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Continuous improvement projects in Supply

Chain HealthCare: The power of documented

process flows

Continuous improvement How difficult can it be, streamlining

logistics flows and satisfying the customer!

Well, it’s not difficult as long as we follow

some basic rules. We’ll come to them one

by one as we go through this white paper.

It starts with making good agreements with

your customer in terms of input and

responsibilities and outcome according the

made agreements. Quality Assurance Plan

(QAP) What do we expect of a QAP?

• It to be a process oriented document that

identifies the process and that describes

how the process is under control

• It has a focus on ‘zero defect’ strategy

and on defect prevention

• It strives for minimum process variability

and maximum process capability

As already stated in the introduction not all

suppliers have their Quality process under

control.

By introducing QAP and making a detailed

description and analyses of the different

process steps and combine this with the

available knowledge the expectations are

high.

A basic question: What do we mean by a

process?

Well it is the way to come to the final

product required by the customer. So it

starts when parts are entering the process

(goods reception – incoming inspection)

till packing the final goods as requested.

(Packaging/ stacking instruction - labeling

included) You are thinking, yeah, but

that’s the content of the Quality manual as

described according ISO. That’s partly

true, but with the difference it has a focus

on continuous Quality improvement in a

production/ logistic environment, that it

contains technical knowledge/ core

competences and that it gives an

immediate overview of problem areas.

This you’ll not find in any Quality

procedure.

The input of course must be the technical

and functional requirements specification/

Service Level Agreement (SLA).

Depending on the above-mentioned

requirements the process is adapted

towards these needs and towards the

Article by

Geert Appeltans

Abstract

If you want to make a statement these days just talk about

continuous improvement. Indeed, about these powerful words a

lot can be said. Everyone agrees to work on continuous

improvement, but how to start if there is no basis or reference to

refer too. Every process, despite its complexity, should be

documented in a process flow chart as an overview, as a SIPOC

and including supportive tools – those need to be described in

detail. As outcome of measurements (Pareto), KPI can be used as

an instrument towards management involvement and eventually

towards continuous improvement.

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agreed Quality level (price!). Therefore it

is utmost important to have a mutual

understanding of what is expected.

What is the purpose of a QAP?

• To increase customer satisfaction

• To have a cohesive system of knowledge

that enables the supplier to strive to zero

defects

• To have specific process targets and

tolerances that are used in and are in line

with the customer requirements

• To be used as a tool to continuous

improve when monitoring the product and

process performance indicators (PIs)

• To be a dynamic document that can be

adapted towards customer needs or

requirements

• To be used during the PPM management

discussions with customers

• To be used to increase management

involvement, in terms of necessary

investment to improve Quality

The added value of a QAP is not only for

the customer satisfaction (because it was

asked) but also for DHL to understand how

the process is under control, including

detailed technical knowledge (read: our

core competences), targets and to create

transparency towards management.

The supplier is questioning why things are

done the way they are. A QAP must

stimulate to talk about quality and

continuous improvement, to ask process-

product related questions to create quality

awareness. It must help to keep focused

and it must serve as a reminder to do and

keep on doing in the process what is

agreed upon with the customer.

In the next chapter we’ll extensively look

to the content, the implementation and the

possible aids. To come to a QAP, we’ll go

through different steps and explain what

we mean in detail.

What is the content of a QAP?

• It is a detailed process flow description

that describes the process steps, each step

includes:

o A detailed process description

o Process step inputs and outputs (SIPOC

diagram)

o Enablers and used tools

o Used documents; instructions and forms

o Measuring tools and follow up

(Performance Indicators - PI)

o Indication of a customer frozen process

(Critical Frozen Process - CFP)

o Inline process verifications (IPV)

• It’s a description done as a process flow

step charting and contains linkage

activities, looking for process and product

relationships (6M)

• It must contain following references:

o A process reference

o A version number

o An initiation date/ validation date

o Internal process document references

• Document trace ability must be in place,

so a QAP can be linked to several DHL

processes

• It must contain measuring tools that

provides an overview (PARETO chart) of

problem areas

Examples of a process flow: Which is

more efficient?

