Showing posts with label Six Sigma Services. Show all posts
Showing posts with label Six Sigma Services. Show all posts

Monday, 17 April 2023

Benefits of Six Sigma

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Introduction


In today's business world, organizations face a constant challenge to improve quality, reduce costs, and increase efficiency. The Six Sigma methodology is one such approach that has gained immense popularity in recent years. Six Sigma is a data-driven, disciplined, and continuous improvement methodology that aims to eliminate defects and improve processes. In this article, we will discuss the various benefits of Six Sigma and how it can help organizations achieve their goals.

History of Six Sigma


Before we delve into the benefits of Six Sigma, let us first understand its history. Six Sigma was first introduced by Motorola in the 1980s to improve their manufacturing processes. Since then, Six Sigma has evolved and is now used in various industries such as healthcare, banking, and IT.

Understanding Six Sigma


Six Sigma is a data-driven approach that aims to minimize defects in a process. It is based on the DMAIC methodology, which stands for Define, Measure, Analyze, Improve, and Control. Let's understand each of these steps in detail.


Define

The first step in Six Sigma is to define the problem or the opportunity for improvement. This step involves identifying the process that needs improvement and the specific problem that needs to be solved.

Measure

The second step is to measure the current performance of the process. This step involves collecting data on the process and measuring its performance using various statistical tools.

Analyze

The third step is to analyze the data collected in the previous step to identify the root cause of the problem. This step involves using various statistical tools such as Pareto charts, histograms, and cause-and-effect diagrams.

Improve

The fourth step is to improve the process by implementing solutions that address the root cause of the problem. This step involves testing the solution and validating its effectiveness.

Control

The final step is to control the process by implementing controls and monitoring its performance. This step ensures that the process remains stable and does not revert to its previous state.

Benefits of Six Sigma


Now that we understand Six Sigma and its methodology, let us discuss its various benefits.

Increased efficiency


Six Sigma helps organizations improve their processes and eliminate waste, resulting in increased efficiency. By reducing the time taken to complete a process and improving the quality of the output, organizations can achieve higher productivity.

Cost savings


Implementing Six Sigma can lead to significant cost savings for organizations. By reducing defects and waste, organizations can save on resources, rework, and other costs associated with poor quality.

Improved customer satisfaction


Six Sigma focuses on meeting customer requirements and improving the quality of the output. By doing so, organizations can increase customer satisfaction and loyalty.

Better decision-making


Six Sigma relies on data-driven decision-making, which helps organizations make informed decisions. By analyzing data and identifying the root cause of the problem, organizations can make better decisions that lead to improved outcomes.

Employee engagement


Six Sigma involves employees at all levels of the organization and encourages them to participate in problem-solving. This leads to increased employee engagement and empowerment.

Competitive advantage


Implementing Six Sigma can provide organizations with a competitive advantage. By improving their processes and reducing defects, organizations can differentiate themselves from their competitors and gain a market advantage.

Conclusion


Six Sigma is a powerful methodology that can help organizations improve their processes and achieve their goals. By implementing Six Sigma, organizations can achieve increased efficiency, cost savings, improved customer satisfaction, better decision-making, employee engagement, and a competitive advantage. It is no wonder that Six Sigma has gained immense popularity in recent years and is now used by organizations worldwide.

Friday, 27 August 2021

Remember these 10 tips for Lean Six Sigma

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You may contest that some of the numbers of these content are straightforward, certain, and judgmental. The not so good news is that in the real world as we know where we're frequently expected to convey various continuous improvement tasks and proficiency gains, these important hints are effortlessly overlooked.

Read More: Six Sigma Certification

In organizations where measure improvement work is just given an empty talk and thought about an idea to have, any defects are regularly exacerbated. Subsequently, the edgy battle to keep constant enhancement for the corporate plan once in a while overshadows and systematic ways forward for those straightforwardly connected with CI programs. 

Here are top tips that could be valuable for your next Green or Black Belt tasks, Lean exercises, or critical thinking tasks. 

1. We all have customers and we all are customers

Always remember that you have customers, but, that you are additionally a customer. On the off chance that you need to control any task, it's critical to be forthright about what you need from your support, partners, project owners, related offices, or different providers. This incorporates timescales for when you need their assistance. Continuously convey these requirements obviously and clarify the effect on your task and the organization should any of your providers fall flat. That way the individuals who are basic to your prosperity can't embrace no effect so no issue if I don't convey' attitude. 

2. Keep your eyes open to progress opportunities

You won't generally deal with technique evolving projects, however, there's normally the chance to make little improvements all over. By consistently making little improvements, you'll witness a fundamentally more skilled cycle long haul. The total of the parts truly can be more outstanding than the entirety. 

Given advances in innovation, best practice, and changing customer needs, there will consistently be a superior way. So ensure you are continually paying special mind to these chances and urge others to do likewise. 

