Monday, 16 September 2019

Difference between PMP® and PRINCE2®

PMP Certifications, PMP Learning, PMP Online Exam, PMP Tutorials and Materials, Prince2 Tutorials and Materials, Prince2 Online Exam
  • Project Management Professional (PMP)® certification exam and PRINCE2® are completely different approaches to looking at Project Management
  • They are both complementary to each other and there is NO OVERLAP
  • Process News recommends that a leader needs to undergo PMP® credential as well as PRINCE2® credential to become a complete Project Manager

PMP® Credential PRINCE2® Credentials 
  • PMP® credential is a bottom-up focus
  • PRINCE2® is the top-down focus
  • PMP® exam focuses on Project Manager mainly and his role and responsibility 
  • PRINCE2® believes that it is not just the Project Manager who is responsible for project success.
  • Other entities such as Vendors, Executives, Business analysts, Client Partners, Supplier Teams are also covered in detail
  • PMP® credential is Tools and Techniques focused
  • You will learn approximately 300 tools and techniques 
  • PRINCE2® is an end-to-end project management methodology
  • You will learn an end to end methodology 
  • PMP® certification answers the questions “How do you do things” 
  • PRINCE2® answers the question “What and when to do things” 
  • PMP® certification deals with tools and techniques. No recommendations on the document formats 
  • Covers Document formats and recommendations on how to write various documents practically
  • PMP® certificate recognizes PRINCE2®. One who attends PRINCE2® course is awarded 36 contact hours towards maintaining PMP® credential 
  • PRINCE2® recognizes PMP®. Anyone who is PMP® certified is exempted from appearing for PRINCE2® foundation examination 
  • PMP® examination is conducted by Project Management Institute (PMI)® 
  • PRINCE2® is by Cabinet Office, UK 
  • The tools and techniques are known worldwide 
  • PRINCE2® methodology is used widely in Europe, UK and common wealth countries. The methodology is generic and used with different usage of terms and terminologies in USA and other countries

Friday, 13 September 2019

Why IT Asset Management Important?

“ITAM”, “Information Technology Asset Management”

ITAM - Information Technology Asset Managementis set of business practices that facilitate the planning and management of full lifecycle of all IT assets, by aligning financial, contractual and inventory areas. This supports the strategic decision making for the IT environment.

IT assets in above definition refers to all aspects of Technologies that includes software, hardware, People, information, Contracts, Services, etc. used in a business.

IT Asset Lifecycle

ITSM, ITAM, IT Asset Management, ITIL Tutorial and Materials, ITIL Learning, ITIL Guides, ITIL Certifications, ITIL Online Exam

IT Asset Lifecycle has 6 Stages

1. Strategy/plan

Clear understanding of organisation’s vision
Evaluation of Existing Assets
Mapping the usage of assets
Establish and verify business requirements

2. Request

Create request for IT Asset
Approval of Request
Assignment of Request to the procurement team

3. Procure

Create purchase orders
Pre-defined PO workflow
Link to cost centres for budgets
PO approvals
Post-purchase, adding to the assets inventory

4. Receive

Deploy the assets and change state from inventory to in-use
Discover the assets in the network for software and hardware inventory
Allocate software to a hardware asset
Add relationship maps

5. Manage

Schedule scans and get audit history
Asset Tagging ownership tracking
Software compliance and license management
Asset depreciation calculations
Maintain contracts for assets
Software license agreements are linked to the software
Total cost of ownership of an asset

6. Retire

Change the state of an asset to expired/disposed
All the software allocated to the disposed asset will get un-allocated

ITAM- 4 key asset areas

ITSM, ITAM, IT Asset Management, ITIL Tutorial and Materials, ITIL Learning, ITIL Guides, ITIL Certifications, ITIL Online Exam

1. Hardware Asset Management (HAM)

Management of the physical components of computers, mobile devices and networks
HAM is tightly connected to SAM as the two asset types cannot be separated

2. Software Asset Management (SAM)

Managing the complete lifecycle of every software asset, involving cost control, documentation, licensing, redistribution, maintenance etc.
SAM is the most crucial as it involves greatest financial and legal risk in terms of vendor license conditions and complex compliance regulations.

3. SEAM - Cloud and Services Asset Management (SEAM)

Service and Cloud refers to services delivered from a cloud service provider’s devices, and includes online data storage, backup solutions, web-based services, hosted applications, database processing etc.

SEAM is the management of the multiple platforms across physical, virtual and cloud environments

4. People & Information Asset Management (PINAM)

The management of People and Information refers to data security, access policies and best practices in regard to knowledge and information sharing.
A key component is increasing the business value of data and information for the right people at the right time in order to ensure an agile and safe workflow and knowledge sharing.

What is Industry Revolution 4.0?

We are at present evidencing the beginning of Industrial Revolution 4.0. Previous Industrial revolutions as shown in the below diagram were

1.0 marked use of Water & Steam
2.0 used Electric Power
3.0 used Electronics and IT
4.0 use of Computers and Automation

ITSM, ITAM, IT Asset Management, ITIL Tutorial and Materials, ITIL Learning, ITIL Guides, ITIL Certifications, ITIL Online Exam

Industrial Revolution 4.0 encompasses the use of various technologies like Internet Of Things (IOT), Artificial Intelligence (AI), Quantum Computing, Biotech, Nanotechnology, Robotics, autonomous vehicles, 3-D printing. Industrial Revolution 4.0 is also referred to as Digital Transformation. Digital Transformation is mainly technology transformation.

