Index
Numbers
1-sigma-churn phenomenon, 5, 8
A
Accelerated change. See Kaizen (accelerated change) events
Adding to existing change models, 13
Alignment to strategy, 18
Analyze phase roadmap
standardization projects, 80–81
understand demand/flow/capacity/value, 71
Applications, from real life. See Project case examples
B
Baldrige, 30
Baseline performance
in breakthrough change approach, 35–36
CT capacity and throughput case example, 86
determining in Measure phase, 66–67
ED throughput case example, 104–105
establishing for Kaizen events, 82
measuring current process, 66
process performance reverting to, 90–91
registration standardization results, case example, 97
in Tier 2 programs, 39
BBs. See Black Belts (BBs)
Behavioral health discovery, project case example, 93–94
Belts. See Black Belts (BBs); Green Belts (GBs); Master Black Belts (MBBs); Project Leaders (Belts)
Benchmarks
characterizing project using percentiles, 44
existing change model relying on, 7–8
fitting with existing initiative, 30–31
project decision not totally dependent on, 92
traditional method of, 2
Black Belts (BBs). See also Project Leaders (Belts)
inpatient placement case example, 106–109
as lead for Tier 2 programs, 39
in Lean Sigma organizational structure, 24
reporting on program status, 52
as very strong Project Leaders, 101
Blue Ocean Strategy (Kim and Mauborgne), 21–22
Bottom-up suggestions, opportunities in, 43
Breakthrough change
continuous improvement vs., 35–36, 78–79
healthcare processes example, 37
Business meetings, daily Kaizen events, 103
Business metrics
change improving key, 19
characterizing for project, 44
developing organizational competence and, 118
as Lean Sigma program focus, 29
in program vision and launch, 115–116
C
Capacity
Analyze phase identifying, 59, 68, 71
ED throughput case, 105
increasing even when maxed out, 88
Kaizen events aimed to increase, 32–33, 82–83
Lean approach to increasing, 56
surgery throughput case, 102–104
Tier 1 projects aimed to increase, 37
Case studies. See Project case examples
Cash enhancement, identifying opportunities, 42
Causes, change based on symptoms vs., 10
complex processes requiring many, 96, 109
Define phase roadmap for, 60–61, 64
developing organizational competence, 119
identifying, 43
Measure phase sign-off, 66
reporting on program status, 52
surgery capacity/throughput case example, 102–104
transforming processes, 120–121
Change agents, 19
creating program infrastructure, 116–117
developing organizational competence, 117–119
globalization, 122
how to start, 123
program vision and launch, 115–116
stabilization and performance management, 121–122
transforming processes, 120–121
Competencies
designing in Improve phase, 73
developing organizational, 114, 117–119
Lean Sigma process improvement and, 34
for program and project roles, 52
Concept, Improve phase roadmap for, 72–73
as change practice, 18
setting program direction, 27
Consultants, for program vision and launch, 116
Containment, as change practice, 17
Context
basing solutions on appropriate, 18
lacking in existing change model, 12–13
making changes in, 78
understanding prior to Improve phase, 71
Continuous improvement
breakthrough change vs., 35–36, 78–79
traditional model of, 2
Control
existing change models lacking emphasis on, 14–15
sustainability as change practice, 18
Control phase roadmap, 74–75, 80–81
Control Plan Summary, 75
Cost reduction
in financially driven projects, 41
identifying opportunities, 42
vision phase and, 123
CT capacity/throughput, project case example, 85–88
Cubicle projects, 4
Customer requirements
in standardization projects, 80–81
VOC. See Voice of the Customer (VOC)
D
Data
analysis in Analyze phase, 69–70
Lean Sigma decisions based on, 78
in traditional change models, 8–9
Decision-making
based on data in Lean Sigma, 65, 78
based on gut feel traditionally, 6
Control Plan Summary documenting, 75
creating program infrastructure, 116
lack of context in, 12
to pilot/ramp up new process, 74
in Tier 2 programs, 39
Decomposition (or deconstruction), 43
Define phase roadmap
define process, 61
determine customer requirements, 61–62
determine project goals, 62–64
low-hanging fruit apparent in, 66
standardization projects, 79–81