3. Everybody is busy effort exertion requires an explanation

On the off chance that you need someone to go the additional mile, you'll have to give them a valid justification. That indicates you must be completely clear about what you need and when you need it – and agree on these with why you need it and the immediate effect it'll have on partners. 

On the off chance that your colleagues don't comprehend the benefits of the objective you're chasing, they won't go along with you on the excursion and positively won't help share the load. 

4. Change requires you to catch both hearts and minds

In a universe of contesting projects and progressively limited resources, even great ideas should be sold and sold once more. Continuously keep your stakeholders and what is most important to them as a top priority, and consistently plot why your idea is attracting – especially to them. 

5. An complex examination requires a simple conclusion

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Your analysis is your journey and your decisions on the objective. In any case, for business stakeholders, no matter how interesting your journey, it's the objective they have to know. The less complex your decisions, the more active you'll get their approval. Spread out our decisions first and go through your examination to back you. Continuously keep it straightforward and ensure your correspondence needs are in a specific order. 

6. Utilize an advocate to excel

When troubles arise even the intense need uphold. With ground-breaking advocates close by, executing authoritative change will be simpler. In a perfect world, your promoters ought to incorporate executives, senior management, project champions, and sponsors, as well as opinion formers at all levels.

If these potential supporters are not on your side, you have to discover why and see what should be possible to adjust their perspectives to yours. This will assist you with accomplishing your objectives faster and get the correct support from the beginning. Work on this as ahead of schedule as conceivable to stay away from future task slows down and limit dissatisfaction. 

7. Perseverance should be admired, but only up to a point

If it requires a great deal of effort and time to demonstrate your point, ensure it's justified, despite all the problems – for you and your support. Perseverance is a praiseworthy quality and pivotal to progress, however, it's critical to realize when to release it and proceed onward. You may here and there need to put your energy in elective tasks to guarantee long haul achievement, so ensure you remain adaptable. 

8. Communicate frequently and consistently look for input

The need to convey may appear to be obvious, however, it's essential to ensure it's a two-way measure. At times practically zero criticism demonstrates arrangement, yet it can likewise mean your message didn't break through to the correct level or has just been overlooked. Not handily acknowledged in organizations, change is frequently seen as just excessively troublesome or excused without thought. 

9. Point of view is significant and yours is one of numerous

If you don't investigate your stakeholder's perspectives you'll never comprehend their intentions. What's more, if you don't comprehend their thought processes, you're probably not going to induce change. It is essential to consider setting, experience, governmental issues, requirements, targets, personal circumstances, mistaken assumptions, and the shade of everybody's points of view. Frequently genuine plans can remain covered up. 

To become more acquainted with your stakeholders, investigate their viewpoints and in particular, show that you give it a second thought. You may not generally get every bit of relevant information or the entirety of their musings, yet you'll draw nearer if you inquire as to whether you don't. 

10. Use improvement tools to include admiration

Likewise, with most things throughout everyday life, it is critical to utilize the correct tools in your tool kit for Lean Six Sigma projects and not simply use strategies for it. You'll figure out how to utilize tools ideally through experimentation, post-preparing experience, and by exhibiting your grip of procedures for Belt accreditation. When you've chosen the correct tools, you'll be shocked at the quality and speed of progress you would then be able to make. Essentially, use DMAIC (Six Sigma strategy) just where it's justified. If the arrangement's unmitigatedly self-evident, at that point 'simply go do it'. 

Even though improvement projects and exercises should be strong, this doesn't infer the requirement for incredible intricacy or a profound investigation on all events. Less difficult is better – and consistently recall over-handling is classed as one of the seven savages wastes in Lean Six Sigma.

Source: novelvista.com

Wednesday, 18 August 2021

What to Focus on When Picking Six Sigma Software

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Putting resources into the software to help your Six Sigma activities is a successful method to ensure that you capitalize on the approach. Setting up a structure for development makes it more straightforward for individuals all through the association to take an interest in, and viably manage ceaseless improvement endeavors. 

Read More: Certified Manager of Quality/Organizational Excellence (CMQ/OE)


Associations that influence Six Sigma software gather more open doors for development, actualize more arrangements, and see a higher ROI for Six Sigma. There are various arrangements available that were either evolved as Six Sigma the board instruments or repurposed accordingly, so we figured it may be useful to recognize the absolute most significant abilities that you should search for while assessing this sort of innovation.

So, How to pick the right Six Sigma Software:


Capture Opportunities for Improvement


Any arrangement you consider should make it simple for each individual in the association to recognize and record open doors for development. This is vital to the Six Sigma approach and ought to be at the core of the arrangement you pick. 

Cloud-based software that is accessible 24 x 7 and on any gadget is the most legitimate arrangement choice. It will make it feasible for individuals to report what they discover from any place they happen to be and for chiefs to react to circumstances regardless of whether they don't occur to be in the workplace. 

