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.

The 5 Deadly Sources of Waste in Services

Counting defective parts may be an easy way to measure waste in the manufacturing industry. But when it comes to services, the continuous improvement practitioner often encounters two challenges. Firstly, it is hard to define waste in certain processes. For example, what is waste in the eyes of an anxious fan waiting for the show to begin? What is waste in the eyes of a patient waiting to see a doctor? Secondly, once waste has been identified, what is the metric that truly portraits such a waste? Let's consider the following 5 deadly sources of waste commonly found in the services industry but not often dealt with properly. Are these sources of waste leading your organization to customer dissatisfaction, product returns, and loss of brand reputation?

1. Waiting: on the phone, in line, for the product to arrive, for the supervisor to approve, for the flight to board. In today's fast pace environment, waiting not only causes financial loss to both customers and organizations but also creates anxiety, frustration, and stress upon your stakeholders.

2. Searching: for the right file, for that piece of information, for the parking lot, for the expired contract. Searching, in most cases, can be a product of lack of training and/or lack of workplace organization. Searching files and spending hours on the phone with the customer may be the result of a poorly managed and disorganized work environment (hint: 5S program).

3. Bad Customer Service: have you ever considered the number of customers that you may have lost due to the fact that your front line employees are just grumpy? Has your organization reimbursed customers because your office personnel did not communicate effectively with the employee assigned for the job?

4. Redundancy: reworking the same Excel spreadsheet over and over again, contacting the customer multiple times to discuss the same problem and offer the same solution, collecting 7 approvals for a low budgeted item. We all cost extra money (to the organization and ourselves) when the work has to be done twice (or three, four times).

5. Meetings: How many are really necessary? How many truly produces an outcome that is value-added to the organization? How much money is your organization spending on GoToMeetings, Webex, and muffins? Lean organizations should start to let go of the rituals set 25 years ago.

These sources of waste can add up quickly to your processes and may be hindering employee morale, service quality, and brand reputation. Whilst it's easier to identify and measure tangible wastes, it is important that Lean organizations be aware of potential sources of hidden wastes. 

eZsigma Group is Canada's leader in Lean Six Sigma. We offer a vast array of services that will help your organization to achieve a new level of excellence. Please contact us for further information about our programs.

The RASCI Matrix and DMAIC

A well developed Six Sigma program has always called for a properly defined project charter. The project charter itself is a great tool that addresses many different aspects of an improvement initiative such as the executive sponsor(s), related metrics, milestones, team members, and so on. But many project charters lack what tend to be an important piece of the puzzle: the rightful assignment of roles and responsibilities of each person involved with the project. Similarly, a well developed Six Sigma planning stage asks for a detailed DMAIC breakdown (Define, Measure, Analyze, Improve, and Control), which nicely sets the tone for the entire project approach.

The RASCI matrix (Responsible, Accountable, Supportive, Consulted, Informed) serves the continuous improvement practitioner as a cross-reference tool that links the roles and responsibilities of involved personnel with the DMAIC steps. One can even utilize a previously developed WBS (Work Breakdown Structure) to list the specific activities in each stage of the DMAIC approach.

The figure below depicts an example of a RASCI matrix.

Once the project's and project manager's names are entered at the top of the matrix, the CI practitioner lists all individual activities (that again, may come from a WBS previously developed) within each of the DMAIC stages. To the right of the matrix, each person's name as well as his/her role in the project are entered (note: this is not necessarily the person's position or title, but his/her role within the project). 

For each activity listed under the DMAIC stages, the facilitator should enter the words Responsible, Accountable, Supportive, Consulted, or Informed, according to each of the roles taken.

The tool itself, of course, is just a tool if not used properly or if not followed up on. The Six Sigma practitioner should always refer back to the RASCI matrix when in doubt about each team member's accountability. The team itself should always consult the RASCI matrix to speed up the decision making process, and along the same lines the team should always be aware of those who need to be consulted and/or informed of critical tasks.

eZsigma Group has extensive expertise in DMAIC deployment and we would welcome our readers to discuss what fits best in your organization's journey with process excellence. Call today to set up a meeting with our team of professionals.

Supplier Performance Management

In process excellence, specifically in a Lean approach, we often speak about closing the loop between the customer's order (which in a pull system triggers production) and the management of supplies that are to serve that specific process. Indeed, it is the customer (or the Voice of the Customer - VOC) that sets the parade in motion, and it is the customer whom of course, pays for value-added activities that he/she is willing to pay - that is the notion of value in a Lean environment as we all know.

But what about the upstream side of things? Is it important that suppliers be well managed in any given process? And what is actually considered "value" from a supplier's perspective? How do we go about measuring supplier performance? This post discusses a few mechanisms that will help the continuous improvement (CI) professional when dealing with supplier's performance management.

Usual assessment tools include, but are not limited to:

Questionnaires: two types are commonly used. The first one is specifically related to the supplier's quality management system. Does the supplier operate under a Lean environment? Does the supplier offer a raw material (be it a tangible product or a piece of information) that truly is highly valuable to your specific flow? What about delivery? Is it under a Just in Time (JIT) process? If not, can it be? The second survey is directed to your organization's overall level of satisfaction with the supplier. Does the supplier work seamlessly with your department? What about issues? Does the supplier offer timely and knowledgeable solutions to the day-to-day problems that may affect your Value Stream Map?

Product Data: your organization may want to ask the supplier to provide specific data about the product per se, statistics on defects (and more importantly, why they occur), root cause analysis, significant changes in the process and so on. Think again about your VSM and how changes in the supplier's processes can affect your own processes.

Delivery Performance: suppliers' information on early or late delivery. Especially in a JIT environment, delivery times can greatly affect the flow of your process. Think about Dell and Toyota. These organizations rely heavily on a smooth delivery practice from hundreds of suppliers scattered across various locations.

Corrective Actions: does your supplier, in most cases, act proactively towards issues or are they always treating the fever and not the cause of the fever? How can you track the resolution of issues, and moreover, how can you help the supplier with the resolution of issues that ultimately affect your processes? Does the supplier use data-based methodologies to tackle internal issues?

Product Price and Total Cost: does the supplier use quality management concepts and/or design evaluation tools to always seek a lower cost of production? How is the progress of such practices tracked? How is it reported back to your organization? Cost of Quality is a concept that can help suppliers (and all of us really) to consistently aim for improvements in quality without compromising price.

Supplier performance management should be done once your own processes have been a) controlled, and b) improved. However, one can argue that working on both ends is also wise, if at all doable. Supplier performance management is a topic that has been ignored by many industries, and unfortunately the mentality of "less cost at all costs" is still present. As the aforementioned suggests, supplier performance management is  a long term commitment, and it can help both the supplier and the organization to achieve higher levels of efficiency in any given process.

We are a process excellence firm which strives to look at all aspects of the analysis we conduct. Supplier performance management is just another expertise that we can offer to your organization in its pursuit of a successful continuous improvement approach.