ITSM, ITAM, IT Asset Management, ITIL Tutorial and Materials, ITIL Learning, ITIL Guides, ITIL Certifications, ITIL Online Exam

As technology are growing exponentially and changing the entire Business outlook on daily basis. 

It has become really very difficult to keep abreast the pace of transformation and cut throat competition in the market. ITAM enables organisations to proactively plan and effectively manage the entire lifecycle of all IT Assets there by also proactively managing the costs associated with IT Assets and Services.

Benefits of IT Asset Management

There are many benefits of ITAMas listed in above diagram. In particular, asset management can help:


Strong IT Asset Management makes it easier to tell when items are lost or stolen and deal with the underlying causesand reduce vulnerabilities. Recovery efforts can also be initiated promptly.

Accurate Forecasting

ITAM helps organisation in maintaining accurate acquisition history that helps in identifying the patterns of demand. As per this demand accurate forecasting would help organisation acquire required assets as and when required. This can provide a basis for predicting IT needs and budgets.


IT Asset Management has a complete list what the business owns and leases, including where assets are located, how they are used, and when changes were last made. Such a detailed information about IT hardware, software, consumables, etc., provides the basis for the other benefits.

Operational Efficiency

IT Asset management enables a full understanding of IT assets, their capabilities, lifecycle, upgrade expectations, maintenance requirements. And it further helps in answering questions like “What can be leveraged before more spending is considered? What can be eliminated to save money? And thereby helps in realizing operational efficiency.

Maintenance cost reduction

ITAM maintains the entire history of entire lifecycle of IT Assets. It keeps a track of all activities required by different assets at different stages of the lifecycle, so asset management can help ensure corporate requirements are met cost-effectively.

Financial reporting

ITAM keeps the track of entire IT Asset costs. It enable accurate financial reporting thereby raising accurate Invoices for IT Asset Management.

Meeting compliance

Some assets will eventually be redeployed, potentially moving from mission-critical application to a remote office or other purposes. Others will be sold or scrapped. At all these stages we have to abide by the Law of the Land (compliance). ITAM helps organization in not defaulting any compliance mandates, thereby avoiding legal penalization.

Where is ITAM in Organization Picture ?

To ensure the ITAM workflow is effective, it is crucial to understand the responsibilities and key roles in the ITAM ecosystem, both internally and externally. ITAM ecosystem is shown as below

ITSM, ITAM, IT Asset Management, ITIL Tutorial and Materials, ITIL Learning, ITIL Guides, ITIL Certifications, ITIL Online Exam

IT Asset Management ecosystem is a complex set of relationships between parties taking part in IT Asset Management actions.A successful ITAM program traverses the organisation across departments and functions, involving everyone at some level e.g.:

◈ Management
◈ Legal
◈ Finance
◈ Procurement
◈ End-users
◈ IT operation

Key ITAM roles in the market

◈ ITAM Executive
◈ IT Asset Manager
◈ Hardware Asset Manager
◈ Software Asset Manager
◈ Lead Analyst -SW Asset Management
◈ IT Asset Management Specialist
◈ IT Asset Management Administrator
◈ IT Asset Coordinator
◈ Executive - Inventory & Asset Management
◈ IT Manager - Warehouse Network Infrastructure

Wednesday, 11 September 2019

Case Study: DMAIC Project Improves Hospital's On-time Completion of Administrative Tasks

DMAIC, Six Sigma Tutorials and Materials, Six Sigma Learning, Six Sigma Certifications, Six Sigma Online Guides

After graduating from medical school, the majority of medical students enter a medical residency program where a significant amount of clinical training occurs. Medical residencies provide a significant value add for the resident as well as teaching hospitals that host the residency programs. During residency, residents are increasingly exposed to a variety of clinical specialties, practices and tasks as well as a multitude of administrative items that must be completed in order to document their ability to perform clinical functions on patients. Additionally, hospitals are able to offset physician shortages by using residents for care and have the ability to generate significant revenue from hosting a residency program.

Despite the benefits of residency programs, there are inherent risks that the hospital assumes by using residents to provide care. Beyond the obvious risk of adverse patient outcomes and sentinel events (an unexpected occurrence in a healthcare setting that results in serious injury or death), there is also a more prevalent risk related to completion of required administrative tasks. While adverse patient outcomes are a serious threat, their likelihood of occurrence is low and ability to detect is high. Residents do not perform care on patients without the supervision of an attending physician. Residents also frequently ask questions to crosscheck other physicians as a part of the learning process, mitigating the risk of adverse outcomes and sentinel events.

Administrative tasks, however, are typically seen as having little-to-no value add by both residents and attending physicians. They are frequently pushed to the bottom of to-do lists when the prospect of a surgery or a rare clinical case presents; there is little ability to detect when they are not completed until it is too late. Not completing an administrative task will likely not result in a serious patient safety event, but there is a high likelihood of tasks not being completed, limited ability to detect when they are not completed and, ultimately, the potential of losing revenue from the residency program when an external audit yields that administrative tasks was not appropriately documented.

Lean Six Sigma (LSS) tools show promise for improvement opportunities across the healthcare industry. A midwestern community hospital in Ohio started a Six Sigma program in 2012 and since then has used the methodologies across the majority of hospital functions—clinical and non-clinical. In a recent project, the Orthopaedic Residency program used the DMAIC (Define, Measure, Analyze, Improve, Control) methodology to increase their on-time resident task completion rate. This article shows the benefits of using LSS methodologies to generate significant improvements with limited resources and funding.

