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INTRODUCTION TO PROCESS IMPROVEMENT AND LEAN SIX SIGMA WHITE BELT TRAINING JANELLE SEENATH UPDATED 2/6/18 1

INTRODUCTION TO PROCESS IMPROVEMENT AND LEAN SIX … 04 24... · 3. What is Lean and Why Lean 4. What is a Lean Project 5. Who is doing Lean 6. Common lean terms: muda, gemba, kaizen,

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Page 1: INTRODUCTION TO PROCESS IMPROVEMENT AND LEAN SIX … 04 24... · 3. What is Lean and Why Lean 4. What is a Lean Project 5. Who is doing Lean 6. Common lean terms: muda, gemba, kaizen,

INTRODUCTION TO

PROCESS IMPROVEMENT AND LEAN SIX SIGMA

WHITE BELT TRAININGJANELLE SEENATH

UPDATED 2/6/18

1

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OBJECTIVES

1. What is Process Improvement

2. Understand Common Improvement Methodologies

3. What is Lean and Why Lean

4. What is a Lean Project

5. Who is doing Lean

6. Common lean terms: muda, gemba, kaizen, yokoten

7. 8 Basic Improvement Tools

8. Understand the roles and responsibilities of the

members on a project team

9. Know how to select a project and identify your project

stakeholders

10.Understand the importance of teaming

2

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12 BREAKTHROUGH PRIORITIES

Increase Access to Health Care

Veteran facing VA internal facing

Implement Care in the Community

Deliver a Unified Veterans Experience

Improve the Comp & Pension exam

Improve the Veteran Experience

Modernize our Contact Centers (to include Veterans Crisis Line)

Develop a simplified Appeals process

Continue to reduce Veteran

homelessness

Staff critical positions

Transform OIT

Improve Employee Experience(to include leadership development)

Transform Supply Chain

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10

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5

3

6

7

8

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WHAT IS PROCESS IMPROVEMENT (PI)?

Definition:

It is the proactive task of identifying, analyzing

and improving upon existing processes within

an organization for elimination of causes of

poor quality, process variation, and non-value-

adding activities for optimization and to meet

new metrics or standards of quality.

4

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TYPES OF PROCESS IMPROVEMENT

Process Improvement Projects Come in Different Sizes:

• Process Reengineering involves wiping out the current

process and creating a brand new one from the ground up.

• Process Redesign projects are a little smaller in scope and

involve maintaining the basic framework of the process while

improving significant components. Sometimes, there is a fine

line between process redesign and reengineering projects.

Stellar results are possible in a process redesign project. This

basic methodology, with a few modifications, can be used to

improve processes of various sizes and scopes, from the

largest reengineering project to a small quick-hit fix.

5

Page 6: INTRODUCTION TO PROCESS IMPROVEMENT AND LEAN SIX … 04 24... · 3. What is Lean and Why Lean 4. What is a Lean Project 5. Who is doing Lean 6. Common lean terms: muda, gemba, kaizen,

• Healthcare/System Redesign involves

making systematic changes to practices

and health systems to improve the quality,

efficiency, and effectiveness of patient care

• Goal: To improve healthcare quality,

reliability and access to care for Veterans

SYSTEM REDESIGN

6

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WHAT IS LEAN?What is Lean?

• Continued focus on providing customer value

• Drive continuous incremental improvement

• Provide the customer exactly what’s needed at the right time

• Daily focus to eliminate all forms of waste

• Long term vision out weighs short term gain

• Speeding up the operation by eliminating idle time created by paperwork and bureaucracy

• A way of thinking

“LEAN provides a way to specify value, line up value creating actions in the best sequence, conduct these activities without interruption whenever someone requests them, and perform them more and more effectively.”

by James Womack and Daniel Jones (1996)

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Changing the Way We Do Business

8

Why LEAN?

• There is an urgent need for business, process and cultural transformation. System

redesign and it’s LEAN components have been chosen to achieve this goal.

LEAN has proven to:

• Effectively reduce organizational costs

• Increase process efficiency

• Improve customer value

Lean is:

• Committing to not accepting defects, not creating defects, & not passing defects on

• Never forgetting why we are here

• Committing to making a positive difference!

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CUSTOMER’S PERSPECTIVEEvery step in the process should be perceived as adding value (no waste): “It does what I require and expect it to do, when and where I want it done.”

The perfect process: • Creates value for the patient • Produces a good result every time• Does not cause delay• Is flexible• Is linked by continuous flow• Is satisfying

• for staff to perform• for managers to manage• for patients to experience

9

The “lean” perspective is the

customer’s perspective.

Your project reflects your

understanding of the customer,

their circumstances, and their

perception of value.

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LEAN PERSPECTIVE ABOUT PROCESSES

10

LEAN is a methodology that shortens the time between start and finish of

any given process by eliminating unnecessary and non-value adding

sources of waste.

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11

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HOW LEAN IS DONE?

Through:• Team work

• Critical thinking

• Transparency

• Courage

• Committing to having a roadmap for each project and using it

• Continuous learning

• Committing to not accepting defects, not creating defects &

passing defects on to other steps in the process

• Committing to making a positive difference!

12

We can’t solve problems by using the same kind of

thinking we used when we created them. - Albert Einstein

Can you solve:

https://www.youtube.com/watch?v=vKA4w2O61Xo

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WHAT IS A LEAN PROJECTA Lean project is any effort that embraces Lean thinking and adheres to a methodology. There are six core VISN2 South Lean methodologies:

1. A3 Problem-Solving (9 steps or boxes) for process improvements where barriers or muda are evident.

2. 5S / 6S for disorganized work spaces (sort, set in order, safety, shine/simplify, standardized, and sustain.

3. Lean (pull systems, flow, 5S / 6S, value stream mapping) for cycle time and wait time issues

4. The scientific method for improving processes when causes of problems are simply not known.

5. Six Sigma DMAIC which mirrors the scientific method, and used where unacceptable variation or defects exist, or root causes of problems or issues are unknown or not well understood. Teams proceed through Define, Measure, Analyze, Improve, and Control phases.

6. Project Management for implementing and managing projects and changes.

7. Others

13

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METHODOLOGY CROSS WALK

VA-TAMMCS

VISION

ANALYSIS

TEAM

AIM

MAP

MEASURE

CHANGE

SUSTAIN

SIX SIGMA

DMAIC

DEFINE

MEASURE

ANALYZE

IMPROVE

CONTROL

PDSA

PLAN

DO

STUDY

ACT

PROJECT

MANAGEMENT

INITIATE

PLAN

EXECUTE

MONITOR &

CONTROL

CLOSE

A3 9BOX

1. REASON FOR ACTION

2. INITIAL STATE

3. TARGET STATE

4. GAP ANALYSIS

5. SOLUTION APPROACH

6. RAPID EXPERIMENTS

7.IMPLEMENTATION/

COMPLETION PLANS

8. CONFIRMED STATE

9. INSIGHTS 14

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Define Measure Analyze Improve Control

DMAIC

• Brainstorming

• VOC/Interviews

• Stakeholder

Analysis

• Pareto Analysis

• Cause and Effect

• Process

Documentation

• Process Map

• SIPOC

• FMEA/FMECA

• POA&M

• Define Project

statement

• VOC/Interviews

• Specifications

• Requirements

• Process/Product

Data Collection

• Process Maps

• Control Chart

• MSA

• FMEA/FMECA

• Defect and

Defective

Product/Process

• First past Yield

(FPY)

• Descriptive

Statistics

• Descriptive

Analysis

• SIPOC

• RASCI

• Pareto Chart

• Cause & Effect

Diagram

• Affinity Diagram

• Process Map

• FMEA/FMECA

• Capability

Analysis

• Process/Product

Analysis

• 5 Whys

• Process Map

• Brainstorming

• FMEA/FMECA

update

• PDSA

• Pareto Analysis

• Solution

selection matrix

• MSA

• Process

Capability

Analysis

• Implementation

Plan

• Final Process Map

• Final

FMEA/FMECA

• Implementation

Plan

• Control Plan

• SIPOC

• RASCI

• SPC Plan

• Audit Plan

• Training/transition

plan

• Project Notebook

Well Defined

Project Scope

& Metric

PDSA

of Improved

Process

List of Proposed

Improvements

to Process

Measure of

Process/Product

Effectiveness

More

Effective

Process

15

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PLAN, DO, STUDY, ACT (PDSA)

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A3 9BOX METHODOLOGY

What is the A3 problem-solving process?

What are the 9 steps?

18

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CORE IDEAS OF LEANPull vs. Push: Let the patient pull the product or service

No delay versus delay (eliminate delays)

Parallel versus sequential process flow (do more things in parallel)

No action versus action (eliminate unnecessary processing)

No movement versus movement (eliminate unnecessary movement)

Determine value using the VOC (what does the veteran want?)

Use the “pull” system to avoid overproduction (batching of lab tests)

One-piece flow make the process flow with out interruptions or wasted time

Level out the workload to the rate of customer demand

Stop and fix problems immediately when they appear

Standardize processes to support improvement

Use visual control so no problem remain hidden

Only use reliable technology that supports the people and the process

From Lean Six Sigma for Hospitals by. J Arthur

19

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WHO IS DOING LEAN

20Mayo Clinic CEO John Noseworthy:

https://www.youtube.com/watch?v=nO_7HyQ1X2k

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WHAT IS “LEAN” THINKING?

• The Toyota Production System (TPS)

• The Toyota Way – Jeffrey Liker

Outlines 14 principles of the Toyota Way; i.e., “LEAN Thinking”

• Philosophy

• Process

• People and Partners

• Problem Solving

21

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PHILOSOPHY

Base your management decisions on a long-term

philosophy, even at the expense of short term goals.

Most difficult is

most important

Leaders must take responsibility

Start with goal of generating value for customers, society, and the economy – NOT

an endpoint

23

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PROCESS

Bring problems to the surface.

Use “pull” systems to avoid overproduction.

Level the workload (tortoise)

Culture of stopping to fix problems. Quality right 1st time.

Foundation of Standardized Tasks.

Visual controls, no hidden problems.

Use only reliable, tested technology.

24

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PEOPLE AND PARTNERS

Grow leaders who thoroughly understand the work, live the philosophy, and teach it to others.

Develop exceptional people and teams who follow company philosophy.

Respect your extended network of partners and suppliers by challenging them and helping them

improve.

25

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PROBLEM SOLVING

Go and see for yourself to thoroughly understand the

situation - GEMBA

Make decisions slowly by consensus, thoroughly considering all options; implement decisions

rapidly.

Become a learning organization through

relentless reflection and continuous improvement.

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Kaizen – “continuous improvement”. Many use the term Kaizen to

mean short duration improvement projects, 1 to 2 days.

Sometimes, these are called, “kaizen events”. We in the VA tend to

use the term to mean Rapid Process Improvement Workshops

(RPIW) that may take from 3 to 5 days.

Gemba – “the scene”. We use the term Gemba to mean the area

under study; or the place where the process lives and where the

action takes place! “Gemba walk” or “walking the Gemba” refers to

walking around and observing a process for the purpose of

understanding, and documenting the current “as is” process.

Muda – an activity that is wasteful and doesn’t add value as defined

from the customer’s point of view

Yokoten - is copying and improving on proven solutions.

COMMON LEAN TERMS

27

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LEAN = Eliminating the Muda or waste; i.e. unnecessary

burden of non-value added work, tasks, things

Typically 95% of Health Care Process Time is non-value added!!!

Eight Forms of Waste

1. Defects

2. Overproduction/Overprocessing

3. Waiting

4. Not Utilizing People/Resources

5. Transport

6. Inventory

7. Motion

8. Extra Processing

Non-value added

Value added

WHAT IS WASTE?

28

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DEADLY WASTES: DOWNTIME

DefectsErrors or mistakes causing rework to correct

the problem

Wrong-site surgeries

Medication errors

Label on the wrong tube

Patient complaints/decreased satisfaction scores

Over-

Production/

Processing

Creating too much material or information

To many approval steps in the process

Batching, delivering set number of items at one

time

Pre-printing documents

WaitingWaiting for material or information, or material

or information waiting to be processed

Patients waiting to make appointments

Patients waiting to be seen for an appointment

Waiting for labs, ancillary tests

Not utilizing

People/

Resources

Not utilizing or underutilizing the talent (scope)

of employees or use of resources, staff not

involved in improvement projects

Top down improvement approach

No Voice of the Customer

Transport Moving material, information, patients

Moving patients from room to room

Charts not centrally located

Poor layouts, lab located a long distance from

the ED

InventoryHaving more material or information than you

need

Overstocked medications on units/floors

Overflowing supply bins, racks, shelves,

excessive stock

Motion Staff motion to get material or information

Excessive bending, reaching, walking to

get supplies

Heavy items on top shelf, light items on bottom

Extra-

Processing

Processing more than necessary to achieve

the desired output

Multiple copies (paper and electronic)

Multiple steps for approval, multiple signatures

Multiple blood specimen collections 29

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8 BASIC PROCESS IMPROVEMENT TOOLSVoice Of the Customer Table capture the

customer needs and helps translate it into actionable measureable

performance steps

Control Charts to measure and monitor the

performance of any process.

Pareto Charts identify the most frequent types of

defects, mistakes and errors.

5 Why’s or Ishikawa (fishbone) diagrams identify

the potential root causes of the problem.

Check sheets to quantify & understand the magnitude

or frequency of the problem

Flow Charts identify current process steps

Run Charts shows data process over time

Box Plots display differences between populations without

making any assumptions

30

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31

Control chart

Pareto chart

Page 32: INTRODUCTION TO PROCESS IMPROVEMENT AND LEAN SIX … 04 24... · 3. What is Lean and Why Lean 4. What is a Lean Project 5. Who is doing Lean 6. Common lean terms: muda, gemba, kaizen,

Check Sheet

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ROLES AND RESPONSIBILITIES

33

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ROLES & RESPONSIBILITIESTeam:

Share the workload and support the team lead in the

successful execution of the project. Should possess

the following skills and abilities, data gathering, data

analysis, focus, commitment to the project and team,

ability to use MS word, MS. Excel, MS. PowerPoint.

Project Leader:The individual who is responsible for keeping the

project team on task and on schedule towards

achieving the project teams goal. Key: Courageous,

leader, follower, focused on results, & timely

completion.

LEAN Coach/Facilitator:Not the project leader, but advisor and coach

regarding appropriate methodology, tools, and

application, investigator, team builder, communicator,

problem solver. Must demonstrate competencies,

learning, & growth. Must facilitate curriculums. Key:

knowledge transfer

Financial Rep:Validator of cost and revenue calculations, evaluator of

benefit categories and translation into financial/budget

terms as avoided costs and actual project savings and

new revenues.

Process Owner/Champion:Co-owner of projects, roadblock remover, strategist,

communicator, alliance builder, reality checker,

identifies/assists in getting resources, identifies and

ensures alignment of projects to strategic objectives;

focuses on meaningful, measureable, scalable,

sustainable results. Responsible for progress. Key:

Authority & availability.

Project Sponsor: Provide guidance relative to the selection and

application of the project benefits, effort and risk

evaluation criteria. Recommend project candidates.

Approve and fund the project.

Supervisor:Assess the resourcing (funding, man-hours, facilities,

equipment) that will be required to execute the project.

Concur in the approval of the project.

VISN Network Office Coach:Consultant, technical advisor, mentor, strategist

focused on facility and team support, high reliability,

sustainability, and transformation; continuous learner,

change agent, curriculum design, improvement

practices, and standards. Coach the coaches and

sometimes teams and team leads.

34

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35

PROJECT SELECTION PROCESS (SCOPE)

Initial Project:

• Local-level project (i.e., usually within individual’s office/team).

• Must have an impact on the operation of a specific unit

(process/team/office/department) of the organization, in terms of one or more

of the following areas: Quality, Cost, Schedule and/or Risk

• The scope of the project should be narrow as it affects a single process or unit

of the organization

Advance Project:

• Strategic-level project (i.e., cross-departmental, leverage-able/replicable,

multi-command or cross-agency type).

• Must have an impact on the operation of more than one organizational unit

(multiple teams/offices/departments) in terms of one or more of the following

areas: Quality, Cost, Schedule and/or Risk

35

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36

BENEFITS – EFFORT/RISK EVALUATION

MATRIX EXAMPLE

Potential Projects

(Priority (9) x Criteria Score (9) = 81)

Pri

ori

ty

(we

igh

t)

Reduce LOS

Inventory

Process

Maintenance

Process

Be

ne

fits

Support Organization Strategy 9 81 27 9

Attract New Business 3 3 3 9

Reduce Operating Cost 9 81 27 81

Improve Ease of Use 3 27 3 3

Total Benefits Ranking 192 60 102

Eff

ort

/R

isk Project Cost 3 9 9

Project Resources 0 3 9

Internal Resistance 1 9 9

Total Effort/Risk Ranking 4 21 27

36

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STAKEHOLDER ANALYSIS

What is a Stakeholder Analysis?

