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A Quick Tutorial on Lean Six SigmaHow to make a great cup of coffee fast ?

Chetan S. Makam

chetanmakam@gmail.com

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Perspectives

Australia

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Scope of this presentation Objectives and Problem Solving Understanding the Blood Supply Chain The Process Excellence Tool box Implementation Approach Case Studies

Project Examples Project – Increasing the yield of plasma from WB

# 1 Reason People Don’t Donate Blood

What I Am Going To Talk About ?

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Scope of the PresentationD

epth

Breadth

Scope

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Fragile blood supply chain Inefficiencies Manual processes

Shrinking donor population for blood donation Deferrals Competing civic opportunities

Clinical complications and adverse reactions from blood transfusions

Rising costs of blood transfusion

Hospitals and Blood Banks Challenges

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What are some of the approaches to problem solving?

If we ignore it long enough, it’ll go away.

Just wait, something worse will come up. Problem? Who said that there’s a problem?

Just throw it away…no one will ever know.

So How Are We Going to Solve Them ?

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Lean Six Sigma Theory of Constraints (for a later time)

Process Excellence Tool Box

“Eighty five percent of the reasons for failure to meet customer expectations are related to deficiencies in systems and process…rather than the employee” _ Deming

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Lets talk Lean & Six Sigma Over Coffee

Brewing coffee Where do you keep the coffee pot, filters, coffee, sugar

How many places do you make coffee (home vs office) Where do you store the supplies

Central location Near each brewing station

Near each other Eliminated unnecessary motion Allow you to refill when needed Reduce time to make coffee

LeanTime & Motion

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Lets talk Lean & Six Sigma Over Coffee

Can all the above help you make a great cup of coffee ? What are the things (variables) that affect the TASTE ?

Coffee Type of Brand – Bru, Coffee brand, Starbucks Roast level – medium, dark…

Ground size – fine, coarse Amount added – 1 scoop, 2 scoops…

Water Amount Source

Milk, cream or the white stuff Amount Brand

Sugar or sweetener Person making the coffee

Six SigmaReduce the Variation

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How can I make a great cup of coffee fast ?

By using the right tools - reducing time and motion

- Reducing the variation

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The Lean Process

Map thingsas they are

Measure

Flow value added

activities and train

Measure againCelebrate the

accomplishments

Eliminate whatdoes not add

value

Start here

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Door to Balloon Time

Patient Arrives Balloon In

Value Added Time

Non- Value Added Time

TIME

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Expressors

CentrifugeHe-MaxBSCBio-Hazard WasteTechnician

A Lab ExampleProcessing-Before Lean Improvements

From AssemblyTo Freeze Prep1

QC Lab

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3

4

5

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9

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Current Process

-1 Operator Processes Product

All the way through

-Excessive Non-Value Added

Wait time

• Space• Product flow• Donor flow• Info flow • Paper flow

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A Lab Example Processing-After Lean Improvements

CentrifugeHe-MaxBSCBio-Hazard WasteTechnician

From AssemblyTo Freeze Prep

1

2

3

4

5

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Operator 1

Operator 2

Operator 3

Improvement in Capacity of 74% and

in productivity of 25% (from 12

operators to 9)

*No more than 1 product

in hood at one time

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Lean Focuses on Eliminating the Seven +1 Deadly Wastes (TIMWOOD)

Transportation Inventory

Excess Stock on Hand Movement

Donor Flow, Excess Worker Motion Waiting

Donor wait time, Collection-Manufacturing match Overproduction

Collecting the wrong product, too many donors Over Processing

Documentation, Checks and Re-Checks Defects

Incomplete Health History, Donor Deferrals

Employee with right skills and training

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What is Six Sigma ?1. A level of performance that strives for

perfection (no defects) in our services & products

2. A process improvement method to accomplish results

3. An organization of people to carry out the improvement activity

4. A statistical measurement of our process capability, as well as a benchmark for comparison

5. A strategic initiative to launch improvement projects where they will have the biggest impact

• Metric• Method• Organization• Benchmark• Strategic

6σ

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2 308,5373 66,8074 6,2105 2336 3.4

s PPM

Sigma Level

Defects perMillion

Opportunities

A Metric

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99.99966% Good (6 Sigma)

20,000 lost articles of mail per hour

Unsafe drinking water for almost 15 minutes each day

5,000 incorrect surgical operations per week

Two short or long landings at most major airports each day

200,000 wrong drug prescriptions each year

No electricity for almost seven hours each month

Seven articles lost per hour

One unsafe minute every seven months

1.7 incorrect surgical operations per week

One short or long landing every five years

68 wrong prescriptions per year

One hour without electricity every 34 years

99% Good (2.8 Sigma)

Six Sigma in Your World

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2020

Adapted and updated from Ann. Intern. Med. 2012;157:49-58 & UBS

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If more defects are created, then more defects are passed on to the customer

Six Sigma: Striving for Perfection

Can you inspect in quality?