The arrangement ought to permit clients to include any records or pictures that may be pertinent to the open door for development and it ought to make a review trail that will store the subtleties of what befalls every open door after some time.

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Accelerate Improvement Workflow


When an open door for development is caught in the framework, there ought to be a characterized work process for what occurs straightaway. Who will assess and organize the chance? By what method will the individual who announced the open door realize what's going on with it? 

The best Six Sigma arrangements have savvy cautions and warnings with the goal that the individuals who will survey and support openings are advised promptly when another one is entered. They would then be able to appoint related assignments to the correct individuals and groups. 

When deal with an undertaking begins, extra cautions advise fitting faculty when assignments are finished, or due dates are missed. This quickens the movement of progress.

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Measure Impact


Six Sigma brings a proof-based, logical way to deal with business management. Each cycle is just changed after a furrowed assessment and pre-characterized improvement cycle like PSDA or DMAIC. It just bodes well, in this way, to carry that equivalent accuracy to estimating the effect of the progressions that are actualized. 

Your Six Sigma software arrangement should assist you with detailing the effect of your improvement work regarding cost decrease, expanded income, improved consumer loyalty, diminished process duration, or whatever other measurements that are imperative to your business. This will help legitimize the interest in Six Sigma programs, keep representatives spurred, and drive chief commitment.

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Visual Management


Numerous Six Sigma strategies include representation. Value stream planning, Kanban, A3, Kaizen sheets, and others all assistance individuals in a flash comprehend complex data in a moment. Search for Six Sigma software that takes visual management to the following level, enabling clients to set up dashboards and reports that rapidly mention to them what they have to know. 

Heads ought to have the option to effectively survey the strength of Six Sigma in the association. Project Managers should see the progression of work and perceive detours right away.

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Improvement Broadcasting


Six Sigma requires a collaboration. The methodology takes care of most when it turns out to be important for the way of life and goes past a specific device or strategy to supply each representative with a solid sense that they are crucial to the achievement of the association and the steady improvement is a key duty of each and every person. Six Sigma software arrangements with worked in progress broadcasting capacities help strengthen the significance of Kaizen. This kind of acknowledgment is additionally intensely propelling and something that representatives reliably tell specialists they need more from businesses. 

Six Sigma can significantly change an association to improve things, however, it doesn't generally do as such. Achievement needs chief help, interest in important instruments and assets, and an ability to grasp steady change. Six Sigma software doesn't ensure results, however, it puts the association on the correct balance to quicken improvement, settle on shrewd choices, and gain from past understanding. Choosing one with solid abilities in every one of these territories will help guarantee that you get an answer and an accomplice that can smooth your way toward better business brings about terms of the measurements you care about most.

Source: novelvista.com

Friday, 20 March 2020

Using SQDCM Boards the Right Way for Effective Gemba Walks

Based on a request that stemmed from a discussion earlier in the year, I spent three days at a company’s plant to help them finetune their Gemba walks. Several of their floor leaders had attended a training session and approached me with questions. The training highlighted a problem they had been having since they implemented their first safety, quality, delivery, cost (sometimes inventory and/or productivity), morale (SQDCM) board about one year earlier.

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Figure 1: Template of an SQDCM Board

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Figure 2: Example of Modified SQDIP Board

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Figure 3: Example of Modified SQDIPM Board

Development of a Typical SQDCM Board


Their first SQDCM board described in this example (not shown in photographs) was put in the department occupying the middle of both the physical facility and process flow. They had included an accountability process* at the board as well. As the year went by, they expanded into other process areas within the facility.

The metrics that were chosen were, for better or worse, “handed down” from the corporate office located in another city. Those metrics were used at each board, with little or no modification permitted. This led to difficulty for many of the company’s leaders. One big problem: The daily Gemba walk was conducted in the order the boards were created, not in the logical flow of the process. As with so many misunderstood elements in an attempted Lean transformation, the focus was on not being red, rather than identifying and correcting problems.

What did this specifically look like? Red items on the fancy SQDCM letters were transferred down to a countermeasure (C/M) sheet, but in many instances, no actions were identified. There was even a checkbox for “no C/M needed.” (Hint: If you have a red, it should always have a corresponding countermeasure!) In addition, red situations were glazed over quickly so green situations could be highlighted.

None of this is uncommon. Too many organizations attempting to either do Lean or possibly transform simply don’t understand the concepts and theory behind the numerous tools. SQDCM isn’t simply putting those letters up on a board. Gemba walks aren’t simply management by walking around (MBWA) – popular in the ’80s and ’90s. Strategic deployment isn’t simply an X-matrix in the CEO’s office or, even worse, an annual operating plan.

When organizations truly want to benefit from Lean thinking, the leadership understands this requires a transformation – the entire business needs to change the way it operates. Most importantly, the organization needs to understand that Lean is a holistic system. This is why a tree is one of the most common visualizations of Lean. The roots, the soil, the trunk, the branches, the leaves, the sun and the rain all must work together for the tree to maximize its potential. Simply dropping a seed in the ground doesn’t guarantee success.

