value Adding Activities

Submitted By: Dr. Bahadir Inozu
Categories: Healthcare

Below is an excerpt from Chapter 6 of our recently published book, Performance Improvement for Healthcare: Leading Change with Lean, Six Sigma, and Constraints Management

A Process-level VSA, or ProcessVSA, is an approach to analyzing a process to identify and eliminate non-value adding activities as well as to develop procedures to manage bottlenecks effectively and break these bottlenecks when needed. For lean six sigma in healthcare, it is also a planning tool that uses process mapping to help understand how material and information flow through a process, as well as to identify constraints at the process level. Additionally, ideal and future state process maps are developed that focus future improvement activities within that process. ProcessVSAs are conducted by following a product’s or service’s path from suppliers to customers. Once the current state of the process is mapped, it is then analyzed to identify waste, inefficiencies, constraints, and other improvement opportunities. After areas of opportunity have been identified, an ideal state map is created to serve as a benchmark. Then a future state map is created showing how the material and information should flow and how the process bottleneck should be managed, if there is one. Champions are designated to sponsor improvement efforts by first determining the best approach. Finally, an action plan is prepared to move from the current state to the future state of the process. This action plan should include recommendations for future rapid improvement events, quick hits, and DMAIC and Constraints Management projects.

A ProcessVSA generally is run as a single event lasting five days or less. There are three phases to this process: pre-event, event and post-event. Each phase has a series of sequential steps to complete for a successful outcome. Figure 6.2 shows the ProcessVSA pre-event roadmap.

Figure 6.2 ProcessVSA pre-event roadmap

Click here for a free download of Chapter 1 of our book, Performance Improvement for Healthcare: Leading Change with Lean, Six Sigma, and Constraints Management.

Lean Healthcare Training Now Available for Local Healthcare Professionals in Georgia and Northern Florida

Lean Healthcare Training Now Available for Local Healthcare Professionals in Georgia and Northern Florida 150 150 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense
Aug 17, 2012

Lean Healthcare Training Now Available for Local Healthcare Professionals in Georgia and Northern Florida

The Lean Green Belt Training Offered By NOVACES is Being Held September 24-28 in Valdosta, Georgia. It is a Certification Course Aimed at Providing Healthcare Professionals With Proven Tools for Improving Performance and Quality of Care.

August 17, 2012 Valdosta, GA — NOVACES will host a Lean Healthcare Training in Valdosta on September 24 thru 28. Rising pressure for medical facilities to become more efficient and to control costs is creating a need for professionals who can implement Lean Healthcare, a process improvement methodology that has proven to speed up the adoption of new ideas and change to create the best place for patients and their families to receive care.

Local healthcare leaders in Georgia and Northern Florida, such as Lou Strickland, Practice Administrator for the Shaw Center for Women’s Health in Thomasville, GA, agree that a training course like this one responds to the increased demand for process improvement and change management skills for today’s professionals. “Lean process improvement has been a quality and efficiency focus in other industries for years, bringing that culture to healthcare is a strategy for improving service and clinical quality as well as cost containment. Process improvement is a big focus for the Shaw Practice as we pursue certification as a Patient-Centered Medical Home,” said Ms. Strickland.

Physician involvement is a key to so many of the improvements being implemented during Lean healthcare workshops. It is no surprise that physicians are getting trained to support these improvement initiatives. A recent training at St. Alexius Medical Center included Dr. Shiraz Hyder MD, who is a neurologist at the medical center’s specialty clinic. Dr. Hyder recognized an interesting parallel from the physician’s perspective, “Finding solutions to patient problems is second nature to a physician as they have been trained accordingly; finding solutions to systems and operational issues requires a different set of skills. Having a Lean Green Belt certification is like having an ACLS or ATLS certification, it is a proof that you have acquired necessary skills to rally a team, analyze and fix a problem.”

The Lean Healthcare training requires an instructor that understands hospitals and private practices, and course materials that are designed for teaching the concepts for application in a healthcare setting. NOVACES, a firm that specializes in teaching performance improvement to healthcare organizations, will be hosting the course at the Valdosta Hilton Garden Inn. Those who attend the course will have an opportunity to receive a Green Belt certification, a much sought after distinction for healthcare professionals looking to enhance their careers and improve the industry.

