What in the name of God is Lean six sigma anyway?

listermint · 19-06-2019 8:23pm

The key with these things are that they are a framework not an anchor.

If its used to redtape and governance then it fails.

banie01 · 19-06-2019 8:27pm

Anyone with any lean or Six Sigma training could make serious efficiency inroads into HSE practice.

Take an outpatients appt as an example, the number of physical moves for the patients paper file/notes alone is a complete waste.

There is much duplication and unnecessary repeat or redundant steps in an OPD appointment that can and should be streamlined.

Adoption of lean practices can go a long way towards this by giving appropriate tools to those most directly involved in the process to make changes.

A big problem with Irish Organisations and their implementation of lean/six sigma is that all too often it is rolled out to management 1st and pushed as a top down change.

Invariably this fails to gain traction, it really needs to be an organisational change led from the bottom up.
Getting staff buy in as early as possible on the transformation process makes it a staff led programme, but staff productivity and genuine involvement make those changes much more involved and resilient.

The goal of 6 sigma really can and does align quite well with Healthcare and the mantra of right 1st time can and does prevent patient injury in organisations that do use 6 sigma.

knipex · 19-06-2019 8:53pm

Lean is a catchall term for what was initially a manufacturing system known as TPS or Toyota Production system. A set of tools that allows for the highest quality paert to be built in the shortest possible lead time and the lowest possible cost by eliminating waste.

Defective parts are one type of waste.

6 sigma is a QUALITY program that aims to develop processes that deliver under 3.4 defects per million. ie to develop consistent, reliable processes.

6 sigma is one of many tools used to build a lean process.

Another is 5S (or 7S as its becoming now)

Kanban is technically a card, or a trigger that an upstream process uses to call for something it needs from a down stream process or a supplier and is a tool within a "Just in Time" manufacturing process.

Over time its evolved to come to mean a parts bin or similar (it tends to develop different meanings in different facilities.)

All these are just tools.

6-sigma
5S
Kaizen
Quality Circles
SMED

All tools that work together or individually to eliminate waste and improve quality.

The problem is you get "specialists", who "specialise" in one element or one tool or indeed in Lean but have no or limited understanding or care for the otehr impacts they may be having.

In an organization where lean tools are used and implemented as part of an overall improvement strategy they can transform organizations (Dell is in PC manufacturing peak was the poster child for lean and Just in Time, Toyota post WW2 developed many of these tools out of necessity, they had limited raw materials, limited finance and limited labour pool.) Japanese manufacturing was built on lean.

In organizations where tools are cherry picked and used in isolation they cause problems. Lots and lots of problems and invariably fail which gives lean a bad name.

Hoboo · 19-06-2019 8:58pm

knipex wrote: »

Lean is a catchall term for what was initially a manufacturing system known as TPS or Toyota Production system. A set of tools that allows for the highest quality paert to be built in the shortest possible lead time and the lowest possible cost by eliminating waste.

Defective parts are one type of waste.

6 sigma is a QUALITY program that aims to develop processes that deliver under 3.4 defects per million. ie to develop consistent, reliable processes.

6 sigma is one of many tools used to build a lean process.

Another is 5S (or 7S as its becoming now)

Kanban is technically a card, or a trigger that an upstream process uses to call for something it needs from a down stream process or a supplier and is a tool within a "Just in Time" manufacturing process.

Over time its evolved to come to mean a parts bin or similar (it tends to develop different meanings in different facilities.)

All these are just tools.

6-sigma
5S
Kaizen
Quality Circles
SMED

All tools that work together or individually to eliminate waste and improve quality.

The problem is you get "specialists", who "specialise" in one element or one tool or indeed in Lean but have no or limited understanding or care for the otehr impacts they may be having.

In an organization where lean tools are used and implemented as part of an overall improvement strategy they can transform organizations (Dell is in PC manufacturing peak was the poster child for lean and Just in Time, Toyota post WW2 developed many of these tools out of necessity, they had limited raw materials, limited finance and limited labour pool.) Japanese manufacturing was built on lean.

In organizations where tools are cherry picked and used in isolation they cause problems. Lots and lots of problems and invariably fail which gives lean a bad name.

