Lean

A presentation for Elizabeth Hospital

Fish Bone Analysis

(Part of Continuous Improvement)
By Dadik Jayadi
FFE Manager Pfizer Indonesia

CIs Foundational Problem-solving Discipline

5. Control
.

1. Define
.. .

DMAIC
4. Improve
.. ..

2. Measure
. . . ..

3. Analyze
DMAIC

.. .

Lean

CI for Companies in Indonesia

13. Phillips 14. Bukaka 15. Indocement 16. Sucofindo 17. Astra Honda Motor 18. YKK 19. Samudra Indonesia 20. Bogasari 21. Bank Indonesia 22. BiNus University 23. Garuda Sentra Medika

1. Pfizer Indonesia 2. Krakatau Medika 3. Kalbe Farma 4. Bukit Asam 5. Indosat 6. Telkom 7. LG 8. Sinar Mas 9. Bio-Pharma 10. Total 11. Semen Gresik 12. First Media

Lean

Why Continuous Improvement ?

Bring the customer voice inside the organization

Get rid of errors

Eliminate waste Speed things up Simplify work Free up colleague time Move diverse groups more quickly to cohesive action

Lean

Objective of the Training

Understand why Continuous Improvement is so important to the organization. Learn the basic tools and techniques of Root Cause Analysis and will enable the participants to engage with problem solution using continuous improvement approach and CI tools at basic level DMAIC Lean Six-Sigma Apply and experience the process of DMAIC and understand how to use CI tools through a very interactive simulation

Lean

Three Core CI Methodologies

Lean

DMAIC Foundational problem-solving discipline

SIX Meet customer needs SIGMA with fewest errors

LEAN

Eliminate waste Increase speed

Lean

Six Sigma
Reduce Unwanted Variation
Process

Lean
Improve Process Flow
Frequent delays Frequent bottlenecks Unnecessary steps Excessively long processes Excessive wait time Incomplete work

varies too much Too much rework Poor quality Missed deadlines Compliance issues Dramatic swings in performance

Slow

customer response Overworked staff Under-utilized talent

Many Issues Require Both Approaches

DEFINE

1. Define the Problem 2. Capture Voice of the Customer 3. Map the Process

Specify problem to be fixed and the impact of fixing it

Why is VOC Important? VOC data helps an organization:

. . . .
Common Sources of Customer Data On-hand Customer Complaints Sales Data Existing Reports

Additional Effort Needed Interviews Focus Groups Surveys Purchased Studies

Traditional Flowcharting symbols Four symbols are sufficient for most process maps
Decision / Review Point yes

Process Step

Documenting Activity

Rework Loop

no

Start or End Point

MEASURE
Importance of Data & Pictures Time Series Charts Histograms Pareto Charts

Use data to form a picture of current process behavior and performance

Why measure? Data helps us to . . .

. .

What Do You See Here?

Sky Smoke Fence Meter Chimney Door Window Flowers Roof Grass Tree Stairs WIRES
Fire

Porch

Antenna

Shrubs

A Picture* Is Worth a Thousand Words

* So is a well-made graph!

What Does the Data Tell You?

Are we getting better or worse? Are month-to-month fluctuations getting bigger or smaller?
Sales ($000)
Year 2004 2005 Jan 70 72 Feb 67 75 Mar 72 44 Apr 79 83 May 82 67 Jun 90 Jul 92 Aug 69 Sep 68 Oct 58 Nov 57 Dec 43

Times Series Plots Reveal Patterns Quickly

A picture of the same data makes it much easer to answer these questions

Time Series Can Reveal a Variety of Patterns

Trends
Upward Trend Downward Trend

Shifts
75

6 or more points in a row increasing or decreasing

8 or more 65 points in a row 60 above or below 55 50 the center line 45

40 1 6 1 2 18 24 30 3 6 4 2 48 54 60

70

MEASUREMENT

Cyclical Variations
MEASUREMENT

Unusual Points / Outliers

80

Major Deviations from Prevailing Pattern

70 C 3 60 50 40

1 2

18

24

30 3 6 I n d e x

4 2

48

54

60

When studying patterns, it is important to distinguish two types of cause

Whats causing red eggs to appear?