understanding, 60
Demand, understanding in Analyze phase, 71
Deming, Dr. William Edwards, 5
Deployment
of Lean Sigma program, 23
phased approach to, 114
program vision and launch, 115–116
Design
Improve phase roadmap for, 73–74
Disparate change groups
informal change approach of, 14
lacking standard change approach, 6
quality improvement lacking in, 4–5
uncontained change of, 5
DMAIC (Define, Measure, Analyze, Improve, and Control), 57. See also Lean Sigma project roadmap
DNFB (reduce discharged not final billed), project case example, 88–90
E
Efficiency, Define phase, 63
E-learning, for organizational competence, 119
Emergency department design, project case example, 109–110
Emergency department throughput, project case example, 104–106
Employees
customers vs., 62
satisfaction of, 44
Entitlement, project goal vs., 47
Event, Kaizen roadmap, 83
Executive Champion, Steering Group, 25
Executive Team
at early stage of Lean Sigma, 111–112, 114
inpatient placement case example, 106–109
program vision and launch, 115–116
setting program direction, 26–28
F
Financial analysts, Steering Group, 25, 66
Financial metrics
identifying opportunities using, 41–42
as Lean Sigma program focus, 28–29
measuring current process performance, 66
Flow, in Analyze phase, 71
Focus
on cash processes in early stages, 88
on process as change practice, 18
of traditional change model, 6–7
G
GBs. See Green Belts (GBs)
Getting started. See Commencing the journey
Goals
characterizing, 43
Define phase determining, 62–64
Lean Sigma setting meaningful, 78
Lean Sigma organizational structure, 24
reporting on program status, 52
running subprojects in Tier 2 programs, 39
Gut feel decision-making, 6, 12–13
H
Human resource (HR) representation, Steering Group, 25, 116
I
Impact, in Lean Sigma program maturity, 113
Implementation
change practice of lasting/sustainable, 18
Improve phase roadmap
developing detailed design, 73–74
pilot/ramping up new process, 74
Incremental improvement, 12, 78–79
Infrastructure. See also Program-level infrastructure
Lean Sigma organizational, 24
Lean Sigma program maturity, 112
Initiation of project, Define phase, 60–61
Inpatient admission standardization, project case example, 98–100
Inpatient placement, project case example, 106–109
IT/IS work, shaping project as, 33
J
Just Do It, shaping project as, 32
K
Kaizen (accelerated change) events
creating program structure, 117
CT capacity and throughput case example, 85–88
ED throughput case example, 104–106
Lean Sigma project roadmap for, 81–84
radiology denials case example, 90–93
shaping project as, 32
surgery capacity/throughput case example, 102–104
transforming processes with, 120–121
L
Launch, program
characterizing projects for, 43–46
commencing Lean Sigma, 115–116
implementation of potential programs for, 117
Lean Sigma roles for, 49
model for performance improvement, 114
stages of Lean Sigma maturity, 112
Layout, ED design case example, 109–110
Leadership. See also Project Leaders (Belts)
as change practice requirement, 19
Lean Sigma structure, 23
learning of. See Project case examples
management roles in healthcare vs., 15–16
reinforcing standardization, 100
stages of Lean Sigma program maturity, 111–114
breakthrough change, 35
characterizing projects, 43–46
fitting with existing initiatives, 29–31
how to start. See Commencing the journey
identifying opportunities, 40–43
program and project roles, 49–52
program tracking/reporting/ongoing management, 52
project case examples. See Project case examples
setting program direction, 26–29
stages of program maturity, 111–114
Kaizen (accelerated change) events, 81–84
Six Sigma vs. Lean Sigma, 55–56
standardization projects, 79–81
Length of stay (LOS) data, 8, 46
Levels, of Lean Sigma program maturity, 111–114
Low-hanging fruit, 66
M
Magnet Recognition Program, 30
Malcolm Baldrige National Quality Award, 30
Management
leadership in healthcare vs., 15
Lean Sigma techniques for, 76
ongoing program, 52
stabilization and performance, 121–122
why Lean Sigma works, 75
Mapping tools, Measure phase roadmap, 64–67
characterizing projects, 43
inpatient placement case example, 106–109
as lead for Tier 3 programs, 40
reporting on program status, 52
role of, 50
MBBs. See Master Black Belts (MBBs)
Meaningful, as change practice, 18
Measure phase roadmap
developing/evaluating measurement systems, 65
implementing quick hits, 67
measuring current process performance, 66
standardization projects, 80–81
understanding process, 65
Measurement Systems Analysis (MSA), 8
Medication delivery, project case example, 95–96
Metrics
aligning Lean Sigma to strategy, 30–31
change improving key business, 19
characterizing project with, 43–46
determining project goals in Define phase, 62–64
Lean Sigma program, 28
Lean Sigma reducing complexity of, 76–78
in Measure phase roadmap, 64–67
in traditional change models, 8–10
Micro-focus, goal setting, 63
Milestones, 20
MSA (Measurement Systems Analysis), 8
N
O
OEE (Overall Equipment Effectiveness), 87
Opportunities, identifying, 43–46
Organizational competence, developing, 114, 117–119
Overall Equipment Effectiveness (OEE), 87
P
Patching (subtracting), from existing change models, 13
PCDA (Plan, Do, Check, Act) change model, 2, 14
People
adding where needed, 92
stages of Lean Sigma program maturity, 112
People-vs.-process
of existing change models, 11–12
failure to control process, 14–15
Lean Sigma process improvement methodology, 34
Performance improvement
aligning Lean Sigma to strategy, 30–31
disparate change groups and, 4–5
setting program direction, 27
model for, 114
Performance shortfall opportunities, 40–41
Physician office standardization, project case example, 100–102
Pilot of new process, Improve phase, 74
Plan, Do, Check, Act (PCDA) change model, 2, 14
Post-Event, Kaizen roadmap, 83
Pre-Event, Kaizen roadmap, 83
Prioritization of project action, 47–48
Problem statement, 43
Problems
Lean Sigma Kaizen roadmap for specific, 81–84
Lean Sigma roadmap and, 77
solving during rollout, 102
unsuccessfully solving, 88
Process design, shaping project as, 33
Process engineers, healthcare lacking, 13
Process Owner(s)
Define phase project initiation, 60–61
Define phase project sign-off, 64
Measure phase sign-off, 66
organizational competence and, 119
stabilization/performance management, 121
surgery capacity/throughput case example, 102–104
unsuccessfully solving problems, 88
Processes
adding vs. subtracting (patching), 13
Control phase roadmap for performance, 75
defining in Define phase, 61
getting good start on improving, 99
Lean Sigma improvement methodology for, 33–34
model for performance improvement, 114
real life redesign of. See Project case examples
systems/roles/people/competencies and, 34
Tier 2 programs addressing linked, 38–39
traditional healthcare model for, 10–15
transforming in early stages, 120–121
Product line, shaping project as, 33
Profitability, Lean Sigma program focus, 28
characterizing projects, 43–46
fitting Lean Sigma with existing initiatives, 29–31
identifying opportunities, 40–43
Lean Sigma, 24
program and project roles, 49–52
program tracking/reporting/ongoing management, 52
setting program direction, 26–28
Programs
Lean Sigma structure, 23
shaping project as, 33
tracking, reporting, and ongoing management of, 52
behavioral health discovery, 93–94
CT capacity and throughput, 85–88
emergency department throughput, 104–106
inpatient admission standardization, 98–100
new emergency department design, 109–110
physician office standardization, 100–102
reduce discharged not final billed (DNFB), 88–90
registration standardization, 96–98
surgery capacity/throughput, 102–104
Project Champion. See Champion(s)
Project Charter
creating program structure, 117
Define phase roadmap, 50, 60–61
Measure phase roadmap, 66
Black Belts as very strong, 101
categories and roles of, 50
Define phase roadmap for, 60–61, 64
developing new, 123
developing organizational competence, 119
Measure phase financial metrics, 66
as part of Team, 51
in political/culturally sensitive projects, 109
program vision and launch, 115–116
stages of Lean Sigma program maturity, 112
Steering Group selecting, 24
Project roadmap, Lean Sigma
Kaizen (accelerated change) events, 81–84
standardization projects, 79–81
Project tiers
defined, 35
Tier 3 complex programs, 39–40
Projects
identifying opportunities for, 43–46
inventory of potential, 117
stages of Lean Sigma program maturity, 113
structuring change, 17
Q
Quality measures
disparate change groups and, 4–5
as Lean Sigma program focus, 28
operations improvement for, 29
Quick hit, 67
R
Radiology denials, project case example, 90–93
Reduce discharged not final billed (DNFB), project case example, 88–90
Registration standardization, project case example, 96–98
Regular (engineering project), 32
Reporting
on program status, 52
stages of Lean Sigma program maturity, 113
early in Lean Sigma journey, 111–112
Process Owners solving problems with more, 88
Project Leaders as external, 87
short changing Team, 51
spending more to get project done, 92
Revenue
identifying opportunities for, 42
as Lean Sigma program focus, 28
P&L statement identifying projects to grow, 42
ROI (return on investment), program vision, 116
Roles
Improve phase roadmap and, 73
Lean Sigma process improvement, 34
for organizational competence, 118
program-level, 52
resilient and sustainability with, 88
S
Scope
as change practice, 18
characterizing project, 43
mistakes when setting goals, 63–64
of program vision and launch, 115–116
stages of Lean Sigma program maturity, 112
when specific failing process is unknown, 88
Shooting from hip, 6
Siloing of functions, 5
Simple tests of change, 14
Skills, organizational competence, 118
Solutions
integral change management for, 76
mistakes when setting goals for, 63–64
poor implementation of, 13
Stabilization, and performance, 114, 121–122
Stakeholders
integral change management for, 76
report program status to, 52
in traditional change models, 2
Standard Work Instructions, Improve phase roadmap, 73
Standardization
disparate change groups lacking, 6
inpatient admission case example of, 98–100
physician office case example of, 100–102
poor implementation lacking, 13–14
registration case example of, 96–98
stabilization/performance management with, 121–122
uncontained change lacking, 5
Standardization projects, 33, 79–81
Steering Committee, 39
Steering Group
creating program structure, 116
developing organizational competence, 117–119
ED throughput case example, 104–106
ongoing management of, 52
overview of, 24
team members, 25
transforming processes, 120–121
Strategy
aligning change projects to, 18
identifying good opportunities, 40
setting program direction, 27
Structuring change
creating program structure, 116–117
with Lean Sigma. See Lean Sigma
within small department, 87
Subtracting (patching), from existing change models, 13
Success, in traditional model, 2
Surgery capacity and throughput, project case example, 102–104
Sustainability. See Consistency/sustainability
Systems
Lean Sigma process improvement methodology, 34
vs. processes in traditional healthcare, 10–11
T
Team members
Define phase roadmap for, 60
Improve phase roadmap for, 71–74
Measure phase roadmap for, 64–67
role of, 51
surgery capacity/throughput case example, 102–104
Tier 2 programs, 38–39, 102, 104–106
Tier 3 complex programs, 39–40, 106–109
Tools
in change practice, 19
Define phase roadmap, 60
traditional change model focused on, 6–7
Tracking
ongoing program, 52
stages of Lean Sigma program maturity, 113
Traditional change model
adding vs. subtracting (patching), 13
changes based on symptoms vs. causes, 10
changes not based on data, 8–9
focus on people vs. process, 11–12
lack of context for solutions, 12–13
management vs. leadership, 15–16
no standard change approach, 6
uncontained change, 5
Training
for organizational competence, 118–119
for program vision and launch, 116
for stabilization and performance management, 121
in stages of Lean Sigma program maturity, 113
Transparency, as change practice, 17
Triggers, Improve phase roadmap, 73
U
Uncontained change, 5
V
Value, Analyze phase, 71
Vision, program
model for performance improvement, 114
setting program direction, 26–28
VOB (Voice of the Business), 33
basing solutions on, 18
behavioral health discovery case example, 93–94
ED design case example, 109–110
for projects touching external market, 87
requirements in Define phase, 61–62
shaping project as IT/IS work for, 33
in Tier 2 programs, 39
W
Wants, customer, 62
Working capital, Lean Sigma program focus, 28
Workplace layout, Improve phase roadmap, 73
X
Y
Y measures, 45