Assisting Physicians with Six Sigma

The National Commission on Certification of Physician Assistants (NCCPA), the only credentialing organization for physician assistants in the United States, continuously works toward making sure that physician assistants meet the established standards of knowledge and clinical skills required to practice.

Physician assistants are midlevel health practitioners whose job complements the services and skills of physicians. What has made their task more daunting is that they oftentimes work in more remote areas and areas of high need. They therefore should be highly skilled as well.

To maintain the quality of services they render, NCCPA turns to Six Sigma. In 2004, the Commission adopted the rigorous Six Sigma methodology for process improvement.

The initiative was used to evaluate the effects of infrastructure changes and software and database improvements. For example, evaluation of NCCPA’s automated phone system suggested changes that will reduce abandoned phone calls at NCCPA in 2005.

Another, NCCPA used Six Sigma to develop the digital file room, a mammoth undertaking to scan all current and historical certification documentation and store it electronically. Before scanning began, a control process that included a two-tier review of all scanned documentation was devised.

Six Sigma was also used to develop secure, customized Web portals that have increasingly automated the work that NCCPA does with state licensing boards and PA programs.

This year, 2005, NCCPA turned to portals to offer enhanced CME collection and reporting services. The CME project, developed with Six Sigma tools, began with the use of now ongoing Web-based surveys.

NCCPAs President Janet J. Lathrop said, “Our adoption of the Six Sigma methodology has raised the ‘quality bar’ at NCCPA and given us a new target to strive for as we serve all of our stakeholder groups. Process improvements are subjected to the highest quality standards, which will allow us to offer the best systems developed around the needs of the customers who will use them.”

NCCPA Aims for Quality via “Six Sigma”

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Overturning the Future at HSBC

Karl Fruecht, managing director and head of US futures at HSBC Securities (USA) Inc., was managing a business that generated over $30m in revenue yet was only marginally profitable. Things became even more difficult when the ‘open outcry’ trading floors had to make way for electronic trading platforms, and the US futures exchanges refused to make the same change. They had to sustain two platforms: a support infrastructure to execute trades via the open outcry trading floors of the Chicago Mercantile Exchange and the Chicago Board of Trade and the need to compete in a world dominated by electronic exchanges.

This was the scenario Karl wanted to overturn. He saw the answer in DMAIC quality strategy. The HSBC quality team then talked to staff in New York and Chicago to identify problems that could be the focal point of improvement projects. Karl decided to focus on significantly improve the bottom line performance of the US futures business. The business went through a full assessment during the define, measure and analyse phases of the project. These initial steps aimed to widely explore opportunities to reduce costs while improving revenue.

The following were some of the steps that were undertaken:

During the early stages of the project, now titled the futures quality initiative, the core team embarked on an assessment of core processes using process mapping to understand the activities that went into servicing a customer and ultimately executing and clearing a futures transaction.

During measure, activity-based costing (ABC) was used and it served as the key innovation factor to understand what factors affecting the net income.

The analyze phase saw the need to refocus sales efforts on the right types of customers. Other problems that had a significant impact on net income were also identified, such as past due accounts receivable were growing, and consuming an increasing amount of back office time to resolve and electronic order corrections – over $400,000 in effort wasted to correct orders each year.

To launch the improve phase, a core team of senior staff was gathered for a two-day offsite session. They divided the tasks and developed a plan for execution. Each member of the core team took on a mini-project using HSBC’s rapid improvement process (RIP) method. RIP projects were prioritised using a project selection matrix in order to focus efforts on projects that could have the biggest impact on net income.

Among the biggest achievement during this initiative was the reduction of trade error. When the project started, market losses on trading errors reached $765,000. The trade error team reviewed 12 months of error data and used Pareto analysis, which worked on the premise that 80 percent of an observed effect is due to only 20 percent of observed causes. The team then went on revising procedures, training sales staff, and conducting monthly review meetings that discuss the cause of trade errors and ways to diminish them. The impact of this project was measured by a reduction in market losses of approximately $600,000.

Back to the Future

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Fuelling with Lean Six Sigma

Last August 24, 2005, UltraCell Corporation announced a new fuel cell power source for portable electronic devices that has twice the energy density of lithium batteries. This new portable power system has the power density of a hydrogen fuel cell but uses readily available, low cost methanol fuel in a convenient, compact package. Weighing just 40 ounces, the power unit is about the size of a paperback novel.

UltraCell has already developed a prototype of this new technology for the military. Subsequently, the U.S. Army’s Communications-Electronics Research, Development and Engineering Center (CERDEC) awarded UltraCell a contract to accelerate its development of a more compact portable system to run at 25 watts. This new power source is being developed for commercial use as the UltraCell25(TM) and will be available in 2006 for professional, industrial and mobile computing applications. Its name for the military will be the XX25.

