Six Steps to Effectively Plan for Lean Six Sigma Efforts

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Some of the complaints commonly levied against continuous improvement deployments is that they focus on the wrong issues, and that projects take too long or require too much investment (time, training and financial) in order to achieve meaningful results. Unfortunately, these complaints are often justified – not because of some fault in the Lean Six Sigma (LSS) process itself but because leadership fails to properly plan and manage deployments. Selection of projects, selection of LSS practitioners, sequencing of projects and the linkage of all these activities to the company’s operating model and overall mission and goals is a vital factor in the long-term success of any continuous improvement initiative. Effective continuous improvement does not happen spontaneously; it requires careful planning and management. This is especially critical when the continuous improvement deployment is driven in a decentralized manner rather than by a strong corporate edict.

Success Comes From Planning

Most well-run companies spend a significant proportion of management time in planning. Budgets, production, new products and other important elements of the business plan are well thought through and tracked. Unfortunately, many of these same companies do not apply this same discipline to their continuous improvement activities. Green Belts (GBs) and Black Belts (BBs) are trained to employ the plan-do-check-act (PDCA) cycle, but the organization then pushes the Belts to do projects that are not well planned. Change is undertaken without a clear understanding of how these projects fit into the long-term business plan. The result is reactive problem solving that may not have a lasting and significant impact on the long-term health of the organization. Effective management of continuous improvement, however, is primarily driven by good planning. Failing to integrate continuous improvement into the overall business planning cycle is a leading cause of failed deployments.

Why LSS Failure Exists

There are many reasons why organizations do not fully integrate their improvement programs into the business planning cycle. Sometimes it is a confidence problem – when the program is new, leadership may not believe it will deliver the promised results. Sometimes it is a trust issue – if the program is being run by an outside consultant, leadership may be hesitant to share strategic plans. Most often, however, it is an oversight – LSS is not considered a core part of the operation and, thus, is not fully integrated into the plan.

Regardless of the reason, failing to incorporate improvement initiatives into the plans used to run the business results in dysfunctional behavior. These dysfunctions sometimes look like solid management of the LSS program. Most, in fact, are good components of a proper portfolio plan, but since the program is incomplete the components tend to drive the wrong behavior. The distinction is whether the components are proactive and long-lived within the organization.

For example, many companies charge one functional area (such as finance or operations) with accountability for LSS projects. This is important from a validation perspective. Unfortunately, when continuous improvement is responsible to only one function, the needs of that function tend to dominate and drive all project selection. For example, when finance is accountable for all LSS projects, priority is given to projects that result in cost reduction even when this is not the most important issue on the strategic plan. Likewise, when the leadership of the continuous improvement program is responsible for project selection, projects tend to be aligned to GB and BB training.

Narrowly governed programs generally have a one-year to five-year lifespan within the organization and are then supplanted by other programs focused on the needs of the functional areas not driving the LSS agenda. Programs aligned with the strategic plan and governed by a scorecard approach in which the needs of all functional areas are represented tend to be sustainable in the long term and create business impact. To do this, however, the organization must actively plan the execution of LSS, not just run projects.

Avoid Failure

What follows is a simple process and set of proven tools that have been used in several industries to help senior leadership teams to:

  • Effectively manage their Lean Six Sigma deployments,
  • Ensure that these programs remain on target,
  • Ensure that the programs deliver meaningful results to the business,
  • Guarantee that the program serves all the key stakeholders, and
  • Focus the LSS deployment on driving delivery of strategic goals.

Six Steps for LSS Program Success

1. Establish a set of goals and objectives for the business to achieve. Most companies do this as part of their employee performance and business planning cycles. These same goals must be the goals of the LSS program. When the LSS program pursues goals not directly related to how the business runs (particularly if its employees are incentivized toward these other goals), the program becomes an add-on activity. Relegating LSS to an additional activity within the employees’ responsibilities ensures that continuous improvement will always be a lower priority than the “real” goals for which they are paid. The role of LSS should be to ensure delivery of those real goals; additional goals serve only to distract the team from the strategic agenda. [Tools for this step include: employee goals and weighting, annual business plan, strategic business plan, and mission statements.]

2. Identify the needs of the business and core competencies. When looking at the goals of a company, there are some goals that will be easily achieved, and for which the activities required to achieve them are well-known, while there are other goals for which the path to success is less clear. By focusing the LSS activities on the business goals that are at risk, efforts are aligned to the areas where the greatest effects will be felt. Furthermore, since LSS is helping key leaders meet difficult goals, buy-in for the continuous improvement program is generated. The goals of the business are the LSS goals. When the business goals are met, the organization is propelled forward and creates value. [Tools for this step include: quality function deployment (QFD), failure mode and effects analysis (FMEA), key process indicator (KPI) scorecards, and system capability scorecards.]

3. Make plans to close that gap. This is, of course, where most organizations want to start. Without the baseline data that shows where and to what extent the LSS projects will improve the real needs of the business, however, the process is likely to create an arbitrary list of project that may or may not support long-term goals. It is vital that these steps be undertaken only after the real needs of the business are understood.

  • Brainstorm project ideas. Once the areas for LSS teams to focus on have been identified, it is time to identify projects. Do not start this until specific areas of focus have been identified, how those areas of focus relate to the overall strategy is understood, and they can be related to specific KPI that the business needs to improve. Be sure that a brainstorming team is fully representative of the functional need of the business. [Tools for this substep include: Ishagawa diagrams and the Theory of Inventive Problem Solving (TRIZ).]
  • Evaluate and prioritize the ideas. Once there is a list of potential projects, it is time to decide which ones are viable and in what order those projects should be undertaken. Develop a list of business specific questions (see “Prioritization Questions” sidebar) to help sort the high impact projects from the less viable ones. [Tools for this substep include: strengths, weaknesses, opportunities, threats (SWOT) analysis, Pugh matrix and prioritization questions.]

Prioritization Questions

  • Does the project support the strategic plan of vision for the business?
  • How will this project affect the KPIs of the business?
  • How realistic is the goal set for the project?
  • How competent are the team members? Can they achieve the goal?
  • Is there a strong project Champion?
  • Does the process affected by the project have the bandwidth to accept the change proposed?
  • Is the approach (DMAIC [Define, Measure Analyze, Improve, Control], DFSS [Design for Six Sigma], Kaizen, etc.) matched to the problem and timeline proposed?
  • Will the change require investment? If so, are there enough funds and will it produce a good return on investment (ROI)?

4. Match team members to projects with problems they have an interest in solving. Many organizations assign their LSS leaders to projects regardless of those leaders’ backgrounds, education and experience. This model works okay if the company also dedicates those LSS resources (i.e., GBs and BBs) full time to improvement projects, but this is not reality for most GBs. Most GBs undertake improvement projects in addition to other responsibilities. Failure to keep this arrangement in mind when assigning teams frequently means people will choose their “day jobs” over project work resulting in project delays. In an ideal case, GBs who work in non-LSS functions should be assigned to projects that directly affect that non-LSS function. This minimizes the conflict of interest between project work and day jobs. [Tools for this step include: skills matrix, organizational charts and training of new LSS practitioners.]

5. Plan project execution. It is a mistake to identify projects and just hand them off to project teams. The success of an effective project portfolio rests on creating a steady, predictable stream of results. To achieve this, projects must be actively sequenced, resourced and managed. Nothing should be left to chance.

  • Choose the right tools and approaches. There are many continuous improvement methodologies; each is tailored to a specific type of problem. While it is possible to solve most problems with any continuous improvement methodology, it is not efficient. Choose the method that best fits the problem and the resources at hand. [Tool for this substep: continuous improvement process selection matrix.]
  • Establish realistic timelines. DMAIC projects typically require about 200 to 300 hours of work to deliver results. Similarly, there is a specific amount of effort required for Kaizen (10 to 120 hours) and DFSS projects (about 350 hours). While shortcuts can be taken, it is important to plan for the actual time the team will require to execute the project rather than arbitrary calendar goals. While a team of five full-time BBs can complete a project in one week (assuming all the data is available), part-time GBs with demanding day jobs will require more time. Add to that holidays, weekends, urgent business issues and a learning curve for GBs new to LSS, and 20 weeks is likely to be the time it takes highly motivated GBs to complete their projects. [Tools for this substep include: Gantt charts and project performance standards.]
  • Use multigenerational plans where appropriate. Sometimes it is desirable to undertake a massive change in stages. This allows several advantages such as reduced risk, the opportunity to include anticipated new technologies and an ability to realize the benefits of early-stage improvements while pursing the larger goal. Project Champions and advisors should guide teams into this approach when appropriate rather than allow them to become stymied by attempting big changes that require a long time to achieve. [Tools for this substep include: multigenerational planning chart and Hoshin Kanri.]

6. Execute the plan. This is the point where all the work in planning pays off. If planning has been done properly, then this stage is simply managing to the plan and dealing with any deviations. The key to success is to make the work visible.

    • Provide teams with the resources, including time, needed to be successful. Once teams have developed project plans and these plans have been approved by leadership, it is critical that both the team and leadership follow the plan. In order for the teams to remain on track to deliver their project on time and on scope, leadership must ensure that time and resources are available as planned.
    • Visibly track and report progress. Unless something is being measured, it is unlikely to happen. A portfolio manager should visibly track the execution of projects. This means all teams must report progress at scheduled intervals (not just at mileposts in their projects) and all projects completing a phase should get a rigorous review. [Tools for this substep include: weekly timeline and status updates, and master project plan.]

Critical Outputs from Good LSS Portfolio Planning

  • Training plan: Who will be trained? Why? When?
  • LSS project plan: Which projects will be done and in what order?
  • Benefits accrual plan: What outcomes are expected from the projects and when will they be realized?
  • Project status report: What projects are underway and who is working them? Will these projects deliver on time?
  • Improvement roadmap: How will the business change? Why? When will these changes occur?
  • Employ tollgate reviews. LSS projects are composed of a series of discrete deliverables that are ordered so that the deliverables that have the highest impact on project risk are first and the highest cost deliverables are delayed. The purpose of tollgate reviews is to ensure that the risk of project failure falls before resources are committed. This means that all the important tasks are verified as done, done correctly and done in the right order. To this end, every project must be reviewed by a Master Black Belt (MBB) and project Champion at the end of each phase. Projects should not proceed to subsequent phases until approval is granted but both the MBB and Champion. [Tools for this substep include: tollgate reports and process performance standards.]
  • Validate results. Promising results and delivering them are different things. It is often a conflict for the teams executing the change to also certify that the benefits have been achieved. Most companies are good at validating financial outcomes (e.g., cost reductions, revenue, ROI, etc.), but what about the other benefits? Operational and soft benefits should be independently confirmed by the functional leadership that is held accountable for those outcomes. For this reason, it is important for the entire leadership team to participate in project outcome reviews. [Tools for this substep include: benefit audits and performance scorecards.]

Ellis Medicine uses lean Six Sigma to create opportunities from problems

Ellis Medicine is a 438-bed community and teaching healthcare system serving New York’s capital region. With four main campuses, five additional service locations, more than 3,300 employees, and more than 700 medical staff, Ellis Medicine offers an extensive array of inpatient and outpatient services. In 2013 Ellis made a commitment to change the way things get done at the century-old institution.

The main goal was to improve quality of care and financial strength by identifying more efficient processes and cost savings. Kristin May, director of organizational performance and innovation, leads the project and focused her attention first on building an internal team to apply principles from lean management and Six Sigma.

From dynamite to Dyno-mite

The first move was to send a couple of bright, young lean leaders to a public Six Sigma course at a dynamite facility in Connecticut to learn about the methodology. It didn’t take Angelo Paglialonga and Christine Waghorn long to bridge the gap between explosives and healthcare, and complete a project on laboratory blood-specimen turnaround time (TAT) at Ellis Hospital with savings estimated over $600K annually.

“At first it seemed odd to be driving to a dynamite factory to learn about the Six Sigma methodologies we were going to implement in a healthcare setting,” Waghorn commented. “But after a few classes, it began to make perfect sense.”

Phase two consisted of creating the six projects onsite at Ellis hospital. The teams were mentored by Waghorn and Paglialonga in between training sessions, which was instrumental in bringing the projects to fruition. It was through their efforts to create a dashboard for the projects that the savings were validated.

As an advocate for lean and Six Sigma continuous improvement, May implemented a hybrid of both techniques with assistance from the Greater Boston Manufacturing Partnership (GBMP).

Initially, May and her team of seven part-time and five full-time Lean leaders used their time to introduce the concept of change and the process of continuous improvement to get the nurses, staff, and other care providers involved in finding solutions and resolving problems. Together they found a solution to IV pump shortages and saved $500K. Next the team turned their attention to the hospital’s lab department. By identifying tests that could be done in-house, the lab department saved $1 million. Although May’s team brings the tools and the structure and the tracking capability to a department, it is the staffs in each department, and their knowledge of the processes and issues, who conceive of and implement the improvements.

Now May is pleased to say there’s a waiting list of those who want to be certified in lean and Six Sigma—people who have seen firsthand the positive outcomes of these techniques on specific problems and the effect of the new culture of change within Ellis.

The Department of Organizational Performance and Innovation provides three paths for those interested in an education in lean and Six Sigma: the six phases of the lean leader continued education path; the four belts of specialized Six Sigma training; and four levels of qualification in project management. In September 2015, six teams set out to tackle six difficult projects. In January 2016, the teams presented their projects to senior management.

“Seeing the fruits of their labor only makes people want to do more, improve more, and work together more,” says Ron Pujalte, GBMP continuous improvement manager and Six Sigma Master Black Belt. “The passion and dedication of this particular group of people is evident in the amount of progress they’ve made, supported by these amazing report-outs and the pride that radiates because they have made a positive impact on patient’s and co-worker’s lives.”

The six team projects were:
• Bed and equipment rentals
• Patient falls
• Pharmacy calls
• Safe patient handling
• Primary care referrals
• Structured interdisciplinary bedside rounds (SIBR)

Cincinnati Manufacturers Sharpen Their Focus for Growth

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During my visit to Cincinnati, Ohio November 1st – 4th, I had the pleasure of meeting with Tony Canonaco, CEO, and Tom Rosenberg, director of Marketing, at Balluff’s North American headquarters based in Florence, Ky.

Canonaco said, “With over 50 years of sensor experience, Balluff is a leading global sensor specialist with its own line of connectivity products for every area of factory automation. Our global headquarters is based in Germany, and our North American headquarters was established in Florence, Ky., in the early 1980s. Our products include a wide variety of sensors, mechanical limit switches, rotary and linear measurement transducers, machine vision and RFID systems, and distributed modular I/O network solutions.  Our products are involved in making the Industrial Internet of Things (IIoT) work.”

As we toured the plant, I saw their sensors being used right on their own production and packaging lines, as well as for inventory control of finished goods. With IIoT’s promise of total visibility, we saw a great example right on their plant floor. IO-Link technology, an advanced point-to-point connection technology, was integrated into all their automated systems providing operators and management a continuous view of the process. With faster response to workload variations, Balluff now has a much leaner operation. Lean examples were also evident in their single-piece flow work cells. Products were produced in a surprisingly small footprint with high efficiency.

Canonaco said, “Many of our internal transitions towards lean began during the recession in 2009. It was during this time, we realized that in order to better compete in the future, we needed to eliminate all types of waste and raise the level of productivity of the company. In addition to the change in their own mindset, we accelerated our new product releases that focused on automation and sensing solutions to help our customers shrink the size of their control panels, reduce their engineering time, and speed up troubleshooting on their machines. We started our journey to become “leaner” and our customers were provided with new products to help them realize performance and productivity machine enhancements as a result of the recession. Nearly a decade later, this path has proven to be a win-win for us and our customers.”

An additional customer-focused effect of their lean journey is with one of their most watched metrics inside of Balluff ─ on time and in-full delivery to the customer promise date. They consistently plan to achieve greater than 97%.

When I asked if they had a problem with finding people to hire with the right skills, he responded, “Finding people with the right skills and the right mindset is always a challenge and makes all of the difference. We require production associates for manufacturing as well as engineers who work in technical sales, marketing, support and operations. We are involved with local workforce development efforts to help ourselves as well as surrounding manufacturing neighbors. Balluff is an active supporter of National Manufacturing Day to highlight the attractiveness of manufacturing as a career choice. This has proven to be very popular with local middle and high schools. We utilize co-op students from select universities and have started our own technical sales training program for recent college graduates that focuses on how to best help manufacturers apply automation in innovative ways.”

“We have our own accredited laboratory and a quality management system certified according to ISO 9001:2015 to form a secure foundation for optimized added value for its customers.

“Our products increase performance, quality and productivity around the world every day. They satisfy prerequisites for meeting demands for greater performance and cost reductions on the global market. We deliver state-of-the-art solutions no matter how stringent the requirements may be.”

TSS Technologies Helps Early Stage Companies Ramp Up

Our last plant visit was to TSS Technologies, located in West Chester, Ohio, where we met with CEO Marc Drapp, followed by a tour of the facility. TSS Technologies provides complex electro-mechanical assemblies and turnkey contract manufacturing solutions to the aerospace, life sciences, energy, semiconductor, solar, sports, consumer, automotive, as well as food and beverage sectors. TSS also builds automation equipment for themselves and other companies.

Drapp said, “TSS Technologies has been in business for over 65 years and is family owned and operated. We have a machining facility totaling 110,000 square feet and an assembly facility totaling 210,000 square feet. We have approximately 225 employees. We are ISO 9001:2008 and 13485:2003 certified, as well as AS9100C certified and won the GE Healthcare Excellence award.”

As we toured the plant, we saw examples of many of the above products being assembled or being staged for assembly for a couple of new products coming online. Contrary to most contract manufacturers, Drapp likes to get involved with early stage companies to help them get into batch production and ramp up to full production. We saw a complete “bakery” producing shelf-stable pretzels that is an example of working with a start-up company to ramp up into full production within his facility. We each gratefully accepted two packaged pretzels and shared one when we returned to the conference room.

When I asked Drapp how the Great Recession had affected them and what they did to recover, he said, “The recession was tough on our company, especially our machine shop. We lost a lot of contract machining work to our customers that brought the work back inside their plants. On the other hand, it really allowed for us to rightsize our operation and allow for us to be more nimble in the coming years.

“We capitalized on the tough times by reorganizing our structure and tightening our manufacturing processes. This allowed us to become more lean and efficient. Ultimately allowing us to come out of the recession quicker and better able to respond to customer needs.

The recession really allowed for us to take a look at TSS and what we wanted to be. It allowed us to focus on the right customers for our business. It also allowed us to focus on the right areas for growth. From a lean perspective, we have always practiced lean manufacturing. The recession didn’t really change that.”

From these stories, we can see that cutting-edge technologies and unique capabilities have been the key to these companies surviving the Great Recession and now thriving. The rebuilding of manufacturing in the Cincinnati region is being helped by the innovative technologies being developed at the University of Cincinnati and the other three regional universities and colleges. The collaboration of public and private entities and far-sighted leaders will enable Cincinnati to achieve their vision of re-industrialzing Cincinnati to create jobs and prosperity.

A Leadership Roadmap for Managing with Metrics

1. Start at the Finish Line: Define Strategic Objectives

By far the worst use of Six Sigma is on non-strategic issues. Chartering projects with little or no significance to the strategy of the organization sends a signal to everyone in the business: “We will push this initiative through, no matter how little sense it makes.” Leadership at all levels needs to invest in making sure Six Sigma projects are aimed at the right targets. This process starts with defining the strategic objectives in a clear, concise manner. The objectives should closely align with the personal goals and objectives of the individual leader. Typically, the outcome of this step is such statements as:

  • Reduce plant operating cost by 10 percent in the next two years.
  • Increase revenue per sales representative by 25 percent in two years.
  • Grow consulting services to pharmaceutical clients by 40 percent in the next three years.
  • Grow market share in OEM (original equipment manufacturer) business by 10 percent by 2007.
  • Reduce product development cycle time by 500 days in the next three years.
  • Develop a profitable after-market business with return on revenue of 10 percent in the next two years.

Obviously, objectives like these can be developed at every organizational level. While their scope tends to be more global in nature at the top of the organization, the key is to define the goal as precisely as possible, with a clearly defined metric and a time frame (less than five years). The outcome should be a short list of statements that all meet the test of being clearly aligned with the objectives of the executive or the leadership team in charge.

2. See the Business as Customers Do: Integrate Customer Perspective

Few businesses can succeed without the customer being satisfied. This step aims at defining performance against customer expectations that will allow the business to reach the strategic objectives. Outside of the sales and marketing functions, this step is often overlooked. To the extent possible, one should aim at verifying the assumptions made at this stage with actual customers or market research. Assumptions such as, “Customers will be glad to buy more financial products from us without a negative impact on our profitability” can be costly. The outcome of this step is a list of statements such as:

  • Deliver within 10 days of the order exactly as specified.
  • Provide value-added advice to physicians based on personal preferences.
  • Reduce cost per vehicle by $50.
  • Provide measurable return on consulting engagements with an ROI of 20 percent.
  • Develop medicines with significant economic benefit relative to cost of care.
  • Provide financial products based on the customer’s personal objectives at a fair value.

While some of these statements, again, can be quite global in nature, the leader or the team should spend some time in making sure they really understand the customer and verifying the outcome with the customer. Again, those in the organization who do not directly deal with customers need to work hard on understanding their role in satisfying external customers as well as analyzing how their performance impacts internal customers (who deal with external customers). An example for the human resources department of an auditing firm would be: “Develop the next generation of account managers capable of managing cross-functional, virtual teams with customer integration.”

3. Y = f(x): Identify Drivers and Processes

The third step is to identify the critical drivers that will make the strategic objective actionable. At this stage, it is useful to involve a cross-functional leadership team or utilize an existing leadership forum to have a dialogue about such questions as:

  • How will the business accomplish this objective?
  • What are the critical drivers?
  • To what degree does the team agree on these drivers?
  • What assumptions does the team make about other factors?
  • What are team members’ joint and individual assumptions about cause-and-effect relationships?
  • What contribution does the team expect a particular driver to have on the overall objective?
  • What performance does the business need to accomplish the goal?
  • To what degree are the different drivers in conflict with each other?
  • How do these drivers link to business processes?
  • Who is responsible for the performance of critical drivers?

The outcome is a list of process drivers, oftentimes with two levels, that everybody on the team agrees to. In the process, the team will have had a frank discussion and converged on a joint picture of what it will take to succeed. Table 1 is an example of a driver tree.

Table 1: An Example of a Driver Tree

Reduce Plant Operating Costs by 10 Percent While Reducing Delivery Time by 60 Percent in Two Years

Labor Costs

Capital Budget

Production

Engineering

Workforce

Reduce indirect labor costs by 20%Increase employee productivity by 10% Increase capacity of existing equipment by 12%Leverage suppliers for non-core processes to reduce overall capital budget by 50% Reduce production cycle by 50% through Lean manufacturing Reduce work in progress and raw materials inventory by 40% through visual mechanical inspection and just-in-time delivery Reduce engineering throughput time by 10 days for custom-engineered products Improve reuse of existing components by 40% Take out two supervisory levels through self-directed teams

Once the drivers have been established, the team should identify the business processes that impact the process drivers and the metrics that will help the team keep track of progress.

4. Agree How to Keep Score: Develop an Operational Definition

To the extent that this process reveals more than was known and agreed upon before – which is to be expected if the team really had a dialogue – the existing metrics will most likely not be sufficient to keep track of progress. In most instances, the leadership team will have to agree on how to keep score and ensure that the definition of the metric reflects the intent. While this seems like a trivial exercise, it is important that the leadership team thinks through to what extent the metric is properly defined. Table 2 provides an example of metric definition.

Table 2: An Example of Metric Definition

Metric

Operational
Definition

Current
Performance
Level

Goal
Performance
Level

How
Displayed

Definition
Which indicators do you want to measure? How will you go about collecting and recording the data? (What metric? When? Including what? Excluding what?) What is the current value? Where do you want to be when? What type of diagram do you want to use to plot the data?
Example
New product revenue Actual, aggregate weekly orders, in dollars, for any product introduced within the previous 12 months. Does not include acquired products or level 2/3 new service releases. $1.45 million in 2005, week 7 $1.2 per week throuhgout 2006 Rolling 52-week period individual/moving range control chart. Backup data to include individual new product monthly order control charts for same period.

5. Know Status Quo: Determine Baseline Capability and Performance Gaps

Once the measurement has been defined, the next step is to develop a picture of the current performance. The emphasis should be on establishing performance over time – typically two years, or a similar period that is representative. Black Belts can be very useful in this process.

After the data collection, the team should reconvene and review the past performance. Typically, displaying the data in a control chart format or a similar way helps all team members to understand the current performance relative to a number of key dimensions:

  • Gaps in meeting the strategic goal and customer needs
  • Variability and predictability of performance
  • Trends and other patterns

As a result, the team should have a clear picture of what improvement will be required.

6. Use Pareto Power: Identify Opportunities to Improve Performance

The data will provide a start for the team to identify the root causes of performance gaps. Following the same logic as with the driver trees, the team will probe for causes, and identify a wide range of possible avenues to close any gaps. Some of these ideas will not necessarily lend themselves to using Six Sigma or Lean, but others will. At this stage, training the executives on the Six Sigma process and providing them with a process for identifying where Six Sigma can help will be critical. The outcome should be a prioritized list of projects that will be sufficient to close the gap, with a clear definition of deliverables and timelines. This stage could take a significant amount of time, especially when delegated to the next level in the organization (which is important to ensure buy-in of those expected to deliver the results).

7. Pull the Trigger: Launch Improvement Projects

This phase is all about mobilizing: Mobilizing Six Sigma teams to tackle the issues, mobilizing the organization to implement the changes, and mobilizing the leadership (from the CEO to every lower executive) to relentlessly drive the projects. The leaders of the business must hold the teams accountable while being patient in terms of the process. They must insist that project teams use data and logic instead of gut response and conventional wisdom. It is all about executive presence and engagement. Many employees and team members will judge project importance primarily on their perception of how important the leader in charge thinks the project is. Project team leaders should expect scrutiny and critical thought from the executive team, as well as visible engagement and support, adequate resources, and a willingness to make responsible, tough decisions in a timely manner.

8. Drive Results: Monitor Achievement of Objectives

Once a project is done or close to being done, the executive needs to ensure that the project delivered on the result. Too many DMAIC (Define, Measure, Analyze, Improve, Control) projects derail in the Improve phase and do not deliver a sustainable improvement in performance. Reviewing performance against the stated objective is critical. It holds the team accountable – formally acknowledging that the team has delivered the expected result, or that it needs to go back to the drawing board and return with a recommendation for closing the gap. The review process also signals that the project is truly critical to the business, and thus deserves a leader’s active involvement.

Project reviews provide an opportunity to demonstrate progress, commitment and consistency, as well as reinforce the message of focusing on the key drivers to accomplish the goal.

9. Learn the Lessons: Refine the Approach

The final step in this iterative process is to review periodically whether the assumptions made along the way are correct. In some cases, the executive or leadership team will realize that they made some incorrect assumptions and refine their tactics and the underlying strategy. Keeping an ear to the ground and being open to learning is crucial to avoid the problem of winning the battle (completing the projects) but losing the war (missing the strategic objective). The leadership team should meet periodically and review whether the assumed link between drivers and outcome is valid or requires adjustment.

Conclusion: Staying Focused

Making sure that Six Sigma is focused on what matters cannot be delegated. It is in the self-interest of every executive to understand how to use this nine-step approach to help them in accomplishing their strategy. At the same time, executives need to be focused and concentrate their energy on the vital few opportunities that will deliver a significant impact.

Hiring for Group Manager_transactional Quality_wns Pune

Job Description

Job Description:

Ensuring timely completion of transaction quality checking as per sampling strategy for F&A domain

Establish and maintain robust tracking mechanism for key indicators of the operations to support decision-making

Conduct process documentation as per ISO standards

Driving customer satisfaction and quality by the use of improvements to business processes / procedures

Prepare and publish Monthly Quality Audit reports

Deployment of Lean & Six Sigma methodologies across processes

Drive continuous improvement initiative through ideation, kaizen and Six sigma projects

Deploy 5s and lean tools for process enhancement

Ensuring completion of monthly compliance audits as per process requirement

Salary: INR 10,00,000 – 15,00,000 P.A
Industry: Other
Functional Area: Other

Keyskills: Lean Six Sigma, Quality Audit, Operations, Kaizen, Maintenance, ISO, Continuous Improvement, Six Sigma Projects, Process Enhancement, Quality Check, transactional quality, F&A, O2C.

six-sigma2

Six Sigma JOB- Associate Business Consultant

Job Description

Role : Associate Business Consultant (BPM) BSG

Job Responsibilities:

  • Responsible for identifying business problem areas and aligning themselves to the pain areas through GB/BB/Other Projects
  • Conduct specific reviews with Green belts / Champions / Sponsors on process improvement projects
  • Responsible for closure of projects, computation of financial benefits accruing from the projects
  • Conduct interactive workshops for employees on quality tools and generate process improvement ideas
  • Strengthen and enhance internal processes to make them more efficient and effective by identify process improvement/re-engineering opportunities.
  • Research to create value added / proactive proposals for prospective/existing customers.
  • Benchmarking performance of existing customers vis–vis competition.
  • Ability to identify opportunities, create solutions, present them as business cases to key stakeholders and execute the solution proposed.
  • Process mapping and identifying non value add steps to create lean and agile processes.
  • Identify Business opportunities through consulting.

Main Competency:

  • Strong Business acumen
  • Detailed knowledge of operations and end to end business in any domain.
  • Knowledge of Six sigma concepts of DMAIC and Lean (and all tools included therein) desired.
  • Highly assertive, strong orientation to statistical analysis, good team player & willingness to lead teams as well as working as individual contributor.
  • Mentoring & experience in creating, reviewing & closure of projects
  • Facilitating sessions, Presentation skills and meetings
  • Presenting data, sharing analysis and getting concurrence from stakeholders on actions (for assigned processes)
  • Willingness & quick to learn service line processes and operations
  • Drive operational excellence initiatives in areas like delivery, productivity, etc
  • Work with process teams to achieve process goals
  • Should have taken part in Continuous improvement initiatives (Kaizen) and other Quality related initiatives to spread the quality awareness

Skills Required

  • Influencing skills & consultative skills
  • Excellent communication & interpersonal skills
  • Knowledge of Six sigma concepts of DMAIC and (and all tools included therein)
  • Self-starter who can work independently, displays initiative and is a problem solver
  • Very good PowerPoint, Excel and Word
  • Project Management skills

Nice To Have Skills

  • Worked as Quality expert in operations, HR, Finance, IT, etc
  • Experience at a MNC / Service industry/ Technology
  • Usage of Minitab, MS Visio
  • Awareness in ISO, CMM, PCMM, COPC,TQM,COPQ, etc

Applicants Specifications & Qualification:

  • Shows flexibility/ownership & works under pressure situation
  • Demonstrate excellent communication skills
  • Ability to work within challenging environment with tight delivery timelines
  • Willingness to travel to any location on Business Requirements.
  • Keen to learn

Targeting : Telecom, BPO, Service industry

Salary: Not Disclosed by Recruiter
Industry: BPO / Call Centre / ITES
Functional Area: ITES, BPO, KPO, LPO, Customer Service, Operations
Role Category: Outside Consultant
Role: Outside Consultant
Keyskills: BPM, Six Sigma, Quality, DMAIC, Lean, Quality assurance, Business Excellence, Process Excellence.

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Measuring Up: Using Lead-time Metrics for Next-Generation Lean

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The points made in the first three articles in this seven-part series on Next Generation Lean include the following;

  • Lean’s current focus on reducing Cost-of-Goods-Sold waste needs to be expanded to cover all waste associated with Order Fulfillment.
  • Introducing an overriding strategy of lead-time reduction to Lean practice will change it from a methodology that produces isolated tactical impacts to one that delivers more comprehensive strategic transformation.
  • An industry-wide customer-focused metric for lead-time needs to be adopted to support strategic Lean practice.
  • Market specific—customer-based lead-time expectations and competitor Order Fulfillment proficiency—Build-to-Demand capability is a company’s Lean end game.
  • Such a lead-time metric could then be used to quantify a company’s current Lean status, as well as to define what it means for a specific company to be considered Lean.  The difference between their current Lean status and their Lean end game goal quantifies a Lean-ness gap, finally giving Lean practitioners a concrete way to say where a company is in its Lean journey.

This column will introduce a lead-time metric that has seen 20 years of successful application in industry and fits-to-a-T what is needed for Next Generation Lean.

Before getting into the details of the lead-time metric being proposed, it is important to lay out two significant aspects related to the above points. Namely, that with Lean’s focus now being on Order Fulfillment—with a target of market specific Build-to-Demand capability—distribution and sourcing lead-times are now important factors to a company’s overall Lean-ness! Specifically this means that a company’s Order Fulfillment lead-time now includes the time involved in ordering/receiving purchased product into their own factory, as well the time involved in moving it out through their distribution channel into customer hands. So, under Next Generation Lean, lead-times—and Lean-ness—are no longer based solely on a company’s own in-factory operations.

This inclusion of suppliers and distribution in Order Fulfillment lead-time is shown pictorially later in this article. Right below that picture is a timeline representation of the corresponding lead-time metric. Take a look at both the picture and timeline now, disregarding the colors and “MCT” term for now—which will be explained shortly. These visuals show that as far as Order Fulfillment lead-time is concerned, both suppliers and distribution can (and usually do) have an enormous negative impact on a company’s ability to service their customers. And isn’t servicing customers what the Lean big pictureis supposed to be all about?

You might dispute the above. I personally know a lot of people in the purchasing profession that would and do. They tend to ignore Total Cost and instead have a sole focus on chasing lower piece-prices. To support my position I’ll refer back to Toyota, whose practices formed the original basis for Lean. Toyota (and most Japanese automobile manufacturers, for that matter) has long employed what is called Keiretsu supplier management. One of the features of Keiretsu is that suppliers are required to locate local to the factories they supply. One of the reasons for imposing this condition is that it all but eliminates supplier resupply transportation times.

In Japan, Keiretsu means suppliers being located “down the block” within a mile or two of the factory they are supplying. In the U.S. —which has by far a larger geographic footprint—Keiretsu has been translated to having suppliers located within four hours of a consuming factory. Ten years ago I had the opportunity to participate in a supply management benchmarking exchange between my employer and a U.S.-based Japanese automobile manufacturer. During that session they revealed that 96% of their annual spend was with suppliers located within a hundred miles of their factory! There is a lesson here for Lean, I think.

Another lesson that can be taken from Toyota (and Japanese automobile manufacturers, in general) is relative to where they locate their assembly factories. The United States is the world’s largest consumer market for automobiles. To reduce product distribution times Toyota has located their plants that service the U.S. market to North America (Canada, the U.S. or Mexico). This takes approximately six weeks off of the time needed to deliver product to their dealers, compared to what would be needed if the cars were manufactured overseas. One of the important Order Fulfillment efficiency metrics used in the automotive industry is the Finished Product Days-On-Hand at Dealerships needed to support acceptable Customer Fill Rates. Historically, Toyota has been able to keep roughly one-half of such inventories as compared to U.S. automobile manufacturers. This represents a significant cost savings.

How do they do it? They’ve eliminated the six-week distribution disadvantage they would have if they manufactured in Japan and reduced almost all of their supply chain resupply transportation times down to less than one day. Compare this to what U.S. automobile manufacturers have done. By chasing the lower piece-prices (sometimes) available overseas they have imposed upon themselves a six-week resupply lead-time disadvantage. That leads to needing more pre-built/pre-positioned Finished Goods Inventory at Dealerships to support the needed Customer Fill Rates. Another way of looking at it is that OEMs with extended supply chains have about the same Order Fulfillment flexibility as if they assembled their product overseas and shipped it to the U.S afterwards.  I think there is a lesson for Lean here, too.

Even though you need to read between the lines to see Toyota’s overall Order Fulfillment focus, it is pretty clear that their manufacturing strategy (including supply chain and distribution) has always taken into account the total time that it takes to service their customers. The question that comes to mind—since Lean was based on Toyota manufacturing practices—is how standard Lean practice in the U.S. and elsewhere missed taking overall Order Fulfillment times into account. Next Generation Lean—and the metric to be proposed—do.

 

MCT as a Universal Metric for Order Fulfillment Lead-Time

Manufacturing Critical-path Time (MCT) is defined as: “The typical amount of calendar time from when a manufacturing order is created through the critical-path until the first, single end-item of that order is delivered to the customer.”

