Improvement We Care For: DFCM, QI Program at U of T

It is known that most - if not all - Quality Improvement and Process Excellence experts have one goal in mind: to make processes, services, and products sustainably better. Whether various Continuous Improvement (CI) initiatives address waste in manufacturing or flow efficiency in services, we all aim at eliminating errors, deficiencies, redundancies, and variation in any given setting. When it comes to making lives better however, there are no more important initiatives than the ones that address the health and quality of living of human beings.

That is exactly what the Department of Family & Community Medicine’s (DFCM) Quality Improvement Program at the University of Toronto has been doing. Since 2010, this group of highly trained health care professionals specialized quality improvement (QI) training opportunities to DFCM including mandatory QI training for residents, QI training opportunities for faculty, an online library of quality-driven projects, and a newsletter that celebrates QI successes of the approach.

Adapted from the Institute of Medicine, the DFCM Quality Improvement Program has embraced the six quality dimensions in its quality efforts:




1. Safety: no one should be harmed by health care.

2. Timeliness: the right care, at the right time, in the right setting, by the right health care provider.

3. Equitability: services to all without discrimination.

4. Effectiveness: servicing based on the best evidence available.

5. Efficiency: avoiding wasteful services, or services where benefits to the patient is unlikely.

6. Patient-centered: ensuring that patient values, needs, and preferences guide clinical decisions.

These dimensions are excellence-oriented processes and they provide DFCM faculty and staff with resources and an approach that help guarantee the correct execution of QI initiatives. For example, teams at the DFCM develop and submit QI Plans each spring to support their organization's QI goals.


It’s well known that it is extremely important to properly address the planning phase in DMAIC projects. DFCM's emphasis on planning helps to ensure the correct approach to quality improvement projects is taken. A quick look at the DFCM’s QI Program website link will also showcase the various resources and knowledge that have been collected and put to use in the health care setting. For example, explore the program's primary care QI newsletter for current events and success stories.


For more on DFCM Quality Improvement news please visit their home page at:

http://www.dfcm.utoronto.ca/programs/quality.htm

eZsigma Group is proud to be a partner of the DFCM's efforts towards Quality Improvement. We congratulate these health care professionals for putting process excellence in the hands of those who look after the most valuable asset of all: the human life.

Edited by Patricia O'Brien and Allison Mullin.

Office Kaizen, Part 4/4 (Asset Wastes)

In this last post of our Office Kaizen series, we address asset wastes, which represent the less than optimal utilization of material and property of an organization. When assets are not utilized in their most efficient manner (buildings, vehicles, parts, and products to name a few) these resources are wasted, leading to the creation of non-value added components to the process occurs. Lareau (2003) describes four types of asset wastes:

Inventory Waste: a very common issue in any push system, idling material waiting to be used creates waste in the process. The same goes for final product inventory waiting to be shipped to the customer. One of the main concepts behind the Toyota Production System (TPS)  - which made Lean Manufacturing very popular in North America, is the optimization of a pull system in which materials are moved through the value stream only when necessary. This in turn, helps the process in not building unnecessary inventory. As clearly implied in the preceding sentences, a pull system, along with metrics that trigger the steps within a value chain, is the best path to an Office Kaizen inventory management approach.

Work-in-Process Waste: often referred to as WIP, work-in-process waste is the type of waste that is generated by resources spent on mid-processes that cannot yet be fully used in the next activity of the value stream. If WIP involves the waiting of steps in the process itself, and if it is an necessary evil in the process, then the human resources that are also waiting in line should be utilized somewhere else. Metrics can be put in place to indicate (upfront) the possible idling of activities by WIP. Workers could then plan ahead and be better utilized in another step of the chain. From a materials perspective, as in Inventory Waste, a pull system can also help in less WIP if the process itself has room for improvement (and usually they all do!).

Fixed Asset Waste: the warehouse, the equipment, and the buildings that are not being maximally used represent this type of waste. In many industries, the normal approach to expansion is to lease or buy more, but in an Office Kaizen environment the first thing we should be concerned about is layout, organization (5S), and ergonomics. Only after the company has explored such alternatives more space should be considered. Remember that fixed assets also suffer depreciation - although not a out-of-pocket expense, it reduces the value of the asset and the customer does not pay for it necessarily.

Moving Things Waste: this type of waste includes "all transport of materials and information, except that used to deliver products and services directly to customers." (Lareau, 2003, p. 37). In an Office Kaizen environment, the team would look into the value stream maps of the most critical processes with the aim of reducing unnecessary transport within these processes. Creation of work cells and change in layout may help with the extra steps that add no value to the final customer.