This?

Or this?

Or this?

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No matter, how your process is build up,

the QAP vision is the same. The content

can be scheduled differently, but has

always the same goal. See the basic

question on page 1. To give you an idea of

what must be the content, we’ll start with a

process flow example and gradually

discuss – explain –‘the way we do things’.

Example (DHL supply chain WHS OPG):

What is SIPOC?

A SIPOC diagram is a tool used to identify

all relevant elements of a process

improvement project. It helps you to define

a complex project, to get the right scope

and to get an overview of each process

step. The tool name prompts to consider

the Suppliers (S) of your process, the

inputs (I) to the process, the Process itself

that needs to be improved (P), the Outputs

(O) of the process and the Customer (C)

that receive the process output. This can be

done for each process step as you have

seen, but it can also be done for an entire

process flow at ones. Further you have the

‘requirements’ around the process, like

used tools, instructions, forms, etc... Also

here we will go more into detail to explain.

But first the question, why we use the

SIPOC diagram, for sure when things are

not clear.

E.g.:

• Who supplies inputs to the process?

• What specifications are placed on the

inputs?

• What is the real output of the process and

is this known?

• Who are the true customers of the

process?

• What are the requirements of the

customer?

• How effective are the used tools?

• Are instructions clear, well understood

and effective?

• Etc…

The SIPOC is typically used during the

measuring face of the Six Sigma DMAIC

methodology. SIPOC is similar and related

to process mapping and in/out of scope

tools, but SIPOC provides further details.

The template we have used can be adapted

as you require, but the 5 basic pillars

remain the same. It is important to

complete the SIPOC diagram in the

following steps:

1. Identify the process that you want to

map.

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2. Identify the output of the process.

3. Identify the customers that will receive

the outputs of this process.

4. Identify the inputs required for the

process to function properly.

5. Identify the suppliers of the inputs that

are required by the process.

6. Identify the requirements of the process;

used tools, instructions, what you want to

measure, etc...

7. Discuss this with all involved parties

and come to a mutual agreement.

By doing this, already a lot of things

become clear. But when having questions,

you can ask the operators or experienced

persons how to handle, how to deal with

issues and/or solve these issues.

Quote: “Go to the Gemba and see with

your own eyes.” (Taiichi Ohno – Toyota –

Founder of TPS – Toyota Production

System - Jaigunta)

What is 6M?

The 6M is a ‘fishbone’ diagram (Ishikawa)

that search for potentional failures that

influence the output. It is a useful tool to

detect in 6 main causes what reflects in or

is influencing the effect (output).

The six categories are:

• Man (people – operators)

• Machine

• Material

• Method

• Measurement

• Mother nature

With each category open questions are

asked to determine how the output will be

influenced.

Some examples:

• How does Man negatively influence the

defect?

• How do(es) the Machine(s) negatively

influence the defect?

• How do(es) the Material(s) negatively

influence the defect?

• How do(es) the Method(s) negatively

influence the defect?

• How do(es) the Measurement(s)

influence the defect?

• How does Mother Nature negatively

influence the defect?

With doing this exercise it can help to

determine the priorities and to focus on the

quick wins. It is not limited to the above-

mentioned questions; also the input can

negatively influence the output, already in

a previous production process step. In this

way it is easy to pin point where the

problems occur and containment actions

can be put in place.

What is 5S?

5S is a Japanese Quality system that

focuses on 5 pillars to identify and check

how clean, orderly and efficiently a work

environment is. This is a basic condition to

produce Quality and to continuous

improve.

The 5 pillars are:

1. Seiri: to have order – make selections

2. Seiton: reorganize (focus on the visual

aspect) – bring structure

3. Seiso: clean up

4. Seiketsu: standardize

5. Shitsuke: maintain

It’s easy to use and simple to implement

and can be used together with our

housekeeping standard to reduce waste and

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work more efficient by e.g. doing the

unpacking in a separate area.