Another major cause of failure is a poor or no change management strategy, organisations expect to implement all these great ideas without even buy in at the top nevermind the other necessary steps. Usually in companies with a weak or undervalued HR team with no seat at the table.

knipex · 19-06-2019 8:59pm

UsBus wrote: »

If Toyota were jumping off cliffs, some manufacturing companies in Ireland would be at it. I could never fathom why medical device companies here would treat a car manufacturer as the Bible in good manufacturing practice..

The TPS and lean moved out of car manufacturing and into other industries in the 80's. It prevailed initially across high volume manufacturing initially starting in heavy engineering type industries but quickly moved in electronics manufacturing industry, PC manufacturing and across the entire manufacturing sector.

Lean has been used in medical device since the 90's in the US, Korea, Japan, even India and China. Ireland is far from unique and in many cases well behind the curve.

For teh last decade or more Lean has made serious inroads in the service industry.

knipex · 19-06-2019 9:02pm

Hoboo wrote: »

Another major cause of failure is a poor or no change management strategy, organisations expect to implement all these great ideas without even buy in at the top nevermind the other necessary steps. Usually in companies with a weak or undervalued HR team with no seat at the table.

No argument on that

If senior management don't embrace and drive it then it will fail. TPS or lean also pushes hard the team approach with huge focus on internal stakeholders and their input and training. Its a collaborative approach and without collaboration it fails. Also huge focus on training and bringing along workers, making them feel involved, getting them to take ownership but many companies balk at this and skimp on the training and involvement so it fails..

Gimme A Pound · 19-06-2019 9:03pm

Did the first part - just basic cop-on. But I know it gets more interesting. I really like the idea - I love streamlining and I hate clutter - but it seems to be a difficult one to package. And it's not suitable for every workplace yet companies seem to think it's "one size fits all".

Stovepipe · 19-06-2019 9:06pm

Lean works very well in some manufacturing settings but it's a pain in the arse when your management tries to force it into an airline, which is not a manufacturer, in case anyone missed it. It's good for tool control, keeping things tidy and so on, but for running an airline, it's a waste of time.

screamer · 19-06-2019 9:07pm

The basic principle of all of it is to reduce waste, thereby increasing efficiency and ultimately profits. Think- do more with the same or from employers POV do more with less. It’s a real racket with training companies raking it in.

banie01 · 19-06-2019 9:13pm

knipex wrote: »

For teh last decade or more Lean has made serious inroads in the service industry.

The toolsets for lean/six sigma are moving into a much wider array of industries.

I was introduced to Six Sigma in 2000's in Dell, I've since worked in multiple roles in other industries that are playing catch up in terms of international competitors and Irish too. I would say however no other company I've worked for has ever approached Dell for the level of integration and commitment it put into those tools.

The urge to embrace these tools always comes from the top, but TBH as you have already said...
The lack of HR and entry level engagement is a serious impediment to any change management programme.

The rush in my experience is always towards ensuring middle/high management getting green/black belt certified.
Which is IMO the wrong way to implement those changes.
I would be evangelical about pushing these changes from the bottom up.

White/yellow belts and kaizen or A3 projects initially,at the point closest to the customer and working back the production stream.
Introduce the Green/Black belt portions of the training to managers of those undertaking the initial projects to allow an amalgamation of those projects and ensuring any potential economies of scale are pushed to all areas.

The Motorola/TPS/lean/6 sigma whatever name you use, is great in so far as it offers a standardised approach to problem recognition, solving and metrics that is transferable across all lines of business and industry.
It is however only ever as good as its actual implementation and control.

knipex · 19-06-2019 9:21pm

Stovepipe wrote: »

It's good for tool control, keeping things tidy and so on, but for running an airline, it's a waste of time.

thats 5S. which is one tool in lean. Just one fo many.

I have heard (not seen but heard) of it being implemented very successfully in a solicitors office and have seen it implemented in a call center, again very successfully.

In both cases it was implemented as part of a larger lean program

Nelbert · 19-06-2019 9:32pm

banie01 wrote: »

Anyone with any lean or Six Sigma training could make serious efficiency inroads into HSE practice.