Tool Use of SQDCM Boards


So, what should this complete transformation look like? Let’s start with two points of basic tool use of SQDCM boards.

1. Always start at the point closest to the customer. It doesn’t matter how good your manufacturing is if you can’t get product out of shipping. Put your first board there. See how you are performing to your external customer. Then put the boards in place moving backward. That might be warehouse, packing, painting, assembly – whatever the process is that delivers to shipping. Don’t wait months between boards. Push for one every week or two. End with boards in scheduling, purchasing and maintenance. If appropriate, get boards to HR, finance, sales, customer service and R&D too. Just remember – start closest to the customer and work your way backward.

2. Determine the right metrics for the boards. Safety is always first. The metrics are presented in the name in order of priority (safety, quality, delivery, cost [sometimes inventory and/or productivity], morale – although I often move morale ahead of safety, in keeping with Toyota’s respect-for-people mantra). The metrics at the floor need to relate to the floor but also need to tie to company goals.

Floor-Specific Goals


Boards that have the same percentage metric or labor/hour metric across departments aren’t scaled to reflect the specific areas. (I’ve never seen shipping, assembly and machining have identical outcomes.) Pay close attention to the behavior the metric drives. For example, with OSHA total reportable incidence rate (TRIR), it either becomes an impossible goal due to injuries, or employees hide injuries to not affect the goal. Instead, try measuring something like “more than five safety opportunities identified each week.” This is a proactive goal. In theory, the more opportunities identified, the fewer actual injuries occur. Thus, the floor metric is supporting the corporate metric of reduced recordable injuries.

It is important to note that not only do these goals need to be floor-specific (as opposed to company-specific), but they also need to be customer-driven. Each department’s customer is the next department in line. Is the machining department delivering product at spec, on time to assembly? Is shipping delivering to the delivery company in the same way? If the organization can deliver on time internally, corporate delivery performance will be improved. Likewise, each department should be managing inventory. Be careful not to simply manage dollars or pieces. Rather, the inventory goal should be reflected by inventory turns and stock-outs. These two metrics drive each department to control their inventory level and strive to have the right inventory on hand. This helps control cost at the corporate level.

Connection with Strategic Deployment


Now, tie this to strategic deployment (SD). As noted above, the plant SQDCM should connect to the corporate goals. This means there should be deployment of those SQDCM goals from top to bottom.

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Figure 4: Connect the Plant SQDCM to the Overall SD

When the X-matrix is created, it should be a three- to five-year plan, with annual achievements. The targets to improve should be related to the stretch goals of the organization (or facility). The plant referred to in the beginning of the article faltered here. They simply took the corporate deployment goals (more like annual operating plan goals) and rolled them into department SQDCM boards. This made the measurement cumbersome, difficult to relate to employees and stifled discussion during the Gemba walks.

Strategic Deployment Is Critical


Early in my career, we started with SQDCM boards without SD. I try not to do this now. For our first 18 months, we struggled with the process. When we initiated SD, it seemed to tie everything together for our managers. It didn’t affect the direct labor employees simply because our initial SQDCM was floor-specific (because there was no strategic deployment). Note: Initial attempts at this process can be time-consuming for an organization. However, the planning becomes both easier and faster with experience.

Here are a couple other tricks for the SD process.

1. Start the process in October. This ensures the organization is ready by January. Remember, a strong SD process has catchball – the two-way process of goal discussion going from executive offices to shop floor.

2. Build a Gantt chart into the SD process. Many first- and second-year SD processes forget about timelines. Plants expect to hit goals in January when the projects aren’t even active until April.

As shown in Figure 5, the goal of the SQDCM board isn’t the pretty green or red letters at the top, but rather the importance of driving problem solving. The focus should be on cause identification and solution implementation, not: are we red or green?

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Figure 5: Root Cause Identification and Problem Solutions

Gemba Walk


Next to the Gemba walk! There are many, many ways to conduct the walk process. There can be different tiers, different frequencies of walk and different expectations of leaders. This describes my way. To start, the highest level in the facility should be on the walk daily (what is often identified as the senior staff). Each department in the facility should also be represented (this is often beyond the senior staff). Strong walks are supported by leaders having team huddles to start the shift, before the walk. These are leaders and their hourly employees.

The walk should start closest to the customer, just like board implementation. The walk works back until it ends at receiving (or sometimes sales/customer service/R&D). Green is acknowledged, but red is discussed. What was the problem, what caused it, what temporary countermeasure was used, what is the next step for a long-term C/M? The temporary C/M is often where teams stop in the process (if they determine anything at all). This displays a lack of Lean understanding.