We conclude this series of 4 posts on Office Kaizen by reinforcing the idea of waste reduction in any organizational setting. Waste is present in any process and there is always room for improvement. With the right tools and the right approach, you can make your organization a better one - an organization that is lean in its operational processes and rich in continuous improvement efforts that ultimately benefit the organization, its employees, its customers and basically all other stockholders related to your product or service. We are here to help in case you need a helping hand!

Reference: Lareau, W. (2003). Transforming Office Operations Into A Strategic Competitive Advantage. Milwaukee, USA: ASQ Quality Press.

Office Kaizen, Part 3/4 (Information Wastes)

In our third discussion on Office Kaizen, we address a type of waste that is extremely important to eliminate, or at least minimize, in any organizational setting. Information Waste is the waste that occurs due to the less than optimum information content in a value stream. There are five types of information wastes, as follows:

Translation Waste: requires effort to correct, change, reassess, and rework data, reports, formats, standards, and process steps. It occurs often in organizations of any size and it consumes managers' time. It can also lead the organization to costly errors and mistakes. In an Office Kaizen setting, the most likely solution to translation waste is to ensure that leadership focuses on factual data that are supported by metrics and simplified in their nature. Less is more here. Standardization (and sticking to it) may also help with the level of translation applied to processes.

Missing Information Waste: this type of waste requires extended efforts to compensate for the lack of information in procedures and processes. Office Kaizen teaches us that a hard look at the value stream to identify key metrics and information flow must be performed in order for the organization to cover all pieces of the puzzle. Visual boards should also be reviewed with respect to flow and cadence of information in the system.

Hand-Off Waste: this type of waste requires the extra effort (effort that the customer does not pay for) to compensate the loss (or improper adjustment) of information due to the hand-off being inadequate. Consider for example, when the next department in the value stream "adjusts" numbers from previous steps without a reason. An Office Kaizen organization would tackle this waste by assigning daily metrics and detailed procedures that are to be strictly followed during the hand-off of information. It may sound like bureaucracy at first, but it will guarantee a better and more accurate value stream in the long term.

Irrelevancy Waste: relates to the energy spent to deal with unnecessary information, or the efforts needed to correct issues that irrelevant information may have caused to the organization's processes. Leadership plays an important role here in supporting the avoidance of unnecessary presentations, revisions, additions, and changes to documentation that are not related to the process (value added). Once again, a good look at the value stream and its steps may be needed in order for the organization to clean up the non-value added pieces of information in the flow.

eZsigma Group offers a highly qualified group of experienced professionals who can help your organization achieve higher levels of productivity, efficiency and employee morale. Contact us to learn more about our programs.

Office Kaizen, Part 2/4 (Process Wastes)

This post addresses the second set of wastes in our series of 4 Office Kaizen discussions. There are 12 wastes when it comes to process, and they are briefly discussed below. Lareau (2003) calls our attention to avoid mixing some of the following wastes with some of the people wastes discussed in the first post of this series.

Control Waste: this waste refers to unnecessary and extreme supervision of work. It sometimes creates irrelevant tension in the work environment which, in turn, lowers employee morale. Work groups (or cells) are the ideal setting in an Office Kaizen environment. As well, clear metrics, strategic alignment, and personal development plans should help the organization to rapidly identify issues in the process.

Variability Waste: resources that are utilized due to outcomes that deviate from the expected or normal outcomes. These resources are typically involved with activities related to re-working solutions, recalling products, and amending services that did not deliver the expected outcome in the first place.

Tampering Waste: the effort required to adjust a process which has been arbitrarily changed without foresight, and the efforts to deal with the consequences of those changes. In an Office Kaizen environment, no arbitrary changes without foundation on metrics, impact on outcomes, and employee's morale would take place.

Strategic Waste: relates to value lost due to the efforts that are concentrated on short-term goals and/or immediate internal customer needs only, i.e. it does not impact the company's long term objectives. Normally, an Office Kaizen approach would be to look into the entire value chain and identify perils about the short-term gains versus the long term losses.

Reliability Waste: efforts related to the correction of unpredictable outcomes that are the fruit of unknown causes. The most likely approach to this situation in an Office Kaizen environment would be to have procedures, visual and/or job aids, and standards that inform the operator of the procedures associated with the unpredictable outcomes (call it the B plan).

Standardization Waste: efforts wasted to correct the variance among operators of the same task. In other words, one operator performs better than the other. The ideal solution here is that the best practice be followed by others, and that the best performer trains (or helps) the others to achieve the standard expected.