Special Cause:

Common Cause: ..

Before you decide how to manage a process, you need to know if variation is a result of special or common cause
19

Measure
Importance of Data & Pictures Time Series Charts Histograms Pareto Charts

Percent

Count

The Pareto Principle

80% of a problem can often be traced to 20% of the contributing factors (also known as 80/20 rule) Implication: We can often solve most of a problem by attacking a vital few causes
20% of Incidents . . .

80% of Problem!

If Pareto Principle Does Not Appear to Hold

When all bars are roughly the same height and/or many categories are needed to account for most of a problem, you need to find another way to look at the data.
70
# of Injuries

40

30 20
10 0

Break down another way

# of injuries

60 50

Number of Injuries by Department

65 55 45 35 25 15 5
Finger

Number of Injuries by Body Part

Hand

Back

Arm

A: Maintenance

Ankle

Eye

Shoulder

B: Production

D: EHS

C: Engineering

E: QO

G: HR

Other

Head

ANALYZE

1. Analyze the Process 2. Brainstorm Underlying Issues 3. Examine Cause & Effect

Dig deep to identify root causes

Process Analysis
Most processes work far less effectively than you might expect.
Careful study (by walking the process) often reveals problems that have been overlooked or simply accepted as normal

Look out for:

1. Typical process design issues
How often does responsibility change hands? Are there appropriate control mechanisms?

2. Value Added / Non value added work

Challenge each process step to see it really adds value Use Value Stream Mapping to highlight delays

1. Typical Process Design Issues

Too Many Hand-Offs Deployment flowcharts highlight flow of information and material between people or functions where handoffs can be critical. Every handoff potentially causes delays and errors
Sales Shipping
1

Customer

Delivers goods

Notifies sales of completed delivery

Receives delivery
9

Sends invoice to customer

Records receipt and claims against this delivery

Lack of Appropriate Controls Are there controls where needed? Look at Escape Points times or places where things deviate from the planned process. Are control mechanisms being followed? If not, explore reasons through root cause analysis. Common Control Types Rules, procedures Physical controls Software controls

10

Notifies billing of invoice

Receives invoice

2. Value-Added / Non Value-Added Steps

Value-Added Step: .. . . Non Value-Added Step: . .. .
. . .

Most Time is Usually Consumed by Non-Value Adding (NVA) Activity Three types of work:
Business Value Added

NVA: Pure Waste

Value-Added

Where Does Waste Occur?

T I M
.. . Avoidable movement of people, products and information (avoidable travel, commuting) Any activity to check work already done (editing, checking, reviews, testing) Avoidable human activities (searching for files & data, retrieving, filing, manual activities, hand-carrying paper)

W
O O D

.
.. ...

Delays waiting for information, reviews, instructions, approvals

Things customer wont pay for (needless formatting, features, actions, revisions, expensive manuals)

Making more than is immediately required (over-production of marketing literature; excessive calls to physician)
Errors, rework, complaint handling, unresolved issues, unimplemented projects, unsupported recommendations

..

Office space, filing space, electronic storage, inboxes

Follow the Thing

The key to value analysis is to follow the thing The request the training planthe applicationthe package Sometimes the thing being processed is the customer!
In most processes, people and machines are busy nearly all the time
but the things they work on are idle most of the time So the key to finding the delays is to Machine Follow the Thing! Process

People Process

Thing Process

Value Analysis & Process Mapping If your biggest problem is lead time, measure delays
They typically account for 95% of the time taken! Mark delay times on your process map
Delay time = difference between one step finishing and next one starting (so you need to capture start / end data by step) Triangles usually used to represent delays
delays (waste!)
Send Purchase Order for approval Confirm order to Supplier Confirm receipt from Supplier

10 mins

2 days

10 mins

5 days

5 mins

Process Analysis: Summary

Process Controls .. Value Added/Non-Value Added steps ................................ ................................ Process Flow ............................... ...............................