Take an outpatients appt as an example, the number of physical moves for the patients paper file/notes alone is a complete waste.

There is much duplication and unnecessary repeat or redundant steps in an OPD appointment that can and should be streamlined.

Adoption of lean practices can go a long way towards this by giving appropriate tools to those most directly involved in the process to make changes.

A big problem with Irish Organisations and their implementation of lean/six sigma is that all too often it is rolled out to management 1st and pushed as a top down change.

Invariably this fails to gain traction, it really needs to be an organisational change led from the bottom up.
Getting staff buy in as early as possible on the transformation process makes it a staff led programme, but staff productivity and genuine involvement make those changes much more involved and resilient.

The goal of 6 sigma really can and does align quite well with Healthcare and the mantra of right 1st time can and does prevent patient injury in organisations that do use 6 sigma.

Agree with your point but it disregards the context.... if hospitals were flush for cash they’d have each spent the few million quid for electronic patient records.....
Big deal made about that European fund loaning Ireland money last year or the year before for EPR..... no sign of it filtering down....
Given a finite budget and political pressures choices are made...... would Waterford prefer an EPR or a second cath lab an expert review says wasn’t required?

_Brian · 19-06-2019 9:37pm

Company I worked in 10 years ago had a real hard on for it, mostly because of the cool buzz words and endless meetings.

We trained and has Kysans out the ying-yang. Loads of useful equipment was deemed surplus which we divided up and brought home - that was the best outcome.

It has some good points but if a company is prone to getting tied up on small stuff in meetings this thing is like opening a suitcase with a black hole in it, people just get sucked into the small stuff and never make any real progress.

banie01 · 19-06-2019 9:38pm

Nelbert wrote: »

Agree with your point but it disregards the context.... if hospitals were flush for cash they’d have each spent the few million quid for electronic patient records.....
Big deal made about that European fund loaning Ireland money last year or the year before for EPR..... no sign of it filtering down....
Given a finite budget and political pressures choices are made...... would Waterford prefer an EPR or a second cath lab an expert review says wasn’t required?

The money actually saved by improving the procedures and handling of OPD alone could easily allow either a higher volume of patients to be treated or for the capital saved to be diverted to capital acquisition projects such as the Waterford Cath lab.

There is a reason the use of these toolsets is becoming endemic in the private sector.
The funds saved as a result of these tools are at the end of the day, financially validated and affect the bottom line.

Introducing new work practices into state bodies is notoriously difficult and it is a lot harder to overcome vested interests supported by "custom and practice" and the sword of Damocles that the unions hold when it comes to working practices.

The assumption is always made that it's just change for the sake of change, each efficiency gained has a cost associated.
Those saved costs can then be redirected.

Nelbert · 19-06-2019 9:42pm

banie01 wrote: »

The money actually saved by improving the procedures and handling of OPD alone could easily allow either a higher volume of patients to be treated or for the capital saved to be diverted to capital acquisition projects such as the Waterford Cath lab.

There is a reason the use of these toolsets is becoming endemic in the private sector.
The funds saved as a result of these tools are at the end of the day, financially validated and affect the bottom line.

Introducing new work practices into state bodies is notoriously difficult and it is a lot harder to overcome vested interests supported by "custom and practice" and the sword of Damocles that the unions hold when it comes to working practices.

The assumption is always made that it's just change for the sake of change, each efficiency gained has a cost associated.
Those saved costs can then be redirected.

Yes but your example is one which requires a significant upfront investment which can’t be ignored. Such capital being spent in one area deprives another until those savings (or additional activity based funding) are actually realised.

_Brian · 19-06-2019 9:43pm

It’s the unions that are ultimately holding back the health services.

No changes in work practice without increases on pay, no flexibility without pay increases, no accountability even with pay increases.

Look at the likes of the SSC in santry where I can make an appt for mri late in the evening or early in the morning thus minimising the idle time and improving throughput for the same capital spend.

I’ve been in a company that got bogged down with Lean stuff.
Imagine the management meetings in the HSE, the endless consultancy fees, the union resistance to making swift immediate changes in practice. It’s a pipe dream that it could ever happen.

banie01 · 19-06-2019 9:53pm

Nelbert wrote: »

Yes but your example is one which requires a significant upfront investment which can’t be ignored. Such capital being spent in one area deprived another until those savings (or additional activity based funding) are actually realised.