Three months after that press release, UltraCell again annonced that it would open a new manufacturing and corporate office facility that will enable them to move from prototype manufacturing to volume production. The new site, located at Tri-Valley Technology Park, 399 Lindbergh Avenue, Livermore, Calif., now uses the latest in lean manufacturing practices.

According to UltraCell CEO Kaschmitter, UltraCell’s new headquarters will focus on enhancing quality, efficiency and delivery, while reducing costs through minimizing non-value-added activities in design, production, supply chain management, and customer service. “Lean manufacturing basically means systematically striving for excellence in everything we do. That’s exactly what we intend to achieve in our new location.”

UltraCell Opens Fuel Cell Production Facility

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Popcorn Anyone?

Who would think that a Six Sigma tool can have something to do with popping corn? But that is just as well, because as a popcorn lover like you, maybe, I hate seeing unpop corns or kernels in my bucket!

In an article published by iSixSigma, it applied DoE to the problem of preparing microwave popcorn. The objective of the study is to learn how to identify the vital few factors from among the trivial many. To put it simply, what factors affect kernels from popping or unpopping.

First, it identified the independent variables: brand, cooking time, microwave oven temperature, preheat time, and tray elevation. Second, it used a Design-Ease® software for design of experiments (DoE) to handle randomizing the samples and the statistical analysis.

Once data are inputted, the software automatically produced a graph, called the normal plot of effects, that helped isolate the factors that were key to determining the yield – the percentage of unpopped bullets or kernels. Some of the interesting results are:

1. Preheating the microwave oven is a waste of time.
2. Elevating the pouch in the oven is a good idea.
3. No matter how powerful your home oven is, cooking microwave popcorn at a high setting and for a shorter rather than a longer time probably produces a tastier result.
4. A name brand performs better than a generic one, although the tests covered only the two brands.

It is important to note that because of this study, the team was able to reduce the presence of bullets or unpopped kernels by 80 percent, a significant gain in yield. Further, the study was a learning opportunity for all participants. The study provided a good opportunity to experience the kind of analysis in breakthrough process improvements. DoE provides the tools to uncover special causes.

Read on

Filed under: Tools/Toolkits

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Seismic SigmaExpress

Input/Output, Inc. (I/O), a leading provider of seismic imaging technologies and digital, full-wave imaging solutions for the oil and gas industry, will use SigmaQuest‘s SigmaExpress software to regulate and manage the manufacturing quality of its land seismic acquisition equipment. SigmaExpress helps ensure that only products of the highest quality and reliability reach the customers. I/O is confident that with the software, they can better address the needs of their customers whose operations rely on precision.

SigmaExpress will collect, aggregate and analyze detailed production and test information from its own product test labs in Houston, Texas, as well as its global contract manufacturers. The company can also leverage the software to gain real-time visibility into performance trends and issues to quickly recognize where and when a product or process improvement should be made.

Ken Maxwell, Hardware Engineering Director at I/O, said, “SigmaQuest’s software and services are expected to provide a faster and easier approach in monitoring production data to ensure we are developing the highest quality products at our outsourced manufacturing facilities.”

SigmaQuest’s SigmaExpress Product Performance

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Six Sigma Restaurant

We often say that Six Sigma is a methodology that achieves 3.4 defects per million opportunities (DPMO). With this basic principle, its ultimate performance target is virtually defect-free processes and products. In some industries or occupations (air traffic controller, surgeon, pharmacist) even a single defect can be catastrophic. In some industries (US Postal Service), the sheer volume of products or services delivered
is such that even 3.4 DPMO can have significant consequences.

In the same breath, if you love dining in restaurants, wouldn’t you want a Six Sigma restaurant? I’m sure everyone does for who would want foreign bodies swimming in his soup or mixed in his favorite dish.

I guess the biggest challenge in the restaurant business happens in drive-thru’s. Drive-thru customers want that

a) food is still hot when they get to their destination,
b) the content of order is correct,
c) the change is correct, and
d) the time spent waiting is reasonable.