Defining the Problem

To help focus the team, the project lead started with a project charter to define the problem they were trying to solve for as well as the goal they were aiming to achieve.

Problem Statement: From April 2018 through June 2018, 38 percent of resident tasks (62 out of 163 opportunities) were not completed on time and were, therefore, delinquent. This is bad because these tasks are requirements for the Accreditation Council for Graduate Medical Education (ACGME), the Medical Education Department and/or the Orthopaedic Program. If resident tasks are not completed on time it can result in the resident being dismissed from the residency program.

Goal: The primary goal was to decrease the resident task delinquency rate from 38 percent to 23 percent by September 30, 2018.

Business Case: Risk reduction is the primary business case in that by increasing the on-time completion rate of residency tasks, we are effectively reducing the risk of residents being dismissed from the program. The healthcare facility pays approximately $144,000 annually per resident. If a resident is dismissed from the program, the hospital loses that money.

Additionally, by increasing the on-time completion rate we are increasing resident and program coordinator job satisfaction. This, in turn, ensures the sustainment of the program by effectively reducing the time spent remediating poor performance and reducing the risk of resident dismissal.

Project Scope: The process begins with the new resident orientation and ends with the six-month resident checkpoint evaluation.

Team Roles: The team consisted of the orthopaedic residency program director, the residency program coordinator (who used the project to meet the requirements for completion of her Green Belt certification), the program’s research director, the chief orthopaedic resident as well as the attending orthopaedic surgeons and orthopaedic residents. Additionally, a Black Belt within the organization provided oversight on completing the DMAIC deliverables for the Green Belt’s certification.

A SIPOC (supplier, inputs, process, output, customer) analysis and Kano model were both used in the Define phase in order to identify the customer base and the customer preferences, respectively (Figures 1 and 2). The SIPOC analysis in Figure 1 identified the primary outcome metric, the customer base and a high-level overview of the current state of the process. Figure 2 shows the Kano model that was used to identify customer preferences.

DMAIC, Six Sigma Tutorials and Materials, Six Sigma Learning, Six Sigma Certifications, Six Sigma Online Guides

Figure 1: SIPOC Analysis

DMAIC, Six Sigma Tutorials and Materials, Six Sigma Learning, Six Sigma Certifications, Six Sigma Online Guides

Figure 2: Kano Model

Measurement and Analysis of the Data

A data collection plan was completed first to identify which administrative tasks were the primary focus of the project. The team determined that the tasks required of the ACGME were of primary focus since those would be the focus of an external audit conducted by the ACGME. Data was then collected to determine the baseline delinquency rate for each of these tasks as well as the combined delinquency rate for all tasks (Figure 3). The primary outcome metric for the project was the combined delinquency rate, which was determined to be 38 percent (62 out of 163 opportunities) between the measurement period of April 2018 through June 2018.

DMAIC, Six Sigma Tutorials and Materials, Six Sigma Learning, Six Sigma Certifications, Six Sigma Online Guides

Figure 3: Number of Residents Not Completing Tasks by Task Type

The team brainstormed potential root causes associated with a delinquency rate of 38 percent and used multi-voting to identify the primary root cause (Figure 4).

DMAIC, Six Sigma Tutorials and Materials, Six Sigma Learning, Six Sigma Certifications, Six Sigma Online Guides

Figure 4. Results from the Multi-Vote on the Potential Root Causes

The results of the multi-voting activity indicated that the primary root causes were the following:

1. Tasks were too tedious and time consuming.
2. Too many requirements existed.
3. There was no accountability structure in place.

The team determined that the organization has little control over the first two root causes, so, in turn, chose to identify solutions that would address the lack of an accountability structure.

Process Improvement

Once the root cause was identified, the team performed a second brainstorming activity to develop a list of solutions that would help enhance accountability. A risk identification and mitigation plan was then put together for each of the solutions in order to help determine which of the solutions carried the lowest risk if implemented.

A visual display board was chosen as the improvement solution given that it was quick and easy to implement with little-to-no risks associated with it. Additionally, visual display boards are commonly used in process improvement projects because of their effectiveness with sustaining long-term process improvement initiatives. The team chose to use a combination of colors, numbers and symbols to indicate progress. There are several individuals on the team who are red-green colorblind and would not have benefited from color alone as an indicator of progress. Figure 5 shows the visual display board implemented in the orthopaedic didactic lecture room. Residents have daily meetings in the lecture room and are therefore able to see their progress each day.

DMAIC, Six Sigma Tutorials and Materials, Six Sigma Learning, Six Sigma Certifications, Six Sigma Online Guides

Figure 5: Ortho Task Master Visual Board

Achieving and Maintaining Results

Following the development and implementation of the visual accountability board, the team finalized its control plan to ensure long-term sustainability of the improvement. The control plan outlined various crosschecks as well as defined timelines for when – and how – to react based on the level of delinquency for each administrative task.

The team felt that all of the tasks required by ACGME were important, but some tasks cannot be made up if the deadline to complete them has passed. As a result, the control plan established firmer reactions for falling delinquent on those tasks when compared to tasks that could be made up should a resident fall behind. Once implemented, the team collected control data to monitor the success of the solution. After the improvement data was collected, a chi-square test determined if the results were significantly different from the baseline results. The improvement results (shown in the table below) showed statistically significant improvement in three of the seven categories including the overall delinquency rate, which was the primary outcome metric for the project.