Quality : Engineered In NOT Inspected Out

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What is Six Sigma ?1. A level of performance that strives for

perfection (no defects) in our services & products

2. A process improvement method to accomplish results

3. An organization of people to carry out the improvement activity

4. A statistical measurement of our process capability, as well as a benchmark for comparison

5. A strategic initiative to launch improvement projects where they will have the biggest impact

• Metric• Method• Organization• Benchmark• Strategic

6σ

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How Do We Measure Variation?

1s 2s 3s-3s -2s -1s

The standard deviation statistic (symbolized by the Greek letter sigma ‘σ’ ) is a measure of the spread of the process. It is an approximation of the average distance from the center of the distribution.

68%

95%

99.7%

Spec

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Six Sigma Striving for Perfection Sources of

variation can be: Identified Quantified Eliminated by control or prevention

TargetVariation is the ENEMY… and

Variation cost $$$$, Customer Dissatisfaction, etc..

Lower Spec

Upper Spec

BEFORE:

Lower Spec

Upper Spec

AFTER:

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Blood Acquisition Transfusion

Blood Products Trauma-Emergency

Blood Delivery Operating Rooms

Value-Added Services (attributes) Labor / Delivery

Blood Supplier Efficiency Infusion Center

Intensive Care

Remote Campuses

Blood Bank Processing Logistics Post-

TransfusionRe-typing Ordering Clinical

Adverse EventsTransfusion Related

Diseases30-Day Length of Stay

Special Processing Receiving

Type & Screen Returns

Crossmatch Blood Issuance AdministrativeReporting

Blood Supply Chain

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Case Studies / Examples

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Value Stream Mapping – Discovery Process

DiscoveryConduct Process Mapping with blood banking and transfusion medicine experts • Goal = Identify costs associated with transfusions from arrival of blood at hospital through post-transfusion• Approach = Minimally invasive, on-site discovery completed in < 20 hours (<2 hours / participant)

AnalysisReview data inputs and observations compiled• Goal = Document bloods’ journey through the hospital to expose best practices and opportunities for excellence

• Approach = ~2 weeks of off-site data input and observation analysis to prepare findings

FindingsPresentation of findings outlining best practices and quantified opportunities for excellence• Goal = Share best practice findings and discuss identified opportunities• Approach = Findings presentation with sponsor, discovery participants and any other appropriate personnel

Automate EXM; Reduce

C/T Ratio

Blood Utilization Optimization

+5S & Visual Management

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Lean Six Sigma in Transfusion Medicine

Areas / Topics Lean / Six Sigma Tools

People / Premises Workspace design / Training, 5S

SOP’s Visual design

Lab Testing Measurement Systems Analysis; Control Charts; TAT; Variation –normal and special cause

Equipment Uptime, Calibration

Documentation Error proofing

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Laboratory Reduced test TAT by 3 hours – Increased capacity Reduced space required by 23% - No need for expansion Increased testing capacity by 22% - Increased capacity

Recruitment, Conversion & Retention Reduced donor walkout rates by 50% (~$145K) Reduced Hematocrit deferrals by 15% (~$365K)

Manufacturing Increased plasma yield by 2% (~$235K) Improved manufacturing productivity by 7% (~$220K) Reduced manufacturing losses by 67% (~$185K) Reduced filter failures by 40% (~300K) Reduced discards due to clots by 66% (~$1.5MM)

Regulatory/ Problem Management Reduced Recalls due to errors

Product Availability Increased Type “O” collections by 3% (~$400K)

Logistics and Transportation Reduced hospital delivery cost by 21% (~ $600K)

Successful Projects – A Short Selection

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Get a deployment expert in Lean/Six Sigma to advise and help you Small or large project – scope and definition Establish a project list based on institutions priorities Get people trained

Project Execution

How do I get started Data – Your software is a good source Starting or redesigning your space

Measure your process – Monitor – Improve !

Implementation Approach

In God We Trust – All Others Bring Data !!!

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Project Statement : Increasing the yield of the plasma derived from whole blood

Benefit: Increased availability of plasma for fractionation Increased revenue for the blood center

Results Increased yield per unit on average by 8 ml

Lean Six Sigma Project Example

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Blood center’s component production mix

random donor platelets cryoprecipitate / cryo-reduced plasma fresh frozen plasma / plasma for transfusion

Choice of leukoreduction filters WB filtration consumes 17-20 mL of plasma / unit

Choice of units for fractionation vs. for transfusion RDP & Cryo Triple units leave less plasma than Doubles

What else impacts your Blood Center’s Plasma Yield Per Unit?

What Causes Differences inPlasma Yield per Unit?

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Potential Causes of Plasma Loss- Observe the process

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Mapping the process – Time and Motion

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Understanding the process - Variables

Variables affecting %plasma recovery – spin speed and HCT %

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Optimizing the variable – best yields

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How Might Your Center’s

Increase Recovered Plasma?

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How Might Your Center’s

Increase Recovered Plasma?

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Verify the data – statistically significant results

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#1 Reason People do not Donate Blood –They were not asked

Initiative started by a high school girl in

Bangalore

I am asking you to register and to ask your friends and family to do the

same