The challenge is to determine the long-term C/M. It is important to now note that the most critical part of the SQDCM board is not the pretty green or red letters, but rather the countermeasure sheet. This shows the actions to get the department (or facility or company) back to green. In addition, the lower information on the board often reflects trends over time. This, too, can be critical, to ensure departments aren’t chasing squirrels and missing the bigger picture. The focus should always be on the ideal state (defined as 1×1, on-demand, on-time, with perfect quality, safely created and delivered, at the best cost).

Source: isixsigma.com

Friday, 21 February 2020

Breakthrough Change: What It Means and Why It Is Needed

Breakthrough. It sounds good. It even sounds like something everyone should support. The problem, however, comes when people are asked to define breakthrough. There is almost always a slight pause, or in some cases a long one, that says they are not certain what it means.

To understand what breakthrough means and why it is an important part of any continuous improvement program, it helps to take a look at the history of the term in regards to Six Sigma and how the concept fits with another familiar Six Sigma idea: control.

Looking Back at Juran


In terms of the quality discipline, Joseph Juran was the first to publish a cognitive effort around the concept of breakthrough in his book Managerial Breakthrough: The Classic Book On Improving Management Performance (McGraw-Hill) published in 1964. He defined breakthrough as “dynamic change.” By means of contrast, he defined control as “lack of change; maintaining status quo.” In the context of Juran’s definition, breakthrough and control are mutually exclusive; it would be impossible to have one at the same time you were involved with the other.

The concept of control is best understood through control charts. Control charts are a tool that allow practitioners to collapse process variation around some measure of central tendency and separate natural variation from an assignable cause.

If reducing variation is control, how do you achieve breakthrough? Why would you want breakthrough since it seems to mean the opposite of control? Figure 1 is similar to the illustration that Juran published in Managerial Breakthrough and shows the benefit breakthrough can bring.

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Figure 1: Representation of Control and Breakthrough

The illustration does not show control and breakthrough as opposite things as much as it shows them as elements of an improvement system. There is a process that is in some state of control; it is driven to a different target and control is reestablished around the new target. The new state is within tighter control limits, meaning the effects of different variables were studied and practitioners determined which variables affected the mean and which affected the variation. This sorting process allowed the process to be reestablished to an improved state. Although the two definitions (breakthrough and control) initially appear diametrically opposed, when they are used together they become a basic roadmap for achieving breakthrough results.

The Six Sigma methodology aligns with what Juran published decades earlier. The shift in Juran’s illustration is a mean shift. In the Six Sigma methodology this occurs in the Improve phase. Juran’s illustration shows control being reestablished once the mean shift is accomplished. The Six Sigma methodology has Control as a final step to institutionalize the breakthrough that took place.

Why Make a Breakthrough


Why would taking a process through breakthrough be a desirable thing? Taguchi’s loss function can provide that answer. The idea is that there is an optimal place, or target, to operate every process. The loss function states that as a process departs from that target there is a “loss imported to society.” When using the concept that Juran illustrated or the methodology of Six Sigma, the process is consistent with Taguchi’s idea – drive the process to an optimal target and reduce variation around the target. The critical element is establishing the target that satisfies both the needs of the customer and is the most financially viable target for a producer.

Selecting the Right Target: A Breakthrough Example


The following case study illustrates the breakthrough concept. There is a plating process that sputters gold. The customer specification is between 900 angstroms and 1,200 angstroms (Figure 2).

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Figure 2: Customer Specifications for Plating Process

The product as defined by the customer is acceptable within these limits; therefore, the most financially rewarding target for the manufacturer is a process with a mean equal to 900 angstroms and a standard deviation of 0.

The current process is targeted low so the mean is toward the lower specification limit. Because the variation is large, the customer is receiving out-of-specification material and they are unhappy. The manufacturer is also dissatisfied with the reject rate and the customer’s complaints (Figure 3).

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Figure 3: Current Production Data

The first step must be to protect the customer, so the target of 900 angstroms is not practical. It would worsen the dissatisfaction of both the customer and the manufacturer.

After applying Six Sigma theory, in its pure state, the new target is six standard deviations inside the lower specification limit; this is a breakthrough change (Figure 4). The customer is protected and satisfied; however, the new target is not the optimal target of 900 angstroms. Based on Taguchi’s loss function, there is a loss in terms of additional gold plated on each piece and that increases material cost for the manufacturer.

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Figure 4: Shift in Mean Six Standard Deviations

The next step is to reduce variation around the mean. It is that decrease in the standard deviation that allows the mean to be shifted toward the lower specification limit or the true target. A shift of the mean, another breakthrough step, toward the lower specification limit with the smaller standard deviation allows the same level of protection for the customer and allows the manufacturer to reduce its cost (Figure 5). There is no disadvantage to either the producer or customer in this process.

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Figure 5: Second Breakthrough Improvement

Incorporating Breakthrough


Establishing a continuous improvement program that focuses on breakthrough introduces the mean shift as a key approach to success. When practitioners focus exclusively on variation reduction, or control, they may be optimizing a process on a suboptimized target and end up leaving huge benefits lying on the table.