The training is a hands-on learning experience with a special healthcare simulation to help participants really understand how to apply Lean in healthcare. “This is a opportunity to learn some of the most effective tools to solve healthcare challenges. Investing in continuous improvement is a must for those who are serious about healthcare excellence,” said Deborah Smith, Senior Vice President of Healthcare Services for NOVACES.

Registration is now open for the course, and is available at http://www.novaces.com/georgia-lean-healthcare-training or by contacting Noel Huston at 504-544-6888 x203. A portion of the proceeds from the training will go to benefit the Physicians’ Institute for Excellence in Medicine, a foundation of the Medical Association of Georgia.

Veterans Health Administration Steadily Increasing Use of Lean Six Sigma Process Improvement to Support Its Systems Redesign Initiative

Veterans Health Administration Steadily Increasing Use of Lean Six Sigma Process Improvement to Support Its Systems Redesign Initiative 150 150 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense

Jul 24, 2012

Veterans Health Administration Steadily Increasing Use of Lean Six Sigma Process Improvement to Support Its Systems Redesign Initiative

NOVACES is Providing Consulting Services for Lean Six Sigma Process Improvement Training and Projects at Various VISNs and VA Hospitals Including Bay Pines VA Healthcare System, Fargo VA Medical Center and North Chicago VA FHCC Medical Center.



July 24, 2012 New Orleans, LA — Troop drawdowns in Iraq and Afghanistan and impending cuts in number of troops directed by the DoD has created an urgent need for business transformation within the VA hospital system that supports our veterans after they have transitioned back to civilian life. Among the various improvement strategies for the VHA is the Systems Redesign, which aims to improve healthcare quality and access to care for veterans.



Systems Redesign leadership in the VHA has been using the process improvement methodology called Lean Six Sigma, which in the last decade has become a key management strategy and driver of change for civilian hospitals, to provide fundamental quality and process improvement tools to the teams who are leading transformation efforts within the VA Medical Centers.



Fargo VA Medical Center could be considered one of the more advanced VA medical centers in terms of adoption of Lean Six Sigma. The organization held a workshop in 2012 on how to manage improvement initiatives, which included an overview of the Lean Six Sigma methodology. Since then, the adoption of Lean Six Sigma has been steadily growing within the organization.



To develop the program from its early stages, leaders of Fargo VA Medical Center Systems Redesign contracted with NOVACES, a management consulting firm that specializes in performance improvement for veteran healthcare, for guidance on how to incorporate the VA High Performance Development Model and Veterans Health Administration System Redesign objectives.



“The right blend of Systems Redesign, TAMMCS, Lean Six Sigma and PDSA in a collaborative setting creates an environment for VA medical centers, like the one being experienced in Fargo, that promotes the kind of improvements needed to continue providing our nation’s veterans with the very highest quality healthcare services,” said retired U.S. Navy Captain Charles Mount, director of government healthcare services at NOVACES.



Other VA healthcare facilities, including VISN 8 Bay Pines VA Medical Center and North Chicago VA James A. Lovell Federal Health Care Center (FHCC) are also rigorously investing in Lean Six Sigma by training staff and leadership and completing improvement projects that are aligned with strategic plans.



Similar to the widespread adoption of Lean Six Sigma in civilian healthcare, healthcare performance improvement experts promote the rigor and analytical capabilities of this healthcare process improvement methodology to also drive the tremendous amount of change that the currently strained VHA healthcare system must undergo to meet the demand for care generated by the nation’s 22 million veterans.



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Veterans Health Administration Steadily Increasing Use of Lean Six Sigma Process Improvement to Support Its Systems Redesign Initiative

Veterans Health Administration Steadily Increasing Use of Lean Six Sigma Process Improvement to Support Its Systems Redesign Initiative 150 150 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense
Submitted By: Brian MacClaren

Troop drawdowns in Iraq and Afghanistan and impending cuts in number of troops directed by the DoD has created an urgent need for business transformation within the VA hospital system that supports our veterans after they have transitioned back to civilian life.  Among the various improvement strategies for the VHA is the Systems Redesign, which aims to improve healthcare quality and access to care for veterans.