An example of a 5S audit can help to give

input, how to conduct such an audit.

Also here a consensus must be reached

internal DHL (management involvement)

to be sure the ‘Shisuke’ is in place. (Why

not make a performance indicator – PI!)

Inline Process Verifications (IPV)

We see often failures occurring at our end

(customer) that could have been detected

in a very early stage of the DHL process.

The failure was not detected during the

outgoing Quality control – OQC – of the

DHL. Doing these controls is costing a lot

of money and effort and is not productive.

A fact is that when we see reoccurrence

failures in our process, it’s raining failures

at the customer side. So for us it’s no

excuse, when DHL is not detecting these

failures, something is wrong with our

Quality system. In most cases an immature

Quality culture with no focus on

continuous improvement is likely to be the

root cause of troubles. Just like a

purchasing strategy, we have a Quality

strategy. We want to focus on continuous

improvement. Nevertheless in most cases

it’s going hand-in-hand. Why? Looking at

our experience this has 1) to do with a lack

of focus on Quality (as being not an

important customer) and 2) with a lack of

communication, meaning not

understanding what the customer wants. In

most cases this also temporally, because

those customers have on along term a good

follow up system to measure customer

satisfaction, they have a well-organized

continuous improvement program and

(maybe most important) they have

management involvement/ support.

Now coming back to IPV, it is better to

detect a failure as soon as possible in a

process flow to have less internal or

costumer failures, but also it is a good tool

to find inefficiencies (in general – look at

the 6M). The communication loop is short

and also very effective in terms of training

and keeps focused on doing thing first time

right. When this is done effectively and it

is measured (measuring one knows) a

performance indicator and targets can be

set. This can be used as a motivator

towards the involved persons.

Pareto principle

A pareto (principle) graph is also known as

the 80/20 rule, meaning that in anything a

few (20 percent) are vital and many (80

percent) are trivial. To give you an

example, how this is seen in a production

or process flow environment, you can say

that 20% of the defects is causing 80% of

the problems. It describes an unequal

distribution and is a very effective tool to

help you visualize and manage. Also we

see it, at DHL WHS OPG 20% of the

problems is causing 80% of the customer

complaints. So by focusing on this 20%

you can solve 80% of the problems. If it

also applies on you personally, I leave it up

to you; is 20% of your spend time, 80% of

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your results or visa versa!! When you

decided and agreed upon the SIPOC, you

also know which forms and registration is

made. From those results, it must be

possible to, not all information is necessary

to monitor, create a pareto graph and

distinguish what is important and valid to

monitor. When the graph shows that one

problem is responsible for 60% of your

rejects, it’s very obvious what to solve

first. When all problems are of the same

height (it can be all one offs), it’s very hard

to have a quick win or to have a focus

point in what to solve first. In this case it

can help to combine failure of the same

sort or origin, so when looking from it

from a different angle, one can come to

surprising conclusions. Here the 6M

exercise can be an input; e.g. combining

workmanship failures, machine failures,

etc...

Also in this don’t overlook the importance

of good and well-documented instructions.

They must be understood and ‘workable’,

too many instructions can have a negative

impact on the Q performance of a process.

Maybe you have seen it, in the process

flow graph; ‘instructions’ is mentioned 2

times!!!

Quote: “When you see data, doubt them.”

(Willy Vandenbrande – Amelior

Consultant)

Kaizen – Continuous improvement

We already have mentioned this several

times. We often get the question, how to

implement this in an organization or in a

process flow. Therefore I deliberately have

also mentioned PI (Performance Indicator),

because this is the way how you can

monitor. Without measuring and have an

agreement with the people involvement on

what is measured, you can never come to

continuous improvement. On top of that it

is equally important to set goals, to

introduce targets, meaning feasible targets.