ANALYZE

1. Analyze the Process 2. Brainstorm Underlying Issues 3. Examine Cause & Effect

Tips for Effective Brainstorming

Go for quantity!
.................................................... ...................................................

Invite the right people

.. . .

Manage the atmosphere

.. . . ..

ANALYZE

1. Analyze the Process 2. Brainstorm Underlying Issues 3. Examine Cause & Effect

Why Cause-and-Effect Diagrams?

They graphically display potential causes of a problem
Problem Causes

The layout highlights underlying relationships among potential causes

Cause-and-Effect Diagram Features

2. One spine leads into head. Contributing causes are arranged on smaller and smaller bones. 1. Problem forms head of the fish Methods

No-one updated the details

3. Causes at lower levels contribute to causes next level up

Data entry form not in same format as system

Data entry error

Customers details on system are incorrect

Materials

People

How to Create a Cause and Effect Diagram

Bottom-Up Brainstorm causes on post-it notes Organize post-it notes into logical clusters Use main clusters as major fish bones and organize subcauses from there Top-Down Start with major categories (e.g., people, process, equipment) Build fish bones by iteratively brainstorming underlying causes (Five Whys)
Ask why? a cause should be present Continue to ask why? for each reason suggested, until root causes are reached

In Reality, The Two Approaches Are Usually Used Iteratively and in Combination

Avoid Common Mistakes

Dont just break issues down into component parts or process elements
Information is missing
Address Telephone number

Name
Data Incorrect

Dont use the tool to list potential solutions

Information is missing
Automatic checks on data entry screens
Train operators in critical data requirements
Data Incorrect

Common Categories for Root Causes

Six Ms .. Related Categories People, Staffing, Organization, Skills, Management Illustrative Questions

Are people trained with right skills? Is there person to person variation? Are people over-worked?

..

Environment, Work Environment, Is the workplace safe and comfortable? Market Conditions, Regulatory Are outside regulations impacting the business? Environment Does the company culture aid the process? Parts, Supplies, Forms, Information, Inputs Procedures, Policies, Documentation, Management Systems Tools, Software, Technology, Equipment, Facilities Judgment

Are parts, forms or supplies obsolete? Are there defects in the materials? Is information stable throughout process?

How is the work performed? Are procedures correct? Are procedures enforced?
Is equipment reliable? Properly maintained? Is there sufficient capacity? Are software platforms compatible? Is data good enough? Is data readily available? Is data open to interpretation or bias? Do different people judge inputs & outputs the same way?

Define

Measure

Analyze

Improve

Control

Fish Bone Analysis for Low Active MD

Measures Material
No targeting for FF (NPC or MD) No standard form for Success Parameter (KPI)

Methods
Inaccurate MD Selection

Insufficient MD Supporting Data (ARB & Olmetec)

MD RECRUITMENT PROCESS
Unclear Communication

Complicated eHCCP form

Patient Do not ignore fill eHCCP eHCCP form

PATIENTS

Less of check Progress by Lack of Direction & electronic Endorsement

Low MD active For Olmetec HCCP

Lack of understanding of HCCP Lack of focus to promote Olmetec

MANAGER (SALES/ Forget to not fill No recognize Inform Do MD eHCCP MARKETING/CD) Or reward patients form Complicated administration Insufficient control or Unclear term DOCTORS monitoring & Condition No available Lack of Pharmacies eHCCP Less Surrounding acceptance information Lack of Target doctor For Olmetec Understanding Benefit as a member

FIELD FORCES
Low Confident Level for Olmetec product Low Less of HCCP detailing Benefit Activities Olmetec for eHCCP

Environment

People