Goal achieved! The primary goal was to decrease the resident task delinquency rate from 38 percent to 23 percent; the project in fact surpassed that goal with a post-implementation delinquency rate of 20 percent.

Comparison of Task Complete Rate Pre- Vs Post-Implementation
Task Baseline Delinquency Rate  Post-Implementation Delinquency Rate  Statistically Significant 
Test Master 17% 9% No
Total Tests  24%  23%  No 
Skill Master  44%  32%  No 
Evaluations  23%  23%  No 
Duty Hours  35%  9%  Yes
Case Logs   35%  7%  Yes
Total Delinquency Rate   38%  20%  YES!

The project sponsor highly regarded the significant change in delinquency rates for the duty hours and case logs tasks because these are two tasks that need to be completed in residency as well as private practice.

Monday, 9 September 2019

4 Key Ingredients to a Quick and Effective Lean Six Sigma Process

Six Sigma Learning, Six Sigma Tutorial and Materials, Six Sigma Certifications, Six Sigma Guides

Continuous process improvement is the key to staying ahead of the competition. By following a proven methodology such as Lean Six Sigma, your company can achieve greater efficiency and quality – and thereby gain the edge it needs to keep costs low and customer satisfaction high. If you need to improve quickly and often, Lean Six Sigma is a solid, proven way to get there.

However, this methodology won’t yield results on its own. How you organize and run project teams as a company can have as much effect on speed of delivery as the teams themselves. Four key ingredients – data access, resources, prioritization and approval structure – can mean the difference between getting there before your competitor and falling behind in the marketplace.

1. Quick and Detailed Data Access

Lean Six Sigma is a data-driven methodology, and you’ll hear many practitioners echo the adage: “You cannot improve what you cannot measure.” Having access to usable data is key for identifying problems and measuring the impact of a team’s changes. If your company hasn’t started measuring and recording every part of the process, that’s the first step. But even if your company is a master at recording data, that doesn’t mean you’re in the clear. Getting access to more than just a summarized report, to the specific details underlying a process, needs to be achievable quickly.

Teams can’t do much with a basic report showing just the average result. Measures of variation are essential to reducing defects, and averages hide this information. If your project teams find themselves waiting days or even weeks for data experts to export detailed data from enterprise data warehouses, you’re causing enormous delays at every step. An efficient project team needs to be able to see the results of their experimental changes as quickly as possible. There are many ways to improve your company’s situation when it comes to data. Ideally you would improve the way data is captured and stored so that most teams are able to pull the detailed data they need themselves. But in the end, if you refuse to spend money on improving data access, you’re wasting a lot more time and money than you realize.

2. Full-time Resources

You want to achieve great things with your process improvements. You spent time training your teams to use Lean Six Sigma tools to solve all types of problems. And you know that you need people with first-hand knowledge of the process on your teams. There’s so much your teams could accomplish! So much for them to work on! In the excitement of it all, you keep asking them to look at more areas and more issues – expanding their project load.

When is the last time you tried to multitask on an important assignment? Wasn’t easy, was it? Dividing the attention of team members, aside from making the process complex and stressful on them, slows the rate at which tasks can be completed on all projects. At best, you’re adding complexity to your process, and at worst you’ve delayed implementation on every solution the teams produce. You may not get every team member’s full-time attention on the project, but do your best to get as close to that as possible. Check for bottlenecks on your team’s work itself. If people are splitting their work time between multiple projects, they may be delaying them both. Get your teams to focus on one thing, and then encourage them to press their own expectations of how quickly they can complete something when they have singular focus.

3. Prioritization and Focus

The more you work on at once, the less you will accomplish. Wide scopes and long project lists give stakeholders the feeling that a lot will be solved, but in reality, a lack of focus will cause less to be done – or certainly done well. Rank order your proposed projects, look at your resources, and assess realistically how many projects you can do at once without stretching company resources too thin. Make sure your projects align with your company’s goals and strategic direction. If you were to complete the projects on your list, would that move you significantly toward achieving company goals? Are any of your projects more pet projects or feel goods instead of strategically necessary?

Concentration can mean the difference between getting it done this month and getting it done in a year. Which path hits your bottom line first? Do you have the right types of resources to cover the workload the team has been given? Make sure you’re considering all resources before you decide on a team’s workload. You may have enough people to find solutions – but will you have enough people to implement their proposals? Don’t waste effort – focus it. Get a small number of the most impactful projects done quickly, rather than a large list floundering with too few resources to finish the work.

4. Streamlined Tollgate Approval

At certain steps in a project, a team will need to get approval to move forward. It’s important that this approval process is well organized and that the right people are involved. Make sure that the stakeholders reviewing each project are aligned with the company vision and strategic direction, have enough knowledge to identify missed components, and – most importantly – that all decisions makers are involved at one time. The worst processes are those where approval is given in steps, and feedback from a later group may contradict or negate approval from prior groups. Get your stakeholders together at one time and hash it out. Don’t leave teams confused and floundering through a complicated approval process.

In the end, if your company is running Lean Six Sigma projects and finding themselves missing completion goals, with large numbers of projects straggling along, you may want to look to the basics of how you have structured your program. If you miss these items, your Lean Six Sigma program may struggle to keep up with competitors. Your teams need to be set up for success, with the data, resources, focus and processes they need to move through the Lean Six Sigma phases with speed and impact.