Systems Redesign leadership in the VHA has been using the process improvement methodology called Lean Six Sigma, which in the last decade has become a key management strategy and driver of change for civilian hospitals, to provide fundamental quality and process improvement tools to the teams who are leading transformation efforts within the VA Medical Centers.

Fargo VA Medical Center could be considered one of the more advanced VA medical centers in terms of adoption of Lean Six Sigma. The organization held a workshop in 2012 on how to manage improvement initiatives, which included an overview of the Lean Six Sigma methodology. Since then, the adoption of Lean Six Sigma has been steadily growing within the organization.

To develop the program from its early stages, leaders of Fargo VA Medical Center Systems Redesign contracted with NOVACES, a management consulting firm that specializes in performance improvement for veteran healthcare, for guidance on how to incorporate the VA High Performance Development Model and Veterans Health Administration System Redesign objectives.

“The right blend of Systems Redesign, TAMMCS, Lean Six Sigma and PDSA in a collaborative setting creates an environment for VA medical centers, like the one being experienced in Fargo, that promotes the kind of improvements needed to continue providing our nation’s veterans with the very highest quality healthcare services,” said retired U.S. Navy Captain Charles Mount, director of government healthcare services at NOVACES.

 

Other VA healthcare facilities, including VISN 8 Bay Pines VA Medical Center and North Chicago VA James A. Lovell Federal Health Care Center (FHCC) are also rigorously investing in Lean Six Sigma by training staff and leadership and completing improvement projects that are aligned with strategic plans.

Similar to the widespread adoption of Lean Six Sigma in civilian healthcare, healthcare performance improvement experts promote the rigor and analytical capabilities of this healthcare process improvement methodology to also drive the tremendous amount of change that the currently strained VHA healthcare system must undergo to meet the demand for care generated by the nation’s 22 million veterans.

US Navy Selects Aurora-CCPM Software to Schedule Maintenance Operations at the World’s Largest Submarine Base

US Navy Selects Aurora-CCPM Software to Schedule Maintenance Operations at the World’s Largest Submarine Base 150 150 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense
Submitted By: Brian MacClaren

San Mateo, CA, July 09, 2012 –(PR.com)– Stottler Henke Associates, Inc. today announced that the US Navy has selected Aurora-CCPM™ software to schedule maintenance operations at the Naval Submarine Support Facility in New London, Connecticut. NSSF provides direct maintenance, repair, and upkeep support to the 21 nuclear attack submarines that operate out of the Naval Submarine Base, the largest submarine base in the world. Aurora software will enable the Navy to generate highly efficient schedules, so necessary maintenance operations can be performed on submarines during their limited times in port.

Submarine maintenance schedules must satisfy complex resource constraints. While submarines are at the NSSF, the Navy must perform many maintenance operations that require different combinations of resources such as maintenance shops and equipment and maintenance teams with specific skills and certifications. Large submarine parts are removed from the submarine and transported to the 35 specialized maintenance shops where they are reconditioned or repaired. Because space in the submarines’ narrow passageways and access to the submarine hatches is very limited, the scheduling system must also reason spatially, so the Navy can schedule transports that minimize interference with the submarine’s other activities and the movements of its crew.

Because the US Navy had successfully used the Critical Chain Project Management methodology to manage other operations efficiently, they desired a scheduling software system that supported CCPM. However, submarine maintenance operations schedules must satisfy complex constraints that exceed the capabilities of ordinary CCPM software. The Navy selected Aurora-CCPM because it uniquely combines the Critical Chain method’s scheduling efficiencies with Aurora’s artificial intelligence-based scheduling engine that can encode and satisfy complex scheduling constraints.

Mr. Hilbert Robinson, a Critical Chain expert, supported a previous successful implementation of CCPM at the US Navy’s Pearl Harbor Submarine Base. Currently a Program Manager at NOVACES, Mr. Robinson now supports the Critical Chain implementation at New London. “Critical Chain showed great success when applied to the submarine maintenance, repair and overall (MRO) process at Pearl Harbor ten years ago. However, we wished we had better support for some of the unique scheduling constraints found in the submarine maintenance domain. In addition to the benefits of Critical Chain, Aurora-CCPM provides the capability to zero in on and potentially mitigate additional factors that could otherwise blindside the project team during execution.”