Regardless of the tool set used, when building a continuous improvement program, it is important to incorporate both control and breakthrough methodologies.

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.

Define


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).

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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.

Measure


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.

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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.

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Figure 3: Causes Affecting Turnaround Time

Analyze


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.

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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.

Improve


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).

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Figure 5: Boxplot TAT Change for Pilot Group

Control


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.

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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.

Monday, 29 April 2019

Integrating Lean and Six Sigma

Both the Lean and the Six Sigma methodologies have proven over the last twenty years that it is possible to achieve dramatic improvements in cost, quality, and time by focusing on process performance. Whereas Six Sigma is focused on reducing variation and improving process yield by following a problem-solving approach using statistical tools, Lean is primarily concerned with eliminating waste and improving flow by following the Lean principles and a defined approach to implement each of these principles.

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The impressive results companies such as Toyota, General Electric, Motorola, and many others have accomplished using either one of them have inspired many other firms to follow their example. As a result, most companies have either a Lean or Six Sigma program in place. However, using either one of them alone has limitations: Six Sigma will eliminate defects but it will not address the question of how to optimize process flow; and the Lean principles exclude the advanced statistical tools often required to achieve the process capabilities needed to be truly ‘lean’. Therefore, most practitioners consider these two methods as complementing each other. And while each approach can result in dramatic improvement, utilizing both methods simultaneously holds the promise of being able to address all types of process problems with the most appropriate toolkit. For example, inventory reduction not only requires reducing batch sizes and linking operations by using Lean, but also minimizing process variation by utilizing Six Sigma tools.

Therefore, many firms are looking for an approach that allows to combines both methodologies into an integrated system or improvement roadmap. However, the differences between the Six Sigma and Lean are profound:

Lean Six Sigma 
Goal  Create flow and eliminate waste  Improve process capability and eliminate variation 
Application Primarily manufacturing processes Improve process capability and eliminate variation 
Approach  Teaching principles and “cookbook style” implementation based on best practice  All business processes 
Project Selection  Driven by value stream map  Teaching a generic problem-solving approach relying on statistics 
Length of Projects  1 week to 3 months  Various approaches 
Infrastructure  Mostly ad-hoc, no or little formal training  Dedicated resources, broad-based training 
Training  Learning by doing Learning by doing

Developing an integrated improvement program that incorporates both Lean and Six Sigma tools requires more than including a few Lean principles in a Six Sigma curriculum or training Lean Experts as Black Belts. An integrated improvement strategy has to take into consideration the differences and use them effectively:

◈ Lean projects are very tangible, visible, and can oftentimes be completed within a few days (whereas Six Sigma projects typically require a few months). An integrated approach should emphasize Lean projects during the initial phase of the deployment to increase momentum.

◈ Lean emphasizes broad principles coupled with practical recommendations to achieve improvements. For example, Lean suggests a technique to analyze and reduce changeover time that does not require sophisticated analysis and tools. However, Lean principles are oftentimes inadequate to solve some of the more complicated problems that require advanced analysis. Therefore, Six Sigma needs to be introduced during the first year of the deployment to ensure that the improvement roadmap includes a generic problem-solving approach.

◈ An integrated improvement program needs to be fueled by a vision of the future state and by a pipeline of specific projects that will help close the gap between current and future state. Lean introduced value stream mapping as the central tool to identify the gaps and to develop a list of projects that can be tackled using Lean or Six Sigma methodology.

◈ Whereas the Six Sigma process and tools can be applied to virtually every process and industry, the Lean approach is much more specific and the content needs to be adjusted to industry needs: For example, reducing set-up time in a plant that has lines dedicated to a single product is pointless. Therefore, the Lean curriculum needs to be adjusted to meet the needs of the specific business.

◈ Training is effective but only when combined with application. Lean principles are typically taught as separate workshops, with each workshop combining a short training session on the principle with direct application on the shop floor. Six Sigma training is broken down into the phases of the DMAIC (Define, Measure, Analyze, Improve, Control) process with time between each training session to apply the tools learned to the project. The extensive analysis required for Six Sigma projects suggests that a workshop structure as used for Lean training would not be effective.

The integrated approach to process improvement (using Lean and Six Sigma) will include:

◈ Using value stream mapping to develop a pipeline of projects that lend themselves either to applying Six Sigma or Lean tools.

◈ Teaching Lean principles first to increase momentum, introducing the Six Sigma process later on to tackle the more advanced problems.

◈ Adjusting the content of the training to the needs of the specific organization – while some manufacturing locations could benefit from implementing the Lean principles with respect to housekeeping, others will have these basics already in place and will be ready for advanced tools.

The following roadmap provides an example for how one could approach the integration of Lean and Six Sigma into a comprehensive roadmap.