A Six Sigma team would then be concerned with the following:

*measurements of wait times (time in line before ordering, time from order to delivery) at different times during the day and week
*measurements of the temperature of different foods as a function of time from receipt of order and from time of delivery.
*the local and foreign competitions

The team would aim for the least wait time, for the acceptable temperature and for the time that food remains above that temperature. To achieve this, the team would most likely do the following:

1. To reduce wait times, additional personnel are put on duty at peak times. During these busy times, the function of order taker and cashier are separated from the function of order fulfillment (also improves order accuracy) and a second window used. Drink dispensers are located near the pickup window to reduce walk time. Customers are allowed to phone in or fax in orders.
2. To improve the accuracy of the orders, the order is repeated to the customers and confirmation requested. Some fast food chains have computer screens so that the customer both sees and hears the order being repeated. The order is confirmed again at the pickup window.
3. To insure that food remains hot until it arrives at the destination, changes have been made in the packaging. A simple aluminum foil wrapper helps to keep the heat in.
4. To improve the accuracy of change, the cashier pushes iconic buttons defining the content of the order and the machine calculates the cost plus any tax. The cashier enters the amount received and the machine
   calculates the correct change.
5. As a control mechanism, timers are used to record customers wait times.

This all looks so simple. Actually, it is—and it is doable, if the company makes the process its system. In other words, if Six Sigma is the culture, then it is achievable.

Six Sigma and CMM

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Understanding the Voice-of-the-Business

Although it is more identified with the manufacturing industry, Six Sigma is now slowly seeping the service industries (including financial, telecom, and healthcare) as well. These organizations have realized that Six Sigma will propel their process toward improving its operations. Operations in the transactional environment mean improved customer services, improved customer-problem resolution, and improved internal support processes.

One of the crucial aspects in these organizations are the call centers, otherwise known as contact centers. Call centers play a significant role in gathering, aggregating and analyzing voice-of-the-customer data that are crucial to customer-centric organizations. Below are examples of where to apply Six Sigma within a contact center environment:

Customer complaints — provides a means to understand why customers are complaining, and identifies internal processes that are causing customer dissatisfaction;

Employee dissatisfaction — customer service representatives will often express frustration that they cannot do their job because someone else doesn’t do theirs;

Help desk — determines why so many calls are being placed with the internal help desk, and identifies types of calls;

Human resources — defines the new hire process by looking at such factors as the length of time it takes to hire a new employee;

Technology — compels review of systems and processes that are in place and how efficient they are in helping CSRs perform their jobs consistently; and

Call monitoring — are the data collected from this forum used to help improve call center processes?

The last part, the call monitoring, is one of many measures used to gather voice of the customer and voice of the business. Through this process, appropriate data through the agent evaluation process will identify strengths and opportunities for improvement. It is therefore important to have an effective quality monitoring process to analyze and report the information to various levels of management. Appropriate metrics must be in place to effectively drive actions and accountability throughout the organization. Below are examples of metrics used within a contact center:

1. Quality objectives
2. Call quality (evaluation score)
3. First call resolution
4. Errors and rework (accuracy – data entry)
5. Efficiency objectives
6. Adherence to schedule
7. Cost performance
8. Cost per call
9. Strategic impact
10. Customer satisfaction scores
11. Customer feedback
12. Employee satisfaction
13. Turnover
14. Percent quality monitored
15. Percent call back
16. Percent sales conversion
17. Average interviews per hire
18. Percent first call resolution

SIX SIGMA AWARENESS – LET’S REJUVENATE

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Foreseeing a Six Sigma Success?

I’ve written in my earlier posts that you cannot really predict the results of your Six Sigma deployment. In fact, The Six Sigma Way book suggested that you test run your deployment first.

There is however a new tool in the market called a Crystal Ball. According to Jonathon Andell, it is a significant software weapon against process and product variation, thus can be aligned with Six Sigma initiaves.

Andell has been using the software since 1993. He and his colleagues were then trying to establish specification limits for component geometries and for placement equipment. They were working in an electronics assembly house that used a robot to mount integrated circuit devices onto printed wiring boards. The complex two-dimensional geometries made it difficult to predict how variation would propagate.

For example, placement machines had target X-axis and Y-axis locations, along with rotational orientations (called the theta axis). Andell and his colleagues could model how a single combination of X, Y, and theta errors would impact whether a pin could penetrate its mating hole, but they lacked the ability to know how distributions of X, Y, and theta would stack up.

To be able to work this problem out, they developed an Excel spreadsheet model that computed the clearance (the output, or “dependent variable”) based on part dimensions, pin diameters, and hole diameters, as well as placement errors in two horizontal axes (X and Y) and one rotational one (theta). Collectively these inputs were called the “independent variables.” The analysis consisted of using statistical Design of Experiments (DoE) to dictate settings for the mean and standard deviation of each independent variable.

After defining the distributions of the independent variables, they then used Crystal Ball to simulate 1,000 trials for each experimental run. This in turn yielded the probability of all leads penetrating their mating holes on the first attempt. The higher the probability, the more closely they could approach the “six sigma” objective. As a result of the simulation, they were able to establish tolerances for component geometries and for placement capabilities.