Sub-optimization Waste: may also be called "the tug of war of processes or departments". This type of waste happens when competing processes a) duplicate the work needed for the entire value chain or b) "compromise each other and degrade the final outcome" (Lareau, 2003, p. 29).

Scheduling Waste: energy spent on compensating activities due to their poor scheduling. A well functioning Office Kaizen would schedule activities respecting their flow, timing, gaps, overlaps, and breathing in between them.

Work-around Waste: the famous informal, out-of-control, and DIY (Do It Yourself) type of procedure that overweighs the formal procedures the organization has in place. Normally the outcome of such procedures are penalties and more control, but in an Office Kaizen mentality, the group involved would look for best practices, share them, and make them the official way of doing things, while at the same time always looking for improvement opportunities.

Uneven Flow Waste: resources allocated to correct the uneven flow of material or information "sitting" somewhere in the process (similar to inventory waste). Just as in a manufacturing setting, the work group in an Office Kaizen would evaluate the value chain and focus on bottlenecks that may be piling up unnecessary materials or information.

Checking Waste: efforts put into the constant inspection of activities due to the poorly designed value stream. Checking, double-checking, and triple-checking are non-paying activities in the eyes (and pockets) of the customer. As in any continuous improvement (CI) approach, the design of the process should aim for an error-free outcome, as once put by Phillip Crosby.

Error Waste: the efforts spent on re-doing, fixing, and amending what has not been done properly in the first place. Although a certain degree of error is expected in all processes, the CI professional in an Office Kaizen environment should always set up the process with enough error-proofing (poka yoke) techniques and methods to secure the correct outcome as much as possible.

The next post will address Information Waste. eZsigma Group offers onsite analysis of processes and their constraints. For a more in-depth discussion on what your organization needs to become a better one, please contact us directly at rperdigao@ezsigmagroup.com.

Reference: Lareau, W. (2003). Transforming Office Operations Into A Strategic Competitive Advantage. Milwaukee, USA: ASQ Quality Press.

Force Field Analysis in 3 Steps

Making a decision about a major undertaking such as the implementation of a Six Sigma program is not an insignificant task. As we all know, the on-boarding of a process excellence initiative may affect the lives of many employees not to mention the possible change in various processes within the organization. The Force Field Analysis was developed in the 40's by Kurt Lewin (a social psychologist). It is a practical and useful tool that you can use to help your organization in the decision-making process of any major change brought by new initiatives. This simple and yet powerful quality tool can provide the practitioner with a visual assessment of the forces that are against or in favour of the initiative being implemented. It also gives the quality professional a pictorial representation of the factors that need to be minimized (restraining forces) and the ones that can be used as leverage (driving forces).

How to Build a Force Field Analysis Diagram in 3 Steps

Step 1. Start by stating in the middle of a flip chart or a sheet of paper what it is that the organization (or department) is about to embark on. This can be a simple Kaizen rapid improvement event or a year-long Lean Six Sigma on-boarding program.

Step 2. On the left side of the central statement, list all factors that may contribute to roadblocks, issues, or even failure in the initiative. The Force Field Analysis diagram should be built through a brainstorming session which it means that, all ideas and insights are welcomed at this point. For a Six Sigma implementation approach, restraining forces could be employees' resistance, cost of remodeling a new process, and lack of inside expertise to name a few.

Step 3. On the right side of the central topic being studied, list all factors that may contribute to the success of the initiative. These include, but are not limited, to savings in time and cost, higher customer retention rate, improved product quality, fewer recall events, and industry recognition in process excellence. As in item 2 above, all ideas related to the success of the central initiative are welcomed at this point.

Some authors suggest the inclusion of a weighing system applied to these forces. For example, are there restraining forces that affect the program being implemented more than others? A simple scale from 1 to 5 (weak to strong) can be used. Once the diagram has been completed, the organization should start working on the minimization (or elimination) of the various restraining forces and on the strengthening of the driving forces. The Force Field Analysis will ultimately provide the user with even a decision on whether or not to go ahead with the program/change/initiative. On one hand, you may find that there are just too many restraining forces to tackle. On the other hand, you may find that the program being considered can be implemented with a great deal of driving forces that will make the entire process a lot easier than expected. One way or the other, the tool can be used to help you in making a better decision.

eZsigma Group is Canada's leader in process excellence. Through the deployment of Lean, Six Sigma, and Strategic Management consulting and education, we have helped hundreds of businesses to improve their processes and be a better organization. Contact us should you have any questions on how we can help your organization to be a better one.  

Six Lean Core Concepts

Lean is often described as the philosophy that aids the organization in reducing the lead time between a customer's order and its shipment (be it a product or a service). It has been applied to various organizational settings over the past years (including services) and it has successfully created more value-added flows of information, activities, and networks that ultimately led organizations to become "leaner" (as the name implies). The journey of LEAN starts by the understanding of its core concepts. Some things to keep in mind as you start your journey towards operational excellence through Lean:

1. Low tech / low cost. Lean is about creativity before capital. It utilizes people's experiences, insights, skills and brainpower to tackle small and/or complex issues. The order here is to avoid the organization's funds and use teamwork and Lean principles to minimize waste and optimize processes.

2. Lean works today! A "perfect" solution in 6 months is not necessarily better than a good solution today. A Kaizen Rapid Improvement Event (aka RIE) is an excellent way of starting your resolution towards eliminating non-value added activities in your process flow.

3. Inventory hurts. It is not necessarily an asset (from a Lean viewpoint). The "pull" system (knowingly utilized successfully by Toyota) avoids the build up of inventory that costs money while sitting in the warehouse.

4. The PDCA (Plan-Do-Check-Act) cycle is the lead carrier of a well implemented Lean approach. PDCA will help your organization to constantly look at new improvement opportunities as there will never be a "perfectly perfect" process.

5. Based on item 4 above, once started, Lean is a continuous effort. Be it through a Kaizen Rapid Improvement Event or by tackling major issues in your entire functional processes, the effort must go on, and on and on. Spinning the PDCA cycle is the best way to guarantee continuous success in eliminating waste and improving your operational activities.

6. Always remember: there is often more non-value added activities to any given process than value-added activities. The customer is not willing to pay for non-value added activities and someone has to pay for it. You can incur that cost (and lower your competitive advantage) or you can eliminate it by creating an environment of constant improvement towards every single aspect of your organization's operations.

EZSigma Group is the leading consulting firm in Lean, Six Sigma, and Process Improvement in Canada. Contact us to discuss how we can help your organization to become world class in process excellence.

Back to Basics: Hoshin Kanri

Process improvement and all of the tools and methods that go along with it have been around for quite some time. Be it the complexity of the full adoption of SPC (statistical process control), or be it the simplicity of a 5 Whys analysis. Somehow, these methods have been leveraged by many foundation approaches, mostly created in Japan post WWII. Hoshin Kanri was designed and popularized mainly by Dr. Yoji Akao in the late 50's. Although there is no agreement on the best term to describe it, the terms management by policy or policy deployment are frequently used. The words themselves mean shining metal, pointing the direction, or compass (Hoshin) and management or control (Kanri). Many writers have also approached Hoshin Kanri as being a system approach to managing change in critical business process. But what really is the most important aspect of adopting a Hoshin Kanri mentality? The initial observations are briefly described below.

Measuring the system as a whole: Similar to the BSC (Balanced Scorecard) approach, Hoshin planning considers the strategic intention of the organization rather than the goals of departmental silos. Another strong aspect to be considered is the adaptability of plans as the organization carries them out. Long term planning (mandate, strategies) are nowadays nearly impossible to be set in stone for a full calendar cycle, or whatever long term metric the organization decides to use as a reference.

Setting core business objectives: A key feature of a well implemented Hoshin approach is to involve those who are about to carry out the plan in the planning itself. The word "Catchball" is frequently used throughout the quality management literature on Hoshin planning. Catchball in this context relates to the fact that employees of organizations should bounce ideas around their peers and other hierarchical levels in a way that they feel a part of the broader dialogue within the organization.

Understanding the environmental situation: This is an important reminder of how well developed organizations consider all facets of the business including, but not limited to, external factors (economical, social, cultural, and legislative), internal factors (employees, board members, and stockholders), and benchmarks.

Providing implementation resources: While Hoshin is utilized to create synergies amongst the various strategies set in place for the business as a system (breakthrough, critical strategies), the approach also recognizes the need for the daily management of resources put in place to achieve the organization's objectives. Daily control is critical and cannot be ignored. It provides the organization with those Kaizen-type of initiatives that ultimately support the larger organizational objectives to be accomplished.

Defining system processes: This is a clear and congruent description of objectives, goals, activities, performance measures, and benchmarks. In addition, a well defined set of expectations and roles for senior and middle management as well as for implementation teams makes the Hoshin Kanri approach a successful and sustainable one.

Contact EZSigma Group to learn about how this and many other approaches can help your organization to become a better one.