No, it really isn't.
Steps are already in train to move to fully EPS compliant systems already.
Acceralation of that particular capital spend is reallocation of a budget line item to bring forward an already approved spend.

That can be fairly quickly offset in practice by elimination of the portering of records from Central Records in a hospital to the clinic secretary, the files subsequent steps from her desk to each of the triage nurse, Clinical nurse specialist and Specialist along with the move back to reception and from there back to central records again.

Eliminate the 2 porter journeys, and the non treatment time of 3 clinicians in walking a file and you have a significant saving on labour cost along with a fair portion of extra actual clinical time available for treatment.

This is just a spitball review of the file walking aspect of an OPD visit.
The term favoured in 6 sigma for things like the file walk is "non value add".
In this instance I don't agree with that particular label.
It is a simple example of a needed step, it is nigh on impossible to treat a patient without a file

But it is a series of actions that bleed cash, staff resources and time from an already heavily strained system.

Now I'm not saying my example is an immediately needed change or even the right one to implement.
Without actually reviewing the system, it would be very arrogant of me to say I'm right do it!
But it as an example of how the flow of a simple interaction for needed information can add layers of touch and work that are unnecessary and easily redirected.

Nelbert · 19-06-2019 10:27pm

I’m not disputing the impact.

I’ve worked on some large scale projects moving towards EPR and some of the financial incentives in terms of realisable cost savings are extremely appealing. I’ve done full cost benefit analysis (with cost savings intentionally underestimated) and despite the scale of investment it does payback.

It requires significant upfront cost however and navigating a lot of vested interests.
My personal view is centralised funding from the HSE / DOH which is ringfenced will make EPR happen anything short of this will leave us in status quo.

Full disclosure; I work in a public hospital, I WISH we had an EPR (doing an MSc in Data Analytics so the opportunities it would open up for improvement and analysis is quite something!). But from previous jobs I can understand the mixture of political intervention, vested interests and unions preventing such a large investment. Ironically I think it will be a political intervention that ultimately leads to the ring fenced money that’s required to make it happen.

The efficiencies and analytical opportunities it would create would I feel have one of the most significant positive impacts on patient care in both acute and community care if done properly.

Basically the clinical secretary in OPD example having time wasted with physical charts is indeed a symptom of a significant systematic waste but it’s not something that could be solved within the confines of a lean project within the OPD in isolation..... it’s a massive transformational project for the entire organisation.

AndrewJRenko · 20-06-2019 12:14am

Nelbert wrote: »

Agree with your point but it disregards the context.... if hospitals were flush for cash they’d have each spent the few million quid for electronic patient records.....
Big deal made about that European fund loaning Ireland money last year or the year before for EPR..... no sign of it filtering down....
Given a finite budget and political pressures choices are made...... would Waterford prefer an EPR or a second cath lab an expert review says wasn’t required?

No sign of it filtering down? How hard did you look?
https://m.facebook.com/story.php?story_fbid=2398623066826880&id=455157191173487&comment_id=2399195470102973&notif_t=feed_comment&notif_id=1560960697992577&ref=m_notif

Nelbert · 20-06-2019 7:34am

AndrewJRenko wrote: »

No sign of it filtering down? How hard did you look?
https://m.facebook.com/story.php?story_fbid=2398623066826880&id=455157191173487&comment_id=2399195470102973&notif_t=feed_comment&notif_id=1560960697992577&ref=m_notif

Not on Facebook for start and if you think that will have the sort of major impact required you’re kidding yourself. It’s a start but you’re talking 10+ million for each of the major acute hospitals

AndrewJRenko · 20-06-2019 8:59am

Nelbert wrote: »

Not on Facebook for start and if you think that will have the sort of major impact required you’re kidding yourself. It’s a start but you’re talking 10+ million for each of the major acute hospitals

How much are NAS spending on the project?

They're in the acute hospitals too

https://www.irishtimes.com/news/health/meet-emily-ireland-s-first-digital-baby-1.2893670

Nelbert · 20-06-2019 7:15pm

AndrewJRenko wrote: »

How much are NAS spending on the project?