Aurora-CCPM combines Aurora, Stottler Henke’s intelligent planning and scheduling system, with the added power and flexibility of Multi-project Critical Chain Project Management. Traditional scheduling methods usually allocate a safety margin to each task. This approach wastes time due to bad multitasking, Student syndrome, Parkinson’s Law and poorly synchronized integration. The Critical Chain method avoids these problems by leveraging the concept of aggregated risk to consolidate per-task safety margins into fewer aggregate safety margins. By allocating safety times strategically, organizations achieve higher throughput. Aurora intelligent scheduling technology enables Aurora-CCPM to apply the Critical Chain method to complex projects that encompass thousands of heavily constrained tasks and hundreds of different kinds of resources. Because Aurora remembers the reasons for its scheduling decisions, it can adjust schedules intelligently when production requirements, resource availabilities, and other conditions change.

Founded in 1988, Stottler Henke Associates, Inc. applies artificial intelligence and other advanced software technologies to solve problems that defy solution using traditional approaches. The company delivers intelligent software solutions for education and training, planning and scheduling, knowledge management and discovery, decision support, and software development. In 2012, Stottler Henke received the Tibbetts Award from the U.S. Small Business Administration which honors outstanding small businesses and individuals who participate in the SBA’s Small Business Innovation Research (SBIR) program. US Government agencies have designated ten Stottler Henke systems as Small Business Innovation Research (SBIR) success stories. Stottler Henke was the subject of a NASA “Hallmarks of Success” video profile for its work developing and later commercializing advanced planning and training software systems. Stottler Henke received a “Brandon Hall Excellence in Learning” award for innovative technology. Stottler Henke was named one of the “top 100” companies making a significant impact on the military training industry by Military Training Technology magazine for 2011 and seven previous years. Stottler Henke has received a Blue Ribbon from Military Training Technology magazine, recognizing it as a company that leads the industry in innovation. Web: http://www.stottlerhenke.com. Email: info@stottlerhenke.com.

5 Imperatives to Hiring a Lean Six Sigma Expert for Your Hospital

5 Imperatives to Hiring a Lean Six Sigma Expert for Your Hospital 150 150 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense
Submitted By: Brian MacClaren

Hiring an expert is often one of the first steps taken by hospitals embarking upon a Lean Healthcare or Lean Six Sigma program. Usually a Lean Six Sigma Black Belt is chosen to develop the program. Unfortunately, there are few Black Belts at large that actually have the Lean Six Sigma skills and healthcare experience necessary to build an effective, self-sustaining program.

Imperative #1- Know How to Evaluate Technical Proficiency

With the recent explosion of open enrollment training programs from local colleges and online providers, there is no shortage of candidates who claim Lean Six Sigma expertise on their resumes. For Lean Six Sigma, training is only a first step of the journey to become proficient in the multitude of tools that your organization can take advantage of. During an interview with a candidate, one imperative is to evaluate the mastery of technical skills.

First and foremost, we have learned that it is unwise to take a candidate’s depiction of technical skills on their resume at face value. These skills must be demonstrated during the interview because, in our experience, Lean Six Sigma certification does not prepare an individual to be an internal consultant for an organization such as yours. But how do you evaluate technical skills during a candidate interview? We recommend doing this in three ways:

1. Written exam
2. Oral exam
3. Platform instruction

Written Exam
Sound like a job for a professional certifying organization? Yes, but… the body of knowledge for Lean Six Sigma professionals varies so much across industries that only one organization can be relied upon for producing a certified Lean Six Sigma Black Belt. This organization is the American Society for Quality (ASQ) – and its Black Belt certification exam is one of the most rigorous in the industry. NOVACES bases all of its Lean Six Sigma courses on ASQ’s body of knowledge. If a resume does not say ASQ CSSBB (Certified Six Sigma Black Belt), then you must be prepared to administer an exam for each these candidates. Administer this exam before you spend time interviewing the candidate – without technical skills you must pass on the candidate completely.