Wednesday, 4 September 2019

Use a Modified FMEA to Mitigate Project Risks

Every project faces a number of elements that risk its success. For instance, a lack of team-member availability, qualified resources, customer information, data, proven technologies, a clear scope – or deficiencies in a number of these areas – represents a risk.

To prevent risks like these from happening, or at least to be prepared when they occur, project leaders and other team members should assess the key risks of any project and determine how they can be addressed.

One format and approach frequently used to complete this risk management is a “light” version of the common failure mode and effects analysis (FMEA). These four steps cover how to create a risk-mitigation plan.

Step 1: Brainstorm Potential Project Risks and Potential Causes

In a meeting early in the process, the project team brainstorms and records potential risks. The leader guides this session with questions such as, “What can go wrong?” or “What might prevent this project from being successful?” These risks are recorded in a modified version of the FMEA (Figure 1).

Concerns from team members or other stakeholders also can be managed as risks. For example, if someone says, “We have tried to work on this issue before,” then the risk “solutions cannot be found” can be included in the project FMEA. This shows that the team members’ concerns are taken seriously.

For each risk, the DMAIC (Define, Measure, Analyze, Improve, Control) phase during which it is most likely to occur is identified. Risks that are not specific to a phase can be assigned to the category “General.”

The team also identifies potential causes for each risk. This will help to better determine corrective or preventive actions during Step 3.

Six Sigma Certifications, Six Sigma Learning, Six Sigma Tutorials and Materials

Figure 1: “Light” Version of FMEA Risk Mitigation Plan

Step 2: Rate Potential Risks

Next, the team rates each risk according to its probability of occurrence and its impact on the project using the following categories: 

◈ 1 = low probability of occurrence, low impact on the project
◈ 2 = medium probability of occurrence, medium impact on the project
◈ 3 = high probability of occurrence, high impact on the project

The team discusses each risk until they reach consensus on its rating. Just because someone thinks a risk is a low probability (1), and another person assumes a high probability of occurrence (3), it is not correct to assign it a 2. 

Step 3: Prioritize Risks and Define Mitigation Actions

Team members prioritize potential risks by calculating the product of the probability of occurrence and the impact on the project. They can create a traffic light scale to indicate which risks warrant mitigation actions and at what priority (Figure 2). The matrix will not be symmetrical because high-impact risks are considered more critical than risks with a high probability of occurring.

Six Sigma Certifications, Six Sigma Learning, Six Sigma Tutorials and Materials

Figure 2: Risk Categorization Matrix

The team designs a plan for each risk in the yellow and red zones, including actions required to mitigate the risk, who is accountable and a due date. 

Team members should always double check whether the actions are truly actionable and will really help to mitigate the impact or the probability of occurrence of the risk. In the best case, actions fully eliminate the risk. Second best are actions that reduce the probability of occurrence, while the third-best option is to define counter measures that work as a fall-back plan (i.e., if the team cannot prevent a risk from happening, they should still know what to do if it occurs). 

Step 4: Continuously Update and Review Project-FMEA

Assessing risk is not a one-off activity. As the project moves forward, the team continuously updates the project FMEA and checks off the completion status of mitigation actions. An example of a chart at this stage is shown in Figure 3.

Six Sigma Certifications, Six Sigma Learning, Six Sigma Tutorials and Materials

Figure 3: Extract from Sample Project FMEA

The team assesses a new probability of occurrence for those risks that are adequately mitigated. Based on this rating, they can calculate and record a new risk status. The team also continues to identify new risks and addresses them as they arise. Deciding how and when new risks are to be addressed is best done during weekly status meetings.

Monday, 2 September 2019

Improving Process Turnaround Time in an Outpatient Clinic

Historically, medical residency teaching clinics provide the heart of medical services to an under-insured population through various government-subsidized health insurance programs. These programs provide medical coverage for eligible individuals with incomes of less than 35 percent of the federal poverty level. It is well-established that people living in poverty are at a higher risk for chronic diseases, such as hypertension, diabetes, dyslipidemia, obesity and psychiatric disorders. Low-income population groups may also experience barriers to receiving healthcare services, such as lack of transportation.

Medical educational residency clinics are challenged to provide accessible, ongoing, quality care while being sensitive to the special needs of the population group they serve. They also must maintain the goal to train new physicians in a fiscally viable manner. Nationally, residency teaching clinics have inefficiencies that cause long patient wait times. Patient wait time for medical care has a direct impact on patient satisfaction, medical compliance, return show rate and patient attitudes toward clinicians, staff and clinics in general.

The Family Ambulatory Health Center (FAHC), located on the main campus of Hurley Medical Center, a public, non-profit teaching medical center in Flint, Mich., consistently scored low in patient wait times on patient satisfaction surveys. Patient wait times to see an internal medicine resident physician in the Hurley FAHC exceeded the patient threshold, causing dissatisfaction, poor medical compliance and high no-show rates. Dissatisfied patients created a domino effect, leading to dissatisfied resident physicians and clinic staff. The resident physicians became frustrated by not being able to manage clinic patients with chronic diseases effectively due to high no-show rates for follow-up appointments. To combat this problem, a Black Belt at the Hurley FAHC began a Six Sigma project.


In January 2010, the Hurley FAHC, in collaboration with North Shore-LIJ Health System, implemented a process improvement project to reduce patient turnaround time (TAT) and improve quality in the internal medicine residency clinic. The project was sponsored by the clinic manager, who monitored the patient satisfaction surveys. The Hurley project was employed to determine clinic inefficiencies and to improve the patient flow process. The premise of this project was that decreased patient wait-times in the internal medicine clinic would increase overall patient satisfaction. The Black Belt leading the project formed a team consisting of a registered nurse, a licensed practical nurse, clerical staff, a nurse practitioner, resident physicians and faculty/clinic physicians. It was important to ensure that the core team and extended members included individuals that have direct contact with the process.

During the Define stage, the team developed a high-level process map to help understand the larger process and to gain consensus for the overall scope of the project (Figure 1).

Six Sigma Tutorials and Materials, Six Sigma Certifications, Six Sigma Learning, Six Sigma Online Exam

Figure 1: High-level Process Map of a Patient Clinic Visit

The process starts when the patient checks in at the registration desk and ends when the patient checks out at the end of the clinic visit. The initial data reflected the total patient visit TAT to be an average of 115 minutes from beginning to end. This process had an upper specification limit (USL) of 60 minutes, which was decided upon by the project sponsor.


The goal in the Measure phase was to determine a baseline metric of the identified overall Y (TAT) from start to finish. The process map was used to identify each step, and a data collection tool was created to capture a metric for the designated incremental steps within the clinic. The team decided to measure the time required to complete the following process increments:

1. Patient checks into the clinic and clerical staff takes chart to holding queue

2. Clinical staff brings patient to exam room and puts chart in resident holding queue

3. Patient waits in exam for resident physician

4. Resident physician sends patient to check out

5. Patient waits to be checked out of clinic

Baseline data for the patient TAT in the adult medical clinic was collected from Mar. 8 to Mar. 26, 2010, during each adult medical clinic session in that time frame. The results are represented by the process capability graph in Figure 2.

Six Sigma Tutorials and Materials, Six Sigma Certifications, Six Sigma Learning, Six Sigma Online Exam

Figure 2: Process Capability of Turnaround Time

The sample N was 362 patient visits, which reflected an average TAT of 115 minutes, with a standard deviation of 32.5 minutes. The USL of 60 minutes translated to a baseline defect per million opportunities (DPMO) rate of 953,039 and a corresponding sigma score of -2. Based on these metrics, the Black Belt determined that the process met the customer expectation of a 60-minute turnaround time 4.5 percent of the time.

In keeping with Six Sigma strategy, the team held a brainstorming session with frontline employees to delineate the perceived causes of delay and to get a broad employee prospective of alleged problems in the patient flow process. The perceived causes are represented in the Figure 3.

Six Sigma Tutorials and Materials, Six Sigma Certifications, Six Sigma Learning, Six Sigma Online Exam

Figure 3: Causes Affecting Turnaround Time


The goal in this phase was to determine which of the identified causes (x’s) of delays in patient TAT had the greatest impact on the total process. This was done by bringing the core group together again to perform a failure mode and effect analysis (FMEA).

Each step of the process was identified and reviewed to determine its failure potential (on a scale of 1 to 10) based on severity, frequency of occurrence and current detection methods. These values were then multiplied to obtain a risk priority number (RPN). The highest values are listed in Table 1.

Table 1: FMEA of Patient Visit Process

Process Step Potential Failure  Failure Effects  Sev  Causes  Occ  Current Controls  Det  RPN 
Patient into room No room Patient has to wait 10 Too many doctors, too many patients, attending Dr. not available, wait for procedure 8 Assign Dr.’s rooms 1 80
Interruptions   Delay getting patient to room  Prescriptions, phone, paper work, page doctors  Locked unit doors  56 
Resident reviews chart  Chart not complete; Resident not on time  Look up results; Can’t see patient  10, 7 Can’t find test results, missing consult letters; Rounding  8, 7  No; Schedule  2, 3  160, 147 
Revisit  Paper work  More time  10   Scripts, forms, referrals, rechecking chart  10  No  100 

Further analysis was performed to discern the vital x’s using hypothesis testing to determine statistical significance. The null hypothesis – that there were no statistical differences in TAT between each process step – was rejected because the p-value 0.000 was less than 0.05, indicating that a statistical difference was found between the steps.

Due to the results obtained on the FMEA, the team performed additional analysis on the resident physician and clinician piece of the process. This data reflected that 42 percent and 40 percent of patients’ time was spent with a resident and clinician, respectively.

There also was a statistically significant difference found in the median TAT (p-value of 0.046) between the charts that were reviewed by a resident physician versus charts that were not reviewed by resident physician prior to their clinic time.

Data analysis also showed that the more-experienced resident physicians (PGY 3) had lower median TAT scores with less variation than newer (less experienced) resident physicians (PGY 1), with a significant p-value of 0.000.

Six Sigma Tutorials and Materials, Six Sigma Certifications, Six Sigma Learning, Six Sigma Online Exam

Figure 4: Boxplot of Overall TAT vs. Experience Level

In summary, the team determined that the most significant inefficiencies occurred during two time periods:

1. The time patients spent waiting in the lobby before being taken to the exam room
2. The total time patients spent in the exam room waiting for a resident physician to examine the patient, consult with a faculty physician and close the patient visit.


The team performed another brainstorming session with representatives from each area where inefficiencies occurred to find solutions that could have a positive impact on patient flow.

The first area of concern was patient wait time in the waiting room. The team found an inadequacy in the check-in process and came up with an easy solution that could be implemented without disrupting staffing boundaries or violating union contracts. This was done by eliminating a step in the check-in process. Prior to the Six Sigma project, patients would sign in and the medical assistants would process their charts. The charts would then need to be carried to the back clinical area to the holding queue for the back-clinic medical assistants to bring patients to examination rooms. The charts were being held in the front check-in area for various extraneous reasons. For instance, the front staff was being interrupted by phone calls, patient walk-ins and other miscellaneous duties.