“For the first time,” Andell explained, “these tolerances were based on objective data, rather than the educated guesses that had preceded this approach. The upshot was that we could relax some tolerances, resulting in cost savings. Other tolerances had to be tightened, but we had hard evidence to drive home the need with those vendors.”

Crystal Ball Provides Quality Insights to Six Sigma Consultant Andell Associates

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Operating with Six Sigma

We often hear of horror stories happening in the operating rooms (OR). That was why when I had a Caesarian section, my first surgery, I was really scared. Good thing everything went well for me. There are many other people who undergo surgery at one time or another, and suffer from the same fear. Just imagine how many OR procedures are done every day in hospitals. Does hospital management have time to monitor the quality of services?

One hospital in Ohio does. This hospital has 12 operating rooms. To be able to manage services well, Management decided to incorporate Six Sigma to improve patient throughput and surgeon satisfaction. Upon deployment, the methodology yielded significant results: OR capacity increased by 6% and average turnover time decreased by 60% for complex cases and by 52% for simple cases.

Six Sigma consultants walked the OR project team through the following steps:

Define the problem. The team’s goal was to decrease turnover time for simple and complex surgical procedures.

Collect pertinent data. The team gathered one year’s worth of turnover time data, including scheduled cast time, patient-in-room time, and schedule gaps.

Identify critical causes. Add-on cases, unavailability of anesthesia providers or materials, and schedule and room changes were all critical causes affecting turnover time. Additionally, the team found that surgeons and nurses differed in their concept of turnover time; for example, surgeons were unaware of the activities necessary to prepare an OR between patients.

Implement improvements. Once identified, the team set about improving the critical causes. For instance, the team implemented a standard operating procedure to improve anesthesia provider accountability. In addition, the team addressed schedule capacity by attempting to shift add-on cases to the trauma room when it was not in use.

Control the process. The last part of the process fell to the individual OR committees. The committee members were taught how to monitor and maintain the quality improvement efforts.

(Six Sigma Gives Leaders Tools for Improving Process in OR. OR Manager 2004 Jun;20[6]:1, 13-5.)

Sharps Injuries in the Operating Room — A New Focus for OSHA (Occupational Health and Health Administration)

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A Six-Sigma Christmas Story

Have you sent your Christmas presents yet? Christmastime is a gift-giving time in the Christian world. As early as October people start sending their gifts and greeting cards to ensure that they will reach the recipient on time. Even then, there are packages that get lost or greeting cards that get stale. I wonder if Santa Claus ever gets late in delivering his gifts. But if Santa learns his Six Sigma strategy, he’ll be able to get his presents at the kids’ doorsteps on Christmas day.

Here’s an interesting story of a Six-Sigma-Belter Santa Claus.

Santa Claus has rolled out his own Six Sigma deployment to help satisfy the global demands of his customers. Kids throughout the world expect their gifts to arrive no later than 6 a.m. Christmas morning so that playtime can be maximized with the newly acquired toys. In recent years, Santa has been hard pressed to deliver the ‘goods’ by 6 a.m., December 25. But 2001 was different.

Early in June, Santa Claus assigned his Yellow Belt elves to map their own work processes and measure key cycle times, durations, and rejection rates. With his Champion, Mrs. Claus, Santa developed a high-level flow chart to illustrate all the key functions necessary to satisfy his young customers. With the data collected and summarized in a Pareto chart, Santa determined that the most critical and time consuming work activity is finding the correct gift stored in his sled for kids like Johnny in Portland and Jane in Seattle. The data indicated that 80 percent of Santa’s work time was spent rummaging around in his sled for the right gift during his delivery run on Christmas Eve. Furthermore, incorrect gift delivery of more than 33 percent has led to many very unhappy customers in years past. Santa quickly assigned his resident Black Belt elf to work on the Process Improvement Project (PIP) that would improve the toy delivery system to ensure timely and accurate delivery.

By September, the Black Belt, working with the Yellow Belt process owner and other subject matter experts, had further reviewed the work process.

Additional data was then collected, and the Black Belt applied statistical hypothesis testing to confirm the suspicion that toy positioning in Santa’s sled did indeed affect Santa’s ability to efficiently deliver the right toy to the children of the world. The PIP team quickly developed an Improve Plan, requiring that a sequential delivery listing be developed prior to packing Santa’s sled. With this list in hand, the elves were then instructed to reverse-pack the sled in the order of delivery.

Furthermore, each gift was labeled with the name and location of the child. The Yellow Belt then implemented the approved Control Plan to periodically check the sled’s packing sequence and confirm that all packages were properly labeled.

Santa declared victory on Christmas Day, when all the children of the world had the correct gifts in time for their early wake-up schedules.

Don’t you just wish that our couriers and post offices are like Santa?

Source:
Bechtel Shares a Six Sigma Parable

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