They're in the acute hospitals too

https://www.irishtimes.com/news/health/meet-emily-ireland-s-first-digital-baby-1.2893670

Maternity only. Yet another silo

AndrewJRenko · 20-06-2019 11:02pm

Nelbert wrote: »

Maternity only. Yet another silo

So why don't you tell us exactly how the €40 million project should be organised? How much research have you done into the project so far, just to save me posting details link by link?

Nelbert · 21-06-2019 7:11am

AndrewJRenko wrote: »

So why don't you tell us exactly how the €40 million project should be organised? How much research have you done into the project so far, just to save me posting details link by link?

The point was someone made it part of a simple lean project.
It’s not, it’s a massive undertaking with multiple important stakeholders at each local and national level.
Galway award a contract to digitise patient records around late 2015..... started scanning in the last few months (3 ish years to scan a page!). These projects are massive undertakings and are an organisation wide change and require some serious funding.

Not to minimise the good work that has started but we are years and some political decisions (rather than local ones) away from dedicated funding being provided and without ringfenced funded (like that from the maternity projects) it’ll take years

AndrewJRenko · 21-06-2019 10:15pm

Nelbert wrote: »

The point was someone made it part of a simple lean project.
It’s not, it’s a massive undertaking with multiple important stakeholders at each local and national level.
Galway award a contract to digitise patient records around late 2015..... started scanning in the last few months (3 ish years to scan a page!). These projects are massive undertakings and are an organisation wide change and require some serious funding.

Not to minimise the good work that has started but we are years and some political decisions (rather than local ones) away from dedicated funding being provided and without ringfenced funded (like that from the maternity projects) it’ll take years

It's a long way from a 'simple lean project'. It is indeed a massive undertaking with multiple important stakeholders. I don't know much about it, other than having seen Richard Corbridge speaking about it a couple of times when he was in the CIO role, but it is a huge project - with a team of about 40-50 involved and a budget of tens of millions.

It includes the National Children's Hospital, Primary Care IT, Cancer Care eHealth, Open Data, ePharmacy, Maternity, Laboratory, Radiology and more.

The Case Studies include St James Scan for Surgery, Galway Digital Notes and Order Sets (a lot more than scanning files), Pharmacy eDischarge, ST James Self Service Check In, St Vincents Messaging, Radiology Referrals, Blood Tracking, GP Referral and Laura Lynn.

Honestly folks, this is a big deal.

Skidfingers · 20-01-2021 3:04pm

Apologies about bumping an old thread but I am currently doing the Green belt.

I'm just wondering is there any tips or how people got on with it? What was the exam and project like?

Irishder · 20-01-2021 11:01pm

Skidfingers wrote: »

Apologies about bumping an old thread but I am currently doing the Green belt.

I'm just wondering is there any tips or how people got on with it? What was the exam and project like?

who are you doing it with? usually a project

Skidfingers · 21-01-2021 10:28am

Irishder wrote: »

who are you doing it with? usually a project

RP Consulting. Have you done it? How'd you find the project and exam?

Irishder · 21-01-2021 9:02pm

Skidfingers wrote: »

RP Consulting. Have you done it? How'd you find the project and exam?

Have a green belt, Lean expert, Lean Masters and currently doing a master black belt.

Never heard of RP consulting, but most green belt programs follow the same basic principles.

They will introduce you to the lean tools and use case studies to demonstrate the effectiveness. You then complete a project showing how you implemented these tools in your place of work.

Id say these have 99% pass rate so once you keep your head down you will be grand

Skidfingers · 21-01-2021 11:45pm

Irishder wrote: »

Have a green belt, Lean expert, Lean Masters and currently doing a master black belt.

Never heard of RP consulting, but most green belt programs follow the same basic principles.

They will introduce you to the lean tools and use case studies to demonstrate the effectiveness. You then complete a project showing how you implemented these tools in your place of work.

Id say these have 99% pass rate so once you keep your head down you will be grand

What did you do the project on? What was the project like?

This help much appreciated!

What in the name of God is Lean six sigma anyway?

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