We recommend an exam that includes a mixture of multiple choice questions related to Lean, Six Sigma, and even Theory of Constraints. The exam should be design with a minimum passing score of 80% and generally no less than 30 questions. If you need help designing such an exam, or would like to have your exam evaluated for content and correctness, please contact us and we will assist you. We also have collections of exam questions with healthcare context to share.

Oral Exam
This is a very effective element of the candidate evaluation process. Granted that the candidate has already passed the written exam, this gives the interviewer a chance to see how the individual might interact with people in your organization that require coaching or explanations of information during projects.

Importantly, this is done without giving the candidate any chance in advance to prepare. Do not be hesitant to do this. It is an exercise that puts their mastery of the skillset to the test. If the candidate needs six months to a year to grow into the job you are hiring them for, then a better alternative is to grow a trusted member of your team that already knows your organization’s culture and politics.

During the oral exam, ask questions that a Black Belt should be expected to be able to answer as if they have been doing this job professionally for several years. These are questions such as:

  • Identify which type of data is represented by several examples
  • Select the correct tool to apply for various scenarios
  • Calculate the number of defects per million opportunities (DPMO)
  • Walk through the steps to correctly perform a hypothesis test
  • Discuss the steps they take when facilitating an improvement workshop from pre-workshop preparation to post-workshop sustainment

The expectation, of course, is that the candidate can correctly answer all of these questions. Failing to do so leaves their technical skills suspect, because this type of knowledge should be automatic. However, what you also need to read into is the following:

  1. How confident was the candidate about the answer? Did they stumble? If so, how did they handle not knowing the answer immediately?
  2. Did they simply answer the question or did they walk you through why they answered the way they did? Were they more like a teacher or a student? You need the teacher.

This part of the interview usually benefits by having someone who is a trusted technical expert listen in and help with the evaluation. The oral evaluation really puts the candidate in the hot seat – which is exactly where you need them to be most effective when working at-large in your organization.

Platform Instruction
The final test to evaluate the technical Lean healthcare and Six Sigma skills for hospitals serves two purposes: (1) does the candidate know the material well enough that they can effectively teach others; and (2) how soon will you be able to internalize the training for your organization by relying on this individual to teach your physicians, nurses, technicians and other staff members?

This part of the interview benefits from preparation in advance by the candidate. Send a selection of two to three sets of slides about 2-3 days in advance of the interview. The selections of slides should consist of your organization’s Lean Six Sigma training materials, such as those that a consulting company used for training an initial group or from an open enrollment course that you may have sent people to for training. The selections should cover the following:

  • An introductory topic, such as “Introduction to Lean Six Sigma”
  • The application of several basic quality tools (fishbone diagram, visual management, metrics, voice of the customer, etc.)
  • The application of a more advanced statistical tool, or a topic that you believe is critical for your organization

During the interview, have the candidate teach the training material as if you were a member of the class. Ask questions (even a couple tough ones) to see how the candidate handles being “off the slide.” Pay careful attention to how information is explained. Is it taught from experience and example, or is the candidate reading the bullets? Has the candidate prepared and demonstrated how they can communicate from the platform. And importantly, can the candidate relate the topics to healthcare and to you?

Summary
Hiring a Lean Six Sigma expert for healthcare is an important task. This person will likely be your one-person army in making the program a success for the first year or two. These technical skills are a must-have for any candidate you will hire into your organization for this job. This individual will be responsible for good results on the first projects and for growing new talent within your organization. Take the steps outlined in this edition of “5 Imperatives to Hiring a Lean Six Sigma Expert for Your Hospital” and increase the chances of growing a productive and rewarding performance improvement program.

Keep watch for the next installment of this series to learn more about the 5 imperatives. You can also find more information about building a best-of-breed improvement program in our book, Performance Improvement in Healthcare.

Healthcare Performance Improvement Mistake 9: Measure Twice, Cut Once

Healthcare Performance Improvement Mistake 9: Measure Twice, Cut Once 150 150 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense
Submitted By: Brian MacClaren

Do you believe your organization has too many performance measures or too few? Having good data available enables better decisions to be made, but not when the expense of collecting all the data is so high that it severely limits your resources to fix problems and improve quality. This results in a lot of measuring, but rarely a chance to make the cut.