These disruptions caused a delay in the charts being brought to the back clinical area holding queue. This problem was corrected by keeping a medical assistant in the check-in area to “arrive” patients and attend to all other duties. The check-in clerk was moved to the back clinic area near the holding queue. Under this arrangement, the charts could now be prepped promptly, without interruptions, and put into the holding queue for back-clinic staff to bring patients to the examination rooms.

There also was a delay in the time it took the medical assistant to bring the patient back to the exam room once the patient was registered in the system. In most cases, this delay was directly related to the lack of available exam rooms, which was due to the time resident physicians spent examining preceding patients. It is to be noted that each resident is assigned two exam rooms. The team understood that the rooms needed to be “turned” faster while maintaining quality care. One solution to this problem was an order board posted in a common area to prevent delays in patients waiting for common office procedures such as injections.

Solutions to resident physician-related matters included having resident physicians review patient charts before their clinic day started and to utilize electronic prescription services. As a result, faculty physicians also became more accessible to resident physicians, and resident physicians were educated on how to present a case to faculty in a more concise manner. The schedules for PGY1 resident physicians were adjusted from 15-minute blocks to 30-minute blocks until they became fully oriented to the outpatient clinic.

The team piloted the improvements with a small group of residents. The solutions that they implemented had a positive impact on the process Y by reducing the TAT from the original baseline average of 115 minutes to 94 minutes (an 18 percent reduction), with a corresponding decrease in the variation for the same pilot of residents (Figure 5).

Six Sigma Tutorials and Materials, Six Sigma Certifications, Six Sigma Learning, Six Sigma Online Exam

Figure 5: Boxplot TAT Change for Pilot Group


To control and sustain these improvements, the team utilized an individual and moving-range (I-MR) control chart. Monitoring the TAT helped to ensure that the process stayed in control, was stable and met the customer’s expectations.

Six Sigma Tutorials and Materials, Six Sigma Certifications, Six Sigma Learning, Six Sigma Online Exam

Figure 6: I-MR Chart of TAT Change for Pilot Group

The team developed a control plan to measure total patient TAT continually and vital x’s for up to one year after the project introduction (Table 2). The management of the Control phase is delegated to a process owner, who is responsible for the day-to-day monitoring and measuring of the process. In this case, the process owner is the registered nurse, who completed Green Belt training and has been directly involved with the project since its inception. The Control phase guarantees continued accountability and allows time for old habits to be dropped and improved habits to be ingrained in the culture of the clinic – from the secretary who checks the patient in to the resident physician.

Table 2: Control Plan for Monitoring Patient TAT

Description Data Type Measurement Method Control/Monitor Frequency Alert Flags Action Responsibility
Y Patient check-in to check-out Continuous Manual measurement tool Control chart Weekly Variation in std dev Review with clinic director Process owner: Melissa Bachman
X Patient arrived to roomed Continuous Cerner   Control chart Weekly Variation in std dev Review with staff Process owner: Melissa Bachman
X Patient arrived to roomed Continuous Cerner/Manual tool Control chart Weekly  Variation in std dev Review with staff  Process owner: Melissa Bachman

Notable Project Considerations

This project clearly demonstrates the Six Sigma methodology as an effective tool in defining inefficiencies and improving patient flow in a residency outpatient clinic. Six Sigma uses hard data to drive changes rather than notions based on individual perceptions, assumptions and agendas.

Although the team didn’t meet the USL of 60 minutes, set by the project sponsor, the FAHC Internal Medicine Clinic has consistently reduced total patient TAT from 115 minutes to 94 minutes. It should be noted that the baseline data was collected during the time the clinic was functioning optimally. The initial data was collected in March, when the resident physicians were performing at high levels. The PGY 2 and 3 resident physicians were very efficient, due to having two and three years of experience, respectively. The PYG 1 resident physicians were just learning the nuances of primary care or getting a handle on patient management in the outpatient setting. March also is a time when few staff members are on vacation, so the clinic was adequately staffed with seasoned RNs, LPNs, medical assistants and medical secretaries.

The post-solution measurement phase occurred during the most hectic time for an outpatient residency clinic; it coincided with the graduation of PGY 3 resident physicians. PGY3 residents were focused on terminating patient relationships, writing clinic summaries and tying up loose ends. As PGY 3 resident physicians are graduating, PGY 1 resident physicians are entering the program and going through orientation. Given the challenges during this time, the team worked extremely well in keeping the process intact.

In retrospect, the team should consider whether the USL of 60 minutes set by the project sponsor was a reasonable and achievable goal for an outpatient residency clinic. In 2006, the national average for time that a seasoned physician spent with a patient was close to 22 minutes. Given the complexity of care that the FAHC patients require, it should be expected that resident physicians would spend more time with patients than their seasoned clinician cohorts.

The goal of this project was to enhance the physician training process by increasing clinic proficiency while maintaining quality patient care. We succeeded in cutting back patient wait-times in certain key steps of the process. The project decreased the amount of time patients wait in the lobby (main waiting area) by 38 percent. In keeping with recommendations set by the Institute of Medicine, our patients wait an average of 18 minutes in the lobby after they check in to the clinic. This group recommends that 90 percent of scheduled patients should be seen within 30 minutes of their scheduled appointment. The project work decreased the amount of time the patient waits for medical services while maintaining the amount of time the resident physician spends with the patient.

In conclusion, the FAHC Internal Medicine Clinic reduced patient total TAT by 18 percent without compromising patient care. We expect to see improved patient satisfaction, improved resident physician satisfaction and improved continuity of care for our clinic patients with the improved process flow implemented through this Six Sigma project.

Sunday, 1 September 2019

How to crack interview in ITIL?

ITIL Online Exam, ITIL Guides, ITIL Tutorials and Materials, ITIL Learning, ITIL Certifications

1. Understand the Job Description

“Please read the offer document carefully before Investing” – Important line in Mutual fund advertisement. Similarly for your job ensure that you “Read the job description carefully before applying”. Ensure that both the preferred and desirable expectations are met while applying (100% preferred and at least 60% desirable should met). In case of they ask for any certifications, don’t try to manage with your content in your profile – Most of the companies are very sensitive about certifications… Kindly ensure that the certification preferred should be in place else feel free to ignore the job so that the effort and time that you put in for your interview will not get wasted (Let’s respect HR’s effort and time as well here)….Please be specific with detailed justifications whenever they ask for Expected CTC…. Avoid mentioning “As per the industry standards / At par with my skills and experience”…

2. Study the current market

This is very crucial activity that you need to perform as part of cracking the interview – Start exploring tools and other aspects in addition to talking about only processes and procedures. Think of improvements/automations in terms of new technology like RPA, AI and ML…. I will not call this as new technology as this was there in the market for many years but still there is a myth that says “process guys are not aware of the technology” – Lets change this saying….

3. Analyse the organization strength and weakness

In addition to analysing the market, it is also important to understand the organization strength and weakness – Clearly analyse where the organisation is now and what is their vision and mission (Achievements and accolades along with concerns/issues). Come up with some roadmap (draft roadmap) to provide your thoughts on how the improvements can be implemented….Have this in place and don’t reveal unless or until if your interviewer specifically asked (There might be a chance where your interviewer will get all your thoughts during interview and reject you….he / she can implement the same as if they arrived the concept… So, be careful while revealing such improvements)

4. Check where you fit in?

This is almost in line with the above point “Analyse the organisation strength and weakness” – Check where you fit in predominantly focus on weakness rather I call this as Improvements….Come up with the strategy on how you can nominate / contribute yourself with respect to the identified Improvements (Please think of 7-Step process of CSI) – Please talk about this by taking any one weakness / improvement as an example and as mentioned earlier, kindly don’t reveal the complete strategy – Guide the interviewer with your thoughts half way through and also please provide your justification diplomatically on why you are not revealing the complete and entire strategy

5. Don’t Quote IT Examples 

Whenever you are mentioning about the process or function as per ITIL, please avoid mentioning examples relating to IT field rather take an illustration from other fields like Hotel Industry, Insurance Industry, Manufacturing Industry… Hotel can be best way to explain about almost all the processes (Especially Availability Management process, Capacity Management process, Incident management process, Problem Management Process, Demand Management Process, Business relationship Management and many more…..)

6. Talk your challenges and how you overcome

This will help the interviewer to recruit you for his / her organization. At the same time, ensure that you should not talk about all the challenges that you faced which shows your incapability of your attitude being proactive. Talk any 2 major challenges that you faced and provide the detailed solution for the same that you arrived. Another important point is ensure that you are not supposed to reveal any client name (even while you are mentioning about the achievements, kindly don’t mention any client name) else this will leads to personal data breach of the client

7. Prove where you fit in

This is in line with the point “Check where you fit in” – You have to be more careful and confident explaining the interviewer where you can actually fit in – Please don’t try to address all the weakness / improvements that you can help the organisation. Pick one or two and explain the interviewer the methodology (not in detail but in broader perspective) that you can arrive for addressing those improvements – As mentioned many times, please don’t arrive the exact solution in detail by providing the step by step procedures / activities

8. Don’t be overconfident

Don’t try to be overconfident which will end up in pathetic situation during interview process – Accept wherever you are lagging and don’t try to over manage the situation… Please start learning and treat every interview as a path for success from learning and positive attitude perspective… Work on the lessons learnt and try to make the interviewer comfortable that you are a good team player and it should be worthwhile selecting you into an organisation

9. Lifecycle in finger tips and not processes 

Ensure that 5 lifecycle modules (Service Strategy, Service Design, Service Transition, Service Operation and Continual Service Improvement) are available in your thought throughout the entire interview process. Don’t try to memorise all the 25 processes (If it is there in your mind, it’s fine else this is not that much required). However ensure that the crucial processes should be well known along with the respective concepts.

10. Make yourself strong in minimum 4 processes

Please make sure that you are confident in minimum 4 processes – Ensure that you know all the concepts behind each one of them and also how it interfaces with other processes (at least couple of other processes) – For Instance, if you have confidence in Problem Management, Ensure that you understand the objective, purpose and how this can be linked to incident process and vice versa…. Have thorough knowledge of RCA and their techniques (like 5-Why Analysis fishbone diagram, pareto chart, brainstorming and so on…) – Try to map this with your current project or earlier project experience on how you address the effective problem management (in terms RCA Effectiveness) without revealing the customer and project name (as mentioned many times). Another Example, if you are confident in Service Level Management, ensure that you know the concepts of SLA, OLA and UPC….. Also focus more on penalty clauses along with rewards / recognition in case of achieving the SLA’s…