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Integrating Lean and Six Sigma Roadmap

From a training perspective, the Lean principles would be taught first, using the simpler projects identified through the value stream map as training projects for the Lean workshops. A Black Belt therefore would learn how to apply these Lean principles working on a real life problem. In addition, a Lean Black Belt would complete a large Lean project over the course of the training to become certified. The Six Sigma process will be introduced once the Lean principles have been taught. Again, the training participants would work on one specific project identified by value stream mapping.

As a result, a Lean Black Belt in this example would receive in total 30 days of classroom training, would participate in five Lean workshops, and complete one large Lean and one large Six Sigma project over the course of one year. Such a Black Belt would be capable of applying Lean and Six Sigma tools to a variety of business problems and choosing the appropriate approach to address the problem at hand.

Saturday, 27 April 2019

Introducing SixSigma3.0

It is a time of change. The world is developing faster with each passing day. Continuous process improvement technologies, which could make these changes more significant and effective, trail far behind this trend. Who suffers? Companies that lose competition, people who cannot find a new place in the changed labor market and countries that are wasting resources that could go to create a new economy. A new efficient business process improvement methodology is a world priority.

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Over the last three years, the Association Six Sigma (in Russia) has been working to create a new version of Six Sigma that is capable of adequately meeting new challenges. But first, a review of Six Sigma’s history.

Evolution of Six Sigma


Initially, Six Sigma originated at Motorola in 1986; I call this Six Sigma 1.0. Then, over the course of 15 years, the methodology quickly spread to the largest corporations, which continued to work on it, adding tools and approaches from the experience of the Toyota Production System and theory of constraints (TOC). With the proliferation of computers and dramatic increase in productivity, many Six Sigma tasks can be solved in more efficient ways today than in years past. There was a need to update Six Sigma.

Several disparate attempts were made to create a new version of Six Sigma. These were Lean Six Sigma, Green Belts v.2.0, Six Sigma 2.0. But in these versions, nothing fundamentally changed. Therefore, we propose SixSigma3.0 as the beginning of a new stage in the development of the methodology, in which there will be a single standard, fully upgraded toolset and an integrated mechanism for regular updates. To distinguish this new version of Six Sigma from all other variations, the name should be written as a single word without spaces.

What SixSigma3.0 Should Be


SixSigma3.0 should become a disciplined professional business process optimization methodology aimed at producing measurable effect. The name is important – written as one word to prevent clients from guessing what methodology they are using. All developments in the methodology should be registered in a centralized standard and distributed universally as upgrades by an authorized international organization – in the manner that computer software is upgraded. We hope that one of internationally recognized Six Sigma certifying bodies (ASQ, IASSC, ISSSP) will be interested in taking on this role.

SixSigma3.0 Methodology


The SixSigma3.0 methodology should include only the most effective concepts, technologies and tools that have a proven track record of efficient application, chosen from continuous improvement systems that exist in this field: Six Sigma, Lean, Kaizen and TOC. Handpicked tools should be organically incorporated into the SixSigma3.0 methodology. Most of the tools require refinement to reduce the learning curve and efficiency of practical use.

The main objectives of the new methodology are:

1. Building logic algorithms that help the practitioner achieve missions as well as develop mechanisms for continuous data flow and seamless exchange of results between tools – eliminating the need to re-enter data. This will help to automate the process improvement professional’s job in the future.

2. Replacement of continuous improvement terminology with the terminology of computer games.

3. Projects will be replaced with Missions or combat tasks. The practitioner’s obligation is to achieve the Mission under any conditions. DMAIC (Define, Measure, Analyze, Improve, Control) will be replaced by 10 Mission Operational Tasks (MOTs), some of which will be performed in parallel and some in sequence. This approach lifts many of the problems with implementation of traditional Lean Six Sigma such as blurred responsibilities, unjustified hopes for management assistance and doubts about what to do in each phase of DMAIC.

Toolset for SixSigma3.0


Divide existing tools of continuous improvement in two groups: Basic Kit and Advanced Toolset. The Basic Kit should include the most effective tools that the Effector must master professionally with a guarantee that this is his or her confirmed minimal competence level. When hiring, the employer should be guaranteed this competency level.

The development of the Basic Kit should be entrusted to an international organization. The Advanced Set will include effective tools specially modified for practical use after thorough analysis.

Effector – New Name for Old Profession


We propose to name the new occupation Effector – a professional in business process improvement methodologies capable of achieving optimization effect. Without a short recognizable name, the occupation lacks drive and energy.

No more Yellow, White, Red, Green or Black Belts; no sensei, operational excellence specialists, Lean leaders or Champions – no more confusion.

◈ Effector: a specialist in systems for improving business processes and operational efficiency.
◈ Effector-in-Chief: manager responsible for operational excellence in the organization.

The SixSigma3.0 Effector should play a significantly more important role than Green and Black Belts in traditional Six Sigma.