There is a lot of power in this definition, including:

  • It reflects “true” lead-times due to its critical-path focus, in which pre-built/pre-positioned inventories (raw, in-process, or finished product) are translated to lead-time elements.
  • It is based on what end-use customers care about when ordering product—calendar time, i.e., how long they’ll have to wait. I’ve never met a customer who cared a bit about factory takt times, or for that matter, even knew what the term meant. Not that takt time isn’t a useful tool but it certainly isn’t a metric that can is easily translated to customer satisfaction.
  • Associating delivery with a single end-item penalizes batches that are above and beyond current customer demand. The larger the batch size the larger lead-time penalty—batch sizes above current demand do not lower product cost, which is a concept that industrial engineers have been trying unsuccessfully for generations to get across to accountants.
  • Delivery to the customer means that manufacturing isn’t done until Order Fulfillment is complete. Again, this ties MCT directly to customers.
  • MCT can be applied to both micro- and macro-situations. MCTs are, in fact, additive such that once product flows and/or value streams are defined, they can be broken down into MCT values for each of the necessary individual operational segments. Yet, the individual operational MCTs can then be consolidated to quantify a “true” overall lead-time from raw material all of the way to customer satisfaction.
  • To use this metric, activities are prioritized based on their projected impact on reducing product MCT, period, end-of-discussion. Why? Because it consolidates the impact of individual Lean events such that they are no longer isolated. A reduced product MCT can be directly tied to improving currently accepted executive level metrics, which means project savings are both quantifiable and recognized

One question I get a lot is whether measuring “true” lead-time in days is discrete enough for an efficiency metric. In a word, I believe the answer is “yes.” My experience with MCT shows that most end-use products and/or value streams—depending on their complexity—have MCTs of months or (at best) weeks. This means that using days to quantify the metric provides sufficient precision. It also means that if you can’t reduce MCTs by days or weeks, you are either very Lean or aren’t really working on what you need to be. Finally, using days as the basis for MCT overcomes the urge to engage in analysis paralysis, something current Lean practitioners are often accused of.

 

Quantifying MCT

I’ll start out with a warning here: Do not use data from your MRP or any other scheduling system to quantify MCTs. This advice is based on experience with hundreds of MCT values where very few were found to accurately relate to scheduled times.

So how do you quantify the metric? Simply stated, an MCT map is a visual timeline of a job experience as it winds its way through its processing critical-path. Some academics show this in “white” wait-times and “grey” touch-times. I prefer defining and showing Value Added (processing) times as green; Non-Value Added but Necessary times as yellow (to differentiate true waste from necessary activities like set-ups); and Non-Value Added-Unnecessary (wait) times as Red. Why? For two reasons. First, the color scheme aligns with something everyone can identify with—traffic lights—and what they mean, i.e., green is good, yellow is not so good, and red is bad. So there is no confusion regarding what the color of a segment of MCT implies. Second, as a former executive I think I can safely say that the best way to effectively communicate with managers is through pictures. And if you really want to get your message across to them, color the pictures! So a black-and-white spreadsheet—or for that matter a white-and-grey visual timeline—does not adequately convey the information to the people you need to support your efforts as well as a colored one. Here’s an example of what both a processing flow and an MCT map look like.

As you can see and as previously pointed out, inventories are translated to MCT segments, i.e., they add to, rather than reduce, overall MCT. Also, as will be discussed extensively in the next article of this series, the “Components of Total MCT” visual looks a lot like a Value Stream Map, doesn’t it?

An MCT is created by having operators record the “start” and “stop” times of the operations needed to produce a product, including supply chain and distribution. Industrial engineers traditionally have worked on improving machine rate (Value Added) and reducing set-up (Non-Value Added but Necessary) times. When creating MCT maps of your products you’ll likely find that these two colors represent a very small proportion of its overall MCT. It is actually the times between operations (Non-Value Added-Unnecessary)—from the end of one operation to the beginning of the next—that will dominate the timeline on most MCT maps.

One question that often comes up is, “How can you base a metric on a single sample size?” i.e., tagging a single job. I agree this can be an issue if you don’t tag normal operations, for instance, if the MCT tagging was conducted on a “rush job.” Otherwise, I’ve found there is usually very little variation in tagging output between jobs, i.e., usually under 10%. I also believe that over time factories should routinely verify their product’s current MCT status through regular tagging—it really doesn’t take much effort once it’s set up.

A significant point needs to be made relative to MCT reduction. Namely, MCT reduction will impact the targeted executive level metrics regardless of the color of the MCT lead-time element that is reduced. Because of this the most impactful projects typically focus on reducing the red Non-Value Added-Unnecessary time segments since they offer the most potential for reduction! Yellow Non-Value Added but Necessary time segments typically offer the next highest potential for improvement. Related to this is the observation that green Value Added processing areas are usually already highly engineered, meaning that it will take new or revised production equipment and/or processes to reduce the time in that portion of an MCT. And in fact, since generations of industrial engineers have spent time focusing on the green, Value Addedprocessing is usually relatively efficient. As a sidenote, isn’t it interesting that the focus of much industrial engineering work over the last 100 years has been on the (much) smaller portion of what impacts those executive level financial metrics?

Another point to be made is that the red Non-Value Added-Unnecessary portion of a product’s MCT is synonymous with waste in Next Generation Lean. By focusing on the fed MCT segments, a Next Generation Lean practitioner is actually focusing on reducing waste—the basis of Lean practice. But it is the waste that has the highest potential for improving executive level metrics. I will tell you that in executive circles it has been my experience that top managers have become somewhat inured to the term waste—probably since Lean waste reduction has been difficult to tie to the operational metrics they get measured on. But I haven’t ever run into a manager and/or owner that wouldn’t aggressively support reducing Non-Value Added-Unnecessary times. I know, I know, theoretically they are the same, but from a practical point-of-view use of the Non-Value Added-Unnecessary term seems to be more effective in garnering executive level support.

Once you have collected the “start” and “stop” times from your tagging exercise you’ll use them to construct a MCT map like the one shown previously. The difference here is that in a normal industrial engineering time study the primary focus is on the processing time, but here the focus is on the time between when one step ends and the point where the next step starts, i.e., the low hanging fruit. In Next Generation Lean all reduced times—whether Value Added or Non-Value Added (Necessary or Unnecessary)—have equal impact on overall MCT so, in looking for high impact Lean activities, you should pursue the low hanging fruit which is usually the red Non-Value Added-Unnecessary MCT elements.

Online MCT mapping tools are available and they are good at both showing and quantifying available waste in a system. Additional Next Generation Lean tools will be discussed in a future article in this series. To get started, though, you don’t need an online tool—just red, yellow and green crayons. You’ll find that MCT maps are great for justifying Lean activities as well as tying the impact of those activities to the waste that is eliminated.

Six Sigma Master Black Belt JOB- Senior Outside Consultant

Job Description

As a transformation consultant you will drive Continuous Improvement Program across multiple Finance & Accounting processes

Primary responsibilities

  • Analyze utilization, efficiency & availability data for large teams.
  • Perform detailed process improvement studies as required across multiple F&A processes to identify opportunities for improved productivity.
  • Apply knowledge of Finance & Accounting processes specific to the Record to Report R2R P2P and O2CDomain.
  • Identify and lead high impact projects involving multiple stakeholders.
  • Drive Lean to identify waste in process.
  • Mentor Green Belt / Yellow Belt projects, possibly Black Belt projects depending on Six Sigma/Lean experience.
  • Drive culture of continuous improvement.

Other Responsibilities

  • Provide quality support to transitions – Development of metrics & dashboards in line with customer requirements, FMEA, review process documentation.
  • Support voice of customer & audit programs.
  • Participate in client visits.

Required Skills

  • Strong communication skills
  • Strong analytical skills – ability to work with large volume of data using statistical tools
  • Excellent knowledge of Six Sigma & Lean methodology
  • Good facilitation skills

Desirable Skills

  • Flexible approach to managing projects
  • Good team player
  • Good presentation skills.
  • Demonstrated success in Project Management
  • Exposure to different improvement frameworks, such as Six Sigma and Lean
  • Thorough knowledge of Microsoft office tools like PowerPoint, Project, and Excel are critical for the job

Salary: Not Disclosed by Recruiter
Industry: Banking / Financial Services / Broking
Functional Area: Strategy, Management Consulting, Corporate Planning
Role Category: Senior Outside Consultant
Role: Senior Outside Consultant
Keyskills:

Six Sigma Master Black Belt, Quality, Lean, Project Management, Green Belt, Finance, Accounting, R2R, P2P,o2c,transformation ,CIopex ,operation excellence.
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Six Sigma Master Black Belt JOB- Analytics Manager

Job Description

1. Assessment

Drive the projects end to end with effective stakeholder management
Managing the projects at the organization level or for the entire Geography as assigned
Responsible for all communication with business leadership and client to drive Change management on an organization level
Responsible for identifying business problem areas and aligning themselves to the pain areas through BB or MBB projects
Strengthen and enhance internal processes to make them more efficient and effective by identify process improvement/re-engineering opportunities.
Seek opportunity for Automation, Robotics and other technology solutions to bring scalability in the processes
Provide quality consulting service by applying lean, 6 sigma and other relevant quality methodologies with the objective to reduce cost/cycle time, improve productivity, increase revenue, improve product/service quality, and/or realign organizational practices with business strategies
Work in coordination with other departments to incubate new solutions and technology for existing and new businesses
2. Analysis and Feedback
Research to create value added /proactive proposals for prospective/existing customers.
Bench-marking performance of existing customers vis-a-vis competition
Conduct interactive workshops for employees on Six Sigma GB/BB and generate process improvement ideas
Presenting data, sharing analysis and getting concurrence from stakeholders on actions(for assigned processes
Meticulously driving the change management and should proactively own the deployment of new ideas and innovation
3. Reporting & Administration
Share progress on Six Sigma and other Continuous Improvement initiatives with leadership team
Participate in Governance reviews to review the update and action plan on various process and system improvements
Spread awareness around practices as Six Sigma, Lean, Automation etc. via workshops, sessions and other activities
Should be managing multiple projects and ensuring smooth governance around the same .

Salary: INR 5,00,000 – 12,00,000 P.A. Best in the industry
Industry: BPO / Call Centre / ITES
Functional Area: Analytics & Business Intelligence
Role Category: Analytics Manager
Role: Analytics Manager
Keyskills:

Job Description

1. Assessment

Drive the projects end to end with effective stakeholder management
Managing the projects at the organization level or for the entire Geography as assigned
Responsible for all communication with business leadership and client to drive Change management on an organization level
Responsible for identifying business problem areas and aligning themselves to the pain areas through BB or MBB projects
Strengthen and enhance internal processes to make them more efficient and effective by identify process improvement/re-engineering opportunities.
Seek opportunity for Automation, Robotics and other technology solutions to bring scalability in the processes
Provide quality consulting service by applying lean, 6 sigma and other relevant quality methodologies with the objective to reduce cost/cycle time, improve productivity, increase revenue, improve product/service quality, and/or realign organizational practices with business strategies
Work in coordination with other departments to incubate new solutions and technology for existing and new businesses
2. Analysis and Feedback
Research to create value added /proactive proposals for prospective/existing customers.
Bench-marking performance of existing customers vis-a-vis competition
Conduct interactive workshops for employees on Six Sigma GB/BB and generate process improvement ideas
Presenting data, sharing analysis and getting concurrence from stakeholders on actions(for assigned processes
Meticulously driving the change management and should proactively own the deployment of new ideas and innovation
3. Reporting & Administration
Share progress on Six Sigma and other Continuous Improvement initiatives with leadership team
Participate in Governance reviews to review the update and action plan on various process and system improvements
Spread awareness around practices as Six Sigma, Lean, Automation etc. via workshops, sessions and other activities
Should be managing multiple projects and ensuring smooth governance around the same .

Salary: INR 5,00,000 – 12,00,000 P.A. Best in the industry
Industry: BPO / Call Centre / ITES
Functional Area: Analytics & Business Intelligence
Role Category: Analytics Manager
Role: Analytics Manager

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Outpatient Care: Delivery of Quality Care Struggles

The United States has spent more than a decade trying to improve the quality of outpatient healthcare delivery. The industry has tried various initiatives to address the quality of care and the inherent value of services to patients, without significant improvement. They have addressed the issues of unnecessary procedures and implemented alternative payments models to encourage and reward efficient care. Until now, the results have rarely been measured properly.

Evaluating Outpatient Care

A recent study published by JAMA Internal Medicine looked at results comparing 2002 and 2013. The authors of the study assessed the change in nine composites of clinical quality. The study revealed improvement was only modestly achieved in four of those nine areas, where quality remained steady or worsened. The study showed that if current deficits in outpatient care should continue, they would present a serious hazard to the health of the American public. Further, the study showed that patients rated their experiences higher. It suggested that these perceptions are created by the response of healthcare providers responding to incentives to improve the patient option. Healthcare providers have responded to the incentives to improve patient perceptions, but missed the opportunities to improve the care provided.

Creating Environments of Change

Changing what is really important is crucial to the delivery of quality healthcare, both outpatient and inpatient. Continued incentivizing the ‘patient perception’ will continue to take us down a rocky road. Healthcare organizations must find a balance between ‘patient perceptions’ and actual ‘quality of care’ delivered to patients. Patients will continue to make decisions based on what is reported to them. Incentives and financial compensation needs to be more sharply focused on providing the highest quality of care possible. Let’s take down the plaques and posters touting how polite we are, and start boasting about how well we care for you!

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