If asked if you believe your organization has too many different measures or too few, how would you answer?

a) We have way too many metrics, but they all provide valuable information
b) We have too many metrics and they don’t provide the information we need
c) We have just the right amount of metrics to balance the need for information and action
d) We have too few metrics to adequately measure performance

If you answered “c,” then you are among those who have implemented a performance management system that truly works for the entire organization. Sometimes we only have the resources to track required measures like CMS Core Measures. Or, we might track so many different measures that at time we believe we are some kind of data manufacturing company instead of a hospital. In this case, it feels like more time is spent compiling data and reports than actually working on improvement projects.

So, what are the characteristics of a good performance measurement system?

The system must be designed as a tool for tracking financial results while simultaneously monitoring the system’s capabilities to meet customer needs, key performance indicators, and critical success factors.

At the executive level, the system represents the acme of a hierarchy of indicators that, ultimately, reach both the bedside and the loading dock. Ideally, each employee knows how his or her work impacts the uppermost corporate indicators. Given these considerations, many organizations seek to implement the balanced scorecard.

Example of a balanced scorecard.

Although the balanced scorecard represents a vision and a benchmark for measuring performance in an organization, the first step is beginning to design effective performance measures. Here are some things to think about when doing just that:

  • Indicators are specific. A hierarchy of metrics links layers of accountability so that staff at every level of the organization are measured on their contribution to metrics at the highest level. There is a clear line of sight upward, from each worker’s job to the executive dashboard and from the dashboard down to division and departmental indicators and the specific activities moving the dial.
  • Indicators are logical and based on clear operational definitions. process capability and performance against objectives is quantifiable.
  • Indicators are actionable. performance improvements can be linked directly to changes in performance indicators
  • Indicators are relevant. Everything that matters (the critical few indicators defined by organizational strategy) is measured and nothing more.
  • Indicators are related to time. Performance over time (trending) is evident and key processes are measured frequently enough to allow for timely corrective action.

As we work towards moving our organizations to “answer c,” the effort will certainly require a collaborative effort involving all stakeholders to find the most efficient use of the organization’s valuable resources. It will be an effort to separate the “critical few” from the “trivial many.”

The Interference Diagram

The Interference Diagram 150 150 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense
Submitted By: Bob Sproull

For those of us engaged in performance improvement initiatives there seems to be a constant bombardment of “things” that seem get in the way of what we’re trying to accomplish.  Things that interfere with our attempts to achieve a goal or objective in our quest to make things better.  Some of these things come out of nowhere in the name of uncertainty to stifle our efforts and still others are there just waiting to be found and acted upon.  Wouldn’t it be great if there was a way, or at least a tool, to help visualize these “things” so that we could do something about them?  Life would be so much easier wouldn’t it?  Good news….such a tool does exist for identifying the myriad of business, production, healthcare and manufacturing issues that face us every day.  It’s called an Interference Diagram (ID).

Most of you have probably never have seen or even heard of an ID before.  Its origins date back to the mid-1990’s with Bob Fox and the TOC Center in New Haven, Connecticut.  As a thinking tool it has not been well publicized and as such, is not well known.  But just because it hasn’t been well publicized, don’t underestimate its importance from a problem solving perspective. The endearing qualities of the ID is that it’s both simple to learn and construct and is quite robust in its application.  The ID is a thinking tool that offers the capacity to define and visualize those interferences or obstacles that block or hinder your ability to achieve a specific goal or outcome.  It’s always far easier to define what we want, but much more difficult to define why we can’t have it and the ID helps us do that.

The ID can be used at many different organizational levels to understand why things at all levels don’t happen or work the way we want them to.  The ID can be used as a stand-alone tool or it can be used in conjunction with other tools, so its uses are multiple.  As a stand-alone tool it provides a discrete analysis to better define and understand the obstacles that prevent accomplishment of our goal. But in a broader application it can be used to supplement the other, more common systems thinking tools developed by Dr. Goldratt as well as his Five Focusing Steps.  No matter which way it is used, the end results can be very dynamic.