• A disciplined project risk management method for identifying the

stakeholders, assessing potential stakeholder impact and planning for

stakeholder involvement

Why perform a Stakeholder Analysis?

• To assure that all of the stakeholders are identified

• To identify the stakeholders’ interest in and expectations of the project

• To assess the stakeholders’ attitude toward the project

• To plan for the stakeholders’ involvement in the project

• To plan for the communication of the core project team with the

stakeholders

37

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STAKEHOLDER ANALYSISWho are your Stakeholders?

• Any individual who can have an effect on a improvement project or

will be affected by the improvement project team recommendation

• All of the stakeholders are to be included as a project team member

(either full time or ad-hoc)

When to perform a Stakeholder Analysis?

• Early in the initial phase of the project

Who performs a Stakeholder Analysis?

• The core project team members perform the analysis and

coordinate the results with the project sponsor, process owner and

coach/mentor

38

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STAKEHOLDER ANALYSIS WORKSHEET

39

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SUCCESSFUL TEAM INGREDIENTS

• Clearly defined goals

• Clearly defined roles

• Interpersonal and Team Skills

• Cooperative

• Balanced Participation

• Ground Rules

• Team Tools

• Face-to-Face Interaction

• Trust

• Communication

40

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TEAM DEVELOPMENT MODEL

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• Expert knowledge & Experience

• Improvement Advisors, lead teams and advise coaches, facilitate trainingsBlack

• Knowledge & experience in advanced tools & leading projects

• May lead projects and coach and facilitate for improvement teams

Green

• Knowledge of basic tools & some experience applying them

• Active participant on improvement teams

Yellow Belt

• Basic understanding of Lean Principles, define value, Identify Waste

• All Staff

White Belt

4 Levels of Lean Mastery

See your lean coach

about training &

certification opportunities

You are here

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REVIEW

1) What is Process Improvement?

2) What is Lean?

3) What are the Lean methodologies?

4) What are the common lean terms?

5) What are the 8 basic process improvement tools?

6) What are 8 forms of waste?

7) Why is project selection important?

8) Why is stakeholder analysis important?

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QUESTIONS

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Janelle Seenath, System Redesign Coordinator/Supervisor x4755

[email protected]

Barbara Carralero, System Redesign Health System Specialist X3087

[email protected]

LOCAL PROCESS IMPROVEMENT EXPERTS

AND GOOD PEOPLE TO KNOW…

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Project Title:

Project Start Date:

Project Origin/Alignment breakthrough priorities:

Process Owner:

Team Lead:

Team Coach:

Project Champion:

Team Members:

Key Metric or Deliverable:

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Aim - 1. Reason For Improvement

Problem Statement:

Scope:

Trigger:

▪ Process Start –

▪ Process Stop –

Limitations:

Box 1 – Reason for Action

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Map - 2. Current State

List of Current State Attributes:

Box 2 – Current State

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Baseline Data

Metric Current (Dates)

Box 2 – Current State

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Map - 3. Target State Box 3 – Target State

List of Target State Attributes:

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Measure - 4. Gap Analysis

Note: Show the gap between the Current State versus Target State, for example:

• Waste difference (i.e. comparison of Value-Added, Non Value-Added But Necessary, and Non Value-Added and Unnecessary process steps)

• Metrics comparison

• Process step comparison (i.e. difference in the total number of process steps)

• Gap Analysis Tools Used (i.e. 5 Whys, Fishbone Diagram, etc…)

• Identified Problems and corresponding Root Cause(s)

Box 4 – Gap Analysis

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Measure - 5. Solution Approach

If we do this… …then we will achieve this….

Box 5 – Solution Approach

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Change - 6. Rapid Experiments

Plan Do Study Act

Box 6 – Rapid Experiments

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Change - 7. Completion Plan

What Who When Status

Box 7 – Completion Plan

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Sustain - 8. Confirmed State

Metric Baseline Goal ActualCountermeasures [Please describe control/sustain tools, like dashboards, control charts, visual controls, etc.]

Baseline or below

Above Baseline, trending to goal

Goal or better

Box 8 – Confirmed State

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Sustain - 9. Insights

What went well?

What did not go well?

Lessons Learned

Box 9 – Insights