What is the use of a target, when you can

never reach it? When e.g. you have

measured a reject level of 3% every month

over the last year, you cannot put a target

of 0.1% for the next month. People

involved will immediately be demoralized

and not willing to support. Maybe

eventually you want to reach the 0.1%, but

you can do it gradually in steps and revise

the target every quarter. It is also not

realistic to ask something that is seen as

ridicules in the minds of many, you will

get poor or even no support to achieve this.

Implementation of the KPI (Key) on the

business-balanced scorecard can be very

useful in terms of management

involvement and support. Assume that you

need support from another department or

that you need to do investments to come to

improvements, you surely need the staff

members (director – stakeholders) support

in this. So don’t under estimate the

importance of talking about process

improvements with management and when

you are backed up by scorecard, PIs,

targets and pareto charts it will help you to

make you point and to get things done.

(Continuous improvement)

Frozen Critical Process steps (FCP)

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As we have seen in the past, suppliers

changes their processes regularly, to adapt

market demands, to reduce production

cost, to increase efficiency, etc… What

often is forgotten is to look at the impact

on Quality, which can result in deviating

specifications or agreements. The

consequence can be huge if the outputs are

not well controlled and/or understood.

Therefore, we as DHL want to know when

critical processes are changed by the

customer. For all others we don’t care,

because they are not influencing our

performance and/or Quality. It is important

that the supplier is aware of his critical

process steps, which can have influence on

the technical and/or functional

specification; therefore it is opportune to

mark every critical process step or part of

it by a flag (CFP). Also the use of tools can

be critical; another example can be the use

of scanning devices. In most cases it is the

core business of a customer or DHL, but

sometimes, we want us to perform a

process in such a way (our core

competence) to make sure our application

is working properly, by doing so we are

certain of the outcome of the process.

When coming to the practical

implementation, we’ll give some examples

how to visualize or highlight.

Zero Defect Strategy (ZDS) – defect

prevention

It is the aim to have no duplication of

efforts. In many cases in the past we were

just double-checking the Quality

parameters of what was already controlled

by the customer. We saw that the

equipment used at DHL was not

comparable with the high tech equipment

that sometimes is used at the supplier.

Looking at the internal investments that

need to be made (e.g. scanning, climatic

chambers, etc…) and looking what the

benefits are, we had no business case

whatsoever (ROI) towards management to

invest in such measuring equipment as

DHL. By making good agreements with

suppliers on what needs to be measured,

we can monitor the process performance

(XR- chart). We make agreements in the

QAP on what to measure, frequency to

measure, what measuring tools need to be

used, how to register, document and/or

procedure references, etc… A huge benefit

is that we have an overview of processes

and that we can immediately verify by

looking at the QAP. It is practical, fast and

very effective. When looking at some

practical examples later on, you will see

this immediately.

The importance of auditing

Once the QAP is finalized and agreed

upon, it can be used as a working

document during auditing, this can be a

system audit, a process or a Quality audit.

We have a checklist that contains out of

different chapters. During each one of

them the content of a QAP can be used to

inform you or to find evidence within the

process flow, starting from material

income to finally packing and shipping of

goods, which can help you understand the

customer’s way of working. E.g. when you

want to verify if continuous improvement

programs are running, you can verify what

will be the benefit by looking at the pareto.

When improvement programs are running

for processes that are not in the top 5 of

worst problems, how effective will that be

or what is the added value of such an

improvement program. You can ask to

prove the output and what the target of the

output must be. By doing so, this will tell

you a lot about the efficiency and lost of

effort. Choosing the right improvement

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projects is VERY important in order to

maximize customer benefits.

Addendum

Customer complaint management

The time that we send the warehouse

related complaints to the customer, without

further discussion is history. Today, we

want to discuss the data that we are

sending to the customer. We call this

customer complaint management. With our

key customers we must have regular fixed

meetings with a fixed agenda to discuss the

Quality status, to discuss continuous

progress, to discuss targets and to

understand their process (discussion about

the QAP content). When communicating

on a regular base, we can solve problems,

when we don’t have communication we

can’t solve problems, that’s a fact. It has

even a bigger advantage with global

customers, in terms of cultural differences.