The Interference Diagram is quite simple to construct as depicted in Figure 1.  The first step in its construction is to decide what it is you want more of or what your goal or objective is.  When you’ve decided what that is, write it inside the circle in the center of a white board or piece of paper.  Make sure that whatever you write here is a succinct, precise statement so that it’s easy to work with.

 

FIGURE 1

After you’ve considered and recorded what it is you want more of, think to yourself “What prevents me from getting more of what I want?” The answer to this simple question becomes the interferences that you record in the boxes surrounding your goal.  Continue to list your interferences until you are satisfied that your list is complete enough to move on.  There are really no rules that govern a specific number of interferences you can list, just be sure to list the major interferences as to why you can’t achieve what it is that you want more of.  Make sure you include things that you might think you can’t do anything about like lunches and breaks.

If your ID analysis is such where time is an important factor, then it is important to quantify your interferences as a function of time.  In other words, how much time does this particular interference take away from what you want?  If time is a factor, and most of the time it will be, then it’s important to keep the time element constant.  That is, record the time element for each individual interference using the same measure, such as minutes or hours or whatever measure you select per day or week. As you will see shortly, this will help you prioritize your interferences in terms of importance and action.  Let’s look at an example.

In this example, suppose you are working in an aviation maintenance, repair and overhaul (MRO) facility and you are responsible for increasing the number of aircraft available on a daily basis.  You haven’t been meeting your contractual targets, so you’ve been receiving large $ penalty losses.  Let’s assume you have already completed a process analysis using a process map or value stream map and have determined the location of your system constraint to be the wait time required to get necessary approvals to permit your maintenance work to begin on the aircraft.  In this scenario you assemble a team of subject matter experts, the people maintaining, repairing and overhauling the aircraft, and you begin construction of an ID.  Since your constraint has been identified as the wait time to begin work on the aircraft, you decide that your goal should be, “Reduced wait time to begin repairs.”   You ask the team the following question, “What is preventing you from beginning work on the aircraft sooner?” One-by-one you then record both the interference the team members have described as well as an “estimate” or “guesstimate” of how much time is being lost for each one.

Figure 2 is an example of the responses (i.e. interferences and estimated times) you received from the team members and the populated boxes surrounding your goal.  If you just eyeball the interferences, you can see that Incorrect Assignments is the largest impediment to reducing the wait time to begin repairs at 210 minutes per week.  This is followed by paperwork and waiting for the rinse crew at 120 minutes each.  Once you feel confident that you have captured the predominant interferences, I recommend that you create either a Pareto Chart or a Pie Chart to prioritize the interferences.

 

FIGURE 2

Figure 3 is the Pareto Chart of repair time minutes lost per week as a result of the interferences identified by the team of SME’s.  The Pareto Chart reflects the priority order to “attack” these interferences to authorize repairs to begin sooner on the aircraft.

 

FIGURE 3

I mentioned earlier that the ID can be used at different levels, so let me provide an example.  Suppose that one of the major interferences was getting the necessary paperwork to the mechanics.  You assemble the core team again and decide that the goal is to “Reduce Time Waiting for Mechanic’s Paperwork.”  You then ask the team, “What is preventing you from getting the necessary paperwork sooner?”  As described earlier, the team then provides a list of interferences and time estimates that are blocking achievement of this goal.

Figure 4 is an example of this lower level Interference Diagram and as you might expect, there are few interferences listed, but they are much more specific than those in the original ID.  In this example, the team decided if they could come up with a way to stop batching “Daily Cards” the process would improve significantly.  Because of the travel time from the flight line to Maintenance Control (the final location for the Daily Cards) the team recommended purchase of scanners so that a copy of the cards could be emailed to Maintenance Control rather than holding them as batches and transporting them to MC at breaks and lunches.

The Interference Diagram is a thinking process tool that is based more on experience and intuition rather than logic, but it is a tool that has proved to be invaluable in terms of visualizing organization problems at all levels.

 

FIGURE 4

Visit our YouTube channel to watch a short video of Bob Sproull presenting an Aviation Maintenance Case Study:

http://www.youtube.com/watch?v=PXNLvkWtQVw

If you would like the full slide set of the case study presentation please contact Morgan Bowman at mbowman@novaces.com

Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense