Quality Management - Focus on Six Sigma

8/12/2019 Quality Management - Focus on Six Sigma

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Chapter 8. Quality Management: Focus

on Six Sigma

An Integrated Approach to

Improving Quality and Efficiency

Daniel B. McLaughlin

Julie M. Hays

Healthcare Operations

Management


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Copyright 2008 Health Administration Press. All rights reserved. 8-2

Chapter 8. Quality Management:

Focus on Six Sigma Defining Quality Cost of Quality

Quality Programs

Six Sigma- DMAIC Process

- Seven Basic Quality Tools

- Statistical Process Control (SPC)

Benchmarking

Quality Function Deployment (QFD)

Taguchi Methods

Mistake Proofing (Poka-Yoke)


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Defining Quality

Organizations perspective- Performance (design) quality

- Conformance (design) quality

Customer perspective- Garvins eight dimensions

- Parasuraman, Zeithaml, and Berrys five

dimensions- Institute of Medicine

- Quality assurance program


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Cost of (Poor) Quality

External failurecosts associated with failureafter the customer receives the product or service

Internal failurecosts associated with failure

before the customer receives the product orservice

Appraisalcosts associated with inspecting andevaluating the quality of supplies and/or final

product/service Preventioncosts incurred to eliminate or

minimize appraisal and failure costs


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Quality Programs

Total Quality Management (TQM) orContinuous Quality Improvement (CQI)

ISO 9000

Baldrige Criteria

Six Sigma


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Total Quality Management (TQM)

Focus on the customer

Top-management leadership and support

Employee involvement

Systems thinking

Continuous improvement

Data-based decision making


7/45Copyright 2008 Health Administration Press. All rights reserved. 8-7

ISO 9000

International standards concerned withensuring that organizations maintainconsistently high levels of quality

Five sections:- Quality management system

- Management responsibility

- Resource management- Measurement, analysis, and improvement

- Product realization



Baldrige Criteria

Award established to recognize organizations fortheir achievements in quality and to raiseawareness about the importance of quality

Seven categories:- Leadership- Strategic planning

- Customer and market

focus

- Measurement, analysis,and knowledgemanagement

- Human resource focus

- Process management

- Results



Six Sigma

Philosophy- Eliminate defects through prevention and process

improvement

Methodology

- Team-based approach to process improvement usingthe DMAIC cycle

Set of tools

- Quantitative and qualitative statistically based tools Goal

- 3.4 defects per million opportunities (DPMO)



Successful Six Sigma

Top-management support

Extensive training

DMAIC approach

Use of quantitative measures

Team-based projects

Impact on organizations financials



Six SigmaCulture

Leadership Training

- Green belt

- Black belt

- Master black belt



DMAIC Process

Define Measure

Analyze

Improve

Control

Define

Improve

Control

Measure

Analyze

Plan

Check

Act

Do


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DMAIC ProcessMeasure

CUSTOMERS

Key

Process

Input

Variables

(KPIV)

Key

Process

Output

Variables

(KPOV)

Crit ical

to

Qual i ty

(CTQ)

INPUT OUTPUTPROCESS


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DMAIC Process

Analyze- Analyze collected data to determine the root

causes

Improve- Identify, evaluate, and implement the

improvement solutions

Control- Put controls in place to ensure process

improvement gains are maintained


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Seven Basic Quality Tools

Run Chart

Scatter

Diagram

Histogram

FishboneDiagram

Check Sheet

Pareto Chart

Flow Chart


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Statistical Process Control (SPC)

SPC is a statistics-based methodology fordetermining when a process is moving out of

control.

All processes have variation in output. Some of the variation is inherent in the process

(common).

Some of the variation is due to assignable

(special) causes.

SPC is aimed at discovering variation due toassignable causes and correcting those causes.


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20

25

30

35

40

0 5 10 15 20 25 30

Day

MeanWaitTime(minutes)

+/- 1 +/- 2 +/- 3

Out ofControl

Sample


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SPCOut-of-Control Situations

Observation

_X=0

UCL=3

LCL=-3

8 or More Samples Above (or Below) Mean

Observation

_X=0

LCL=-3

UCL=3

6 or More Samples Increasing (or Decreasing)

Observation

_X=0

UCL=3

LCL=-3

One Sample More Than +/- 3 Standard Errors fromMean

Observation

_X=0

UCL=3

LCL=-3

14 or More Samples OscillatingOne Sample More Than +/- 3 Standard

Errors from Mean

14 or More Samples Oscillating

8 or More Samples Above (or Below)

Mean

6 or More Samples Increasing (or

Decreasing)

Observation

_X=0

UCL=3

LCL=-3

8 or More Samples Above (or Below) Mean

Observation

_X=0

LCL=-3

UCL=3

6 or More Samples Increasing (or Decreasing)

Observation

_X=0

UCL=3

LCL=-3

One Sample More Than +/- 3 Standard Errors fromMean

Observation

_X=0

UCL=3

LCL=-3

14 or More Samples OscillatingOne Sample More Than +/- 3 Standard

Errors from Mean

14 or More Samples Oscillating

8 or More Samples Above (or Below)

Mean

6 or More Samples Increasing (or

Decreasing)


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Current Wait Time

15 20 25 30 35 40 45

Wait Time (m inutes)

Wait Time Goal

15 20 25 30 35 40 45

Wait Time (minutes)

50% of

patients

wait

morethan 30

minutes

10% of

patients

waitmore

than 30

minutes


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Process Capability

A measure of how well the process canproduce output that meets desiredstandards or specifications

Compares process specifications(set bythe customer or management) to controllimits(the natural or common variability in

the process)

P C bilit


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Process CapabilityCp and Cpk

sxUSLor

sLSLxC

xUSLor

LSLxC

s

LSLUSL

C

LSLUSLC

pk

pk

p

p

33min

byestimatedisand33

min

6

byestimatedisand6

P C bilit


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Process CapabilityCp and Cpk

sxUSLor

sLSLxC

xUSLor

LSLxC

s

LSLUSL

C

LSLUSLC

pk

pk

p

p

33min

byestimatedisand33

min

6

byestimatedisand6


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Rolled Throughput Yield

Step 2

95/100error-free

products

Step 3

95/100error-free

products

Step 4

95/100error-free

products

Step 1

95/100error-free

products

Proportions

Step 2

95 in90 error-freeproducts

out

Step 3


out

Step 4


out

Step 1


out

Actual

Q lit F ti D l t (QFD)


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Quality Function Deployment (QFD)House of Quality

Correlation

matrix

Design

requirements

Customer

requirementsCompetitive

assessment

Relationship

matrix

Specifications

or

target values

Importance

Importance weight

Importance

Importance weight


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Customer

needs

Knowledge that it is time for an office visit

Knowledge of why follow-up is needed

Convenient to schedule

Known appointment length

Appointment on time

Goal: Develop a system to

ensure that diabetes patients

receive preventive exams

QFD Example


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Technical

responses

On-time

appo

intmen

t

Appo

intmen

t

lengt

hrange

Time

to

sc

hedu

le

Inform

ationon

need

Su

bs

equen

t

no

tifi

ca

tion

Initial

no

tifi

ca

tion

Time knowledge

Why knowledge

ConvenientAppointment length

Appointment time

QFD Example


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Importance:

Patient desire

Cost

Compet i t ive

advantage

Time knowledge 5

Why knowledge 3

Convenient 4

Appointment length 3

Appointment time 4

QFD Example

On-t

im

e

appoin

tmen

t

Appoin

tmen

t

leng

th

range

Timeto

sc

hedu

le

Informa

tion

onnee

d

Su

bsequen

t

no

tifica

tion

Initial

no

tifica

tion


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Time knowledge 5 Why knowledge 3 Convenient 4 Appointment length 3 Appointment time 4

QFD Example

On-t

ime

appo

intmen

t

Appo

intmen

t

leng

thrange

Time

to

sc

he

du

le

Infor

ma

tion

onnee

d

Subs

equen

t

no

tif

ica

tion

Initia

l

no

tif

ica

tion

Relationships: Strong = 5 Medium = 3 Weak = 1


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Time knowledge 5 5 3

Why knowledge 3 5

Convenient 4 3Appointment length 3 5 3

Appointment time 4 3 5

QFD Example

On-t

ime

appo

intmen

t

Appo

intmen

t

leng

thrange

Time

to

sc

he

du

le

Infor

ma

tion

onn

ee

d

Subsequen

t

no

tif

ica

tion

Initia

l

no

tif

ica

tion

Replace icons with numbers

Relationships:

Strong = 5 Medium = 3

Weak = 1


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Why knowledge 3 5

Convenient 4 5Appointment length 3 5 3


25 15 15 20 27 29

QFD Example

On-t

ime

app

ointmen

t

App

ointmen

t

leng

thrange

Tim

eto

sch

edu

le

Info

rma

tion

onnee

d

Sub

sequen

t

not

ifica

tion

Initial

not

ifica

tion

Mult ip ly b y impor tance and sum


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Why knowledge 3 5

Convenient 4 5

Appointment length 3 5 3


25 15 15 20 27 29

QFD Example

On-t

ime

appo

intmen

t

Appoin

tmen

t

leng

thrange

Time

to

sc

he

du

le

Informa

tion

onnee

d

Su

bseq

uen

t

no

tifica

tion

Initial

no

tifica

tion

TechnicalcorrelationsRelationships:+= Strong positive = Strong negative

+ +


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Why knowledge 3 5

Convenient 4 5

Appointment length 3 5 3


25 15 15 20 27 29

QFD Example

On-t

ime

appo

intmen

t

Appoin

tmen

t

leng

thrange

Time

to

sc

he

du

le

Informa

tion

onnee

d

Su

bseq

uen

t

no

tifica

tion

Initial

no

tifica

tion

Target:

100diabetics/month;85% compliance

QFD Example


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QFD ExampleOutcome

To: Dan McLaughlin

From: Southview Clinic

Dear Dan,

You had an appointment with Dr. Adams about six months ago, and it

is now time for another visit. We need to check your blood pressure,do some blood tests, and adjust your prescriptions if needed. We

would like to review these preventive procedures in advance, so

please see www.southview.com/prev22.

We have two openings available next week, on Tuesday at 8:30 am

and Thursday at 2:30, to see Dr. Adams. Click on one of these days to

make the appointment, or e-mail us with dates and times that workfor you.

We appreciate you continuing your care with us, and Dr. Adams looks

forward to seeing you.


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Taguchi Methods

Taguchi loss function- A quality product is a

product that causes aminimal loss

(expressed in $) tosociety during its entirelife.

Design of Experiments

(DOE) Design for Six Sigma

(DFSS)

Taguchi Loss Function

Y ($)

LSL Target USL

Loss

222 $whereLoss

kTYk


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Design of Experiments (DOE)

A structured approach to the investigation ofa system or process that determines thelevel of each input variable for each trial and

does not require all possible levels of everyinput variable

Requires fewer trials because it eliminates

the need to change one variable at a time Can find effects of combinations of input

variables


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Benchmarking

Process of identifying, understanding, andadapting outstanding practices andprocesses to improve organizational

performance Steps in benchmarking:

- Determine what to benchmark

- Determine how to measure it- Gather information and data

- Implement the best practice within theorganization

Best

Worst

Rangeof

values

Yourorganization

Best

Worst

Rangeof

values

Rangeof

values

Yourorganization

Yourorganization


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Mistake Proofing (Poka-Yoke)

A mechanism that either:- Prevents a mistake from being made

- Makes the mistake immediately obvious

Eliminates errors

Riverview Generic Drug Project


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Riverview Drug Prescription Process

Patient

needs

drug

Clinician

prescribes

drug

Informationon drugs

Type of

drug

Drug

efficacyEnd

Drug

efficacyEnd

GenericDrug

works

Non-Generic

Drug

works

Drug

doesnt

work

Drug doesnt work

Ri i G i D P j t


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Riverview Generic Drug ProjectDrug Type and Availability

65% 35%

15%

20%

Generic

Non-Generic,GenericAvailable

Non-Generic,Generic NotAvailable

Microsoft Excel screen shots reprinted with permission from Microsoft Corporation.


42/45



Microsoft Excel screen shots reprinted with permission from Microsoft Corporation.

Clinician Prescriptions

0

5

10

15

20

Davis Jones Smith Swanson AndersonClinician

Non-genericprescriptions

whereagenericis

available/month

Non-Generic Prescriptions Where There Is a Generic Available

0

5

10

15

20

O W J V B H M A C I G D K L T U N P Q R

Drug

Prescriptions/month

DMAIC Process


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DMAIC Process

Seven Quality Control Tools

Tools and TechniquesDe

fine

Mea

sure

Analyze

Improv

e

Control

Cause-and-Effect Diagram xRun Chart x x

Check Sheet

Histogram x x

Pareto Chart x x x

Scatter Diagram x xFlowchart x x

DMAIC Process


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DMAIC Process

Other Tools

Tools and Techniques

Bar Graph x

Line Graph x

Pie Chart x5 Whys/ Root Cause x

FMEA x x

Hypothesis Testing x

Regression Analysis x

DOE x

Control Chart x x x

Process Capability x x x

Simulation x

DMAIC Process


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DMAIC Process

Other Tools

Tools and Techniques

Quality Function Deployment x x x

Poka-Yoke x

Brainstorming

x

x

xBenchmarking x x x x

Project Planning x x x

Charters x

Gantt Chart x

Tree Diagram xForce Field Analysis x x

Activity-Based Costing

Balanced Scorecard

Cost and Benefit Analysis x

Documents

Quality Management - Focus on Six Sigma