It is opportune 1) to always look for

opportunities to do better and to improve

and 2) to strive to a ‘win – win’ situation

on long term. Without direct and/or

personal contact with your customer it’s

very hard to accomplish this.

Six-sigma – DMAIC methodology

About Six sigma; a lot of information can

be found on the Internet or you can follow

especial courses. So we don’t want to give

here a full overview of what Six-sigma

mean or what the content is. Nevertheless

we want to say something about DMAIC,

because it is a good approach –

methodology - on how to solve problems.

Input: DMAIC approach GE

Define the customer, their critical to

Quality (CTQ) issues, and the core

business process involved.

• Define who customers are, what their

requirements are for products and services,

and what their expectations are.

• Define project boundaries; the stop and

start of a project.

• Define the process to be improved by

mapping the process flow.

Measure the performance of the core

business process involved.

• Develop a data collection plan for the

process

• Collect data from many sources to

determine types of defects and metrics

• Compare the customer survey results to

determine shortfall.

Analyze the data collected and process

map to determine root causes of defects

and opportunities for improvement.

• Identify gaps between current

performance and goal performance

• Prioritize opportunities to improve.

• Identify sources of variation

Improve - Implement the target process

by designing creative solutions to fix and

prevent problems.

• Create innovate solutions using

technology and discipline.

• Develop and deploy implementation plan

Control the improvements to keep the

process on the new course.

• Prevent reverting back to the ‘old way’.

• Require the development, documentation

and implementation of an ongoing

monitoring plan.

• Institutionalize the improvements through

the modification of systems and structures

(staffing, training, incentives)

Deliverables:

• Fully trained team is formed, supported

and committed to work on improvement

project.

• Customers identified and high impact

characteristics (CTQs) defined, team

charter developed, business process

mapped.

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Checkpoint for completion:

• Team readiness

_ Team is sponsored by a champion or

business leader

_ Team formed and team leaders assigned

_ Improvement team members fully trained

on Six sigma and DMAIC

_ Full participation by members in

regularly held team meetings

_ Team members perform project work

when assigned and in a timely fashion

_ Team members regularly document their

project work

_ Team is equipped with available and

reliable resources

• Customers (CTQs)

_ Customer(s) identified and segmented

according to their different needs and

requirements

_ Data collected and displayed to better

understand customer(s) critical needs and

requirements

• Team charter

_ Project management charter, including

business case, problem and goal

statements, project scope, milestones, roles

and responsibilities, communication plan

• Business process mapping

_ Completed, verified and validated high

level ‘as is’ (not ‘should be’ or ‘could be’)

business process map

_ Completed SIPOC representation,

describing the suppliers, inputs, process,

output and customers

Questions to determine appropriate

application:

• Team readiness

_ Who are the improvement team

members?

_ Has everyone on the team, including the

team leaders, been properly trained

(on DMAIC)?

_ Does the team have regular meetings?

_ How often are the team meetings?

_ Is there regularly 100% attendance at the

team meetings? If not, have appointed

substitutes attended to preserve cross-

functionality and full representation?

_ If substitutes have been appointed, have

they been briefed on the project charter and

goals and received regular communications

as to the project’s progress to date?

_ Has the project work been fairly and/or

equitable divided and delegated among

team members who are qualified and

capable to perform the work? Has

everyone contributed?

_ Are there any constrains known that bear

on the ability to perform project work?

How is the team addressing them?

_ How is the team tracking and

documenting its work?

_ Is the team adequately staffed with the

desired cross-functionality? If not, what

additional resources are available to the

team?

• Customers (CTQs)

_ Has the customer(s) been identified?

_ Are there different segments of

customers?

_ Has the improvement team collected the

‘voice of the customer’ (obtained feedback

– qualitative and quantitative)?

_ What customer feedback methods were

used to solicit their input?

_ Have the customer needs been translated

into specific, measurable requirements?

How?

• Team charter

_ Has a team charter been developed and

communicated?

_ Has the charter changed at all during the

course of the project? If so, when did

it change and why?

_ Does the charter include the following?

_ Business case: What are the compelling

business reasons for embarking on this

project? Is the process linked to key

business goals and objectives? What key

business process output measure(s) will the

project leverage and how? What are the

rough order estimates on cost savings/

opportunities on the project?

_ Problem statement: What specifically is

the problem? Where does it occur? When

does it occur? What is it’s extend?

_ Goal statement: What is the goal or

target for the improvement team’s project?

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Do the problem and goal statements meet

the SMART criteria (specific, measurable,

attainable, relevant, and time-bound)? Has

anyone else (internal or external to the

organization) attempted to solve this

problem or a similar one before? If so,

what knowledge can be leveraged from

these previous efforts? How will the

project team and the organization measure

complete success for this project?

_ Roles and responsibilities: What are they

for each team member and its leadership?

Where is this documented?

_ Project scope: What are the boundaries

of the scope? What is in bounds and what

is not? What is the start point? What is the

stop point? How does the project manager

ensure against scope creep? Is the project

scope manageable? What constraints exist

that might impact the team?

_ Milestones: When was the project start

date? When is the estimated completion

date? Is the project currently on schedule

according to the plan? Has a project plan,

Gantt chart, or similar been developed/

completed? How did the project manager

receive input to the development of the

plan and the estimated completion dates/

times of each activity? Is there a critical

path to complete the project? How will

variation on the actual durations of each

activity be dealt with to ensure that the

expected project completion date is met?

_ Communication plan: What are the

dynamics of the communication plan?

What critical content must be

communicated – who, what, when, where

and how? When are meetings minutes sent

out? Who is on the distribution list? How

do you keep key subject matter experts in

the loop?

• Business process mapping

_ Has a high level ‘as is’ process map been

completed, verified and validated?

_ Has a SIPOC diagram been produced

describing the suppliers, inputs, process,

output and customers?

_ Is the improvement team aware of the

different versions of a process: what they

think it is vs. what is actually is vs. what it

should be vs. what it could be?

_ Is the current ‘as is’ process being

followed? If not, what are the

discrepancies?

_ Are different versions of process maps

needed to account for the different types of

inputs?

_ How was the ‘as is’ process map

developed, reviewed, verified and

validated?

_ What tools and roadmaps did you use for

getting through the Define phase?

Deliverables:

• Key measures identified, data collection

planned and executed, process variation

displayed and communicated, performance

base lined, sigma level calculated.

Checkpoints for completion:

• Key measures identified

_ Key measures identified and agreed upon

_ High impact defects defined and

identified in the business process

• Data collection planned and executed

_ Solid data collection plan established that

includes measurement systems analysis

_ Data collected on key measures that were

identified

• Process variation displayed/

Communicated

_ Process variation components displayed/

communicated using suitable charts,

graphs, plots

_ Long term and short-term variability

accounted for

• Performance baseline/ Sigma calculation

_ Measure base line process performance

(capability, yield, sigma level)

Questions to determine appropriate

application:

• Key measures identified

_ What are the key input variables? What

are the key process variables? What are the

key output variables?

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_ What key measures identified indicate

the performance of the business process?

_ What are the agreed upon definitions of

the high impact characteristics

(CTQs), defect(s), unit(s) and opportunities

that will figure into the sigma calculations

and process capability metrics?

• Data collection planning and execution

_ Was a data collection plan established?

_ What data was collected (past, present,

future/ ongoing)?

_ Who participated in the data collection?

_ How did the team select a sample?

_ What has the team done to assure the

stability and accuracy of the measurement

process?

_ Was a gauge R&R conducted?

_ Was stratification needed in the data

collection and analysis?

• Process variation displayed/

communicated

_ What charts has the team used to display

the components of variation in the process?

_ What does the chart tell us in terms of

variation?