The weakness of the traditional approach is a shift in responsibility for the success of projects toward leadership support, corporate culture and other external circumstances. In fact, the entire responsibility for the success of the projects should lie with the SixSigma3.0 Effectors. An Effector should be able to perform the task in any conditions. Only in this way can the SixSigma3.0 methodology can take root in an organization and benefit it.

The selection and training of Effectors should be based on the following principles:

◈ Strict prior assessment
◈ Special motivation
◈ Total mastery of the methodology and Basic Kit
◈ Continuous study and use of tools from the Advanced Toolset
◈ View each project as a combat mission
◈ High discipline


Training and Certifying Effectors


The duration of basic training should be limited to three to four days (or 20 training hours), which is the requirement of most customers. Training should be more practical and applicable to real world situations. A book of knowledge should be constantly updated with practical experience.

It is necessary to simplify the certification procedure. After successful examination in an authorized organization, the trainee will receive a temporary certification for a period of one year. Certification must be confirmed after the successful implementation of an operational task. Certification will be confirmed by a committee of an organization consisting of three or more certified Effectors, who will assess the results of the operational task.

The Mission of SixSigma3.0


Unlike traditional Six Sigma, the optimization tasks in SixSigma3.0 are set by management as Missions.
The Mission is the most important element of the SixSigma3.0 methodology. A Mission is a task with any type of goal: problem solution, streamlining of business process, or improvement of high-level corporate key performance indicators (KPIs) or certain process KPIs.

Unlike a project manager, the Mission leader can use various approaches to achieve the task: project management planning, fast just-do-it projects, a Kaizen blitz or Agile tools (Scrum and sprint).

Solving business problems as missions could add additional energy to operational efficiency initiatives and increase the responsibility of Mission leaders for their accomplishment. The mental attitude of the leader and the team should be focused on unconditional success.

Mission goals and inputs are concisely and comprehensively described in a Mission Brief.

No More DMAIC


At the heart of Lean Six Sigma’s methodology is a five-step solution to business problems – DMAIC. The experience of applying DMAIC demonstrates that the methodology itself needs improvement. Its steps are not equivalent, and its sequence of actions and the use of tools leads to difficulties in the project.

We suggest that the improvement mission in SixSigma3.0 be guided by Mission Operational Tasks (MOTs), which are executed sequentially, but with the possibility of returns and parallel implementation. Each operational task is a key factor in the successful implementation of the mission.

10 Mission Operational Tasks (MOTs)

  1. Scanning: Scan the business landscape to identify areas of inefficiency and missed opportunities.
  2. Capture the goal: Determine the reason for an optimization Mission and identify target business process, main metrics (KPIs) and target values.
  3. Execution: Ensure support of the mission by the company’s leadership, secure necessary resources, organize efficient Mission implementation team and choose the appropriate project execution approach (project, just do it, Agile, Scrum, sprint, etc.)
  4. Process: Research the Mission’s target process, process baseline parameters, levels of KPIs, regulatory requirements and customer needs.
  5. Data: Analyze the Mission’s needs for data and install a data collection system.
  6. Analysis: Search for problems in the process that impede the implementation of the Mission’s goals, identify cause-and-effect relationships, factors of influence and root causes.
  7. Development: Develop solution packages for troubleshooting problems from the registry of root problems using modern business improvement and design technologies.
  8. Implementation: Test the developed solutions for mistakes and inefficiencies before full-scale implementation/deployment.
  9. Control: Develop a set of measures for monitoring and fixing implemented solutions.
  10. Report: Prepare and present Mission Report to top management touching upon economic effect, learned lessons and opportunities to apply solutions to other business areas.

Nine Reasons for Switching to SixSigma3.0

  1. Revive the brand in new conditions. Currently we see a decline in the interest in continuous improvement methodologies.
  2. Create a new occupation in the field of management and make it catch on (the occupation lacks short and recognizable names like lawyer, manager, auditor, etc.) We propose a new name – Effector.
  3. Improve efficiency compared to other continuous improvement methodologies that are made up of too much useless knowledge and a lack of professionalism.
  4. Ensure continuous development of the methodology and its relevance in a changing world.
  5. Maintain a single basic level of training specialists in operational improvement opposed to the existing system in which every organization has its own program and approaches to Belt training.
  6. Revive interest in improving business processes. There is an undeserved lack of interest in improving processes for psychological reasons among millennials and Generation Z.
  7. Initiate emergence of SixSigma3.0 professionals’ community. Today, operational excellence professionals are separated by their adherence to different methodologies.
  8. Develop and constantly upgrade a SixSigma3.0 standard based on application practices and research developments. The existing Six Sigma standards never change.
  9. Develop a professional software that provides automation of the methodology and direct exchanges of data and calculation results between instruments. Currently, Six Sigma education is based on manual calculations and standalone tools – we must create demand for advanced Six Sigma software.