• Performance baseline/ Sigma calculation

_ What is the current process performance

in terms of it capability indices?

_ What is the current process performance

in terms of its yield or sigma level(s)?

_ How large is the gap between current

performance and the customer-specified

(goal) performance?

_ Have you found any ‘ground fruit’ or

‘low hanging fruit’ for immediate remedies

to the gap in performance?

_ What particular quality tools did the team

find helpful in getting through the measure

phase?

Deliverables:

• Data and process analysis, root cause

analysis, quantifying the gap/ opportunity

Checkpoints for completion:

• Data and process analysis

_ Identify gaps between current

performance and the goal performance

• Root cause analysis

_ Generate list of possible causes (sources

of variation)

_ Segment and stratify possible causes

(sources of variation)

_ Prioritize the list of ‘vital few’ causes

(key sources of variation)

_ Verify and quantify the root causes of

variation

• Quantifying the gap/ opportunity

_ Determine the performance gap

_ Display and communicate the gap/

opportunity in financial terms

Questions to determine appropriate

application:

• Data and process analysis

_ What does the data say about the

performance of the business process?

_ Did any value added analysis or ‘lean

thinking’ takes place to identify some of

the gaps shown on the ‘as is’ process map?

_ Was a detailed process amp created to

amplify critical steps of the ‘as is’ business

process?

_ How was the map generated, verified and

validated?

_ What did the team gain from developing

a sub-process map?

_ What were the crucial ‘moments of truth’

on the map?

_ Were there any cycle time improvement

opportunities identified from the process

analysis?

_ Were any designed experiments used to

generate additional insight into the data

analysis?

_ Did any additional data need to be

collected?

_ What model would best explain the

behavior of output variables in relation to

input variables?

• Root cause analysis

_ What tools were used to generate the list

of possible causes?

_ Was a cause and effect diagram used to

explore the different types of causes

(or sources of variation)

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12 HealthCare 2010

_ What tools were used to narrow the list

of possible causes?

_ Were Pareto charts (or similar) used to

portray the ‘heavy hitters’ (or key sources

of variation)?

_ What conclusions were drawn from the

team’s data collection and analysis?

_ How did the team reach these

conclusions?

• Quantifying the gap/ opportunity

_ What is the cost of poor Quality as

supported by the team’s analysis?

_ Is the process severely broken such that a

re-design is necessary?

_ Would this project lend itself to a DFSS

projects?

_ What are the revised rough order

estimates of the financial savings/

opportunity for the improvement project?

_ Have the problem and goal statements

been updated to reflect the additional

knowledge gained from the analyze phase?

_ Have any additional benefits been

identified that will result from closing all

or most of the gaps?

_ What were the financial benefits

resulting from any ‘ground fruit or low

hanging fruit’ (quick fixes)?

_ What Quality tools were used to get

through the analyze phase?

Deliverables: • Generate (and test) possible solutions,

select the best solutions, design

implementation plan

Checkpoints for completion:

• Generating (and testing) possible

solutions

_ Possible solutions generated and tested

• Selecting the best solution(s)

_ Optimal solution selected based on

testing and analysis

_ New and improved process (‘should be’)

maps developed

_ Cost/ benefit analysis of optimal

solution(s)

_ Small-scale pilot for proposed

improvement(s)

_ Pilot data collected and analyzed

_ Improved process (‘should be’) maps

modified based on pilot data and analysis

_ Project impact on utilizing the best

solution(s)

• Designing implementation plan

_ Solution implementation plan

established, including schedule/ work

breakdown structure, resources, risk

management plan, cost/ budget and control

plan

_ Contingency plan established

Questions to determine appropriate

application:

• Generating (and testing) possible

solutions

_ How did the team generate the list of

possible solutions?

_ What tools were used to tap into the

creativity and encourage ‘outside the box’

thinking?

• Selecting the best solution(s)

_ What tools were used to evaluate the

potential solutions?

_ Were any criteria developed to assist the

team in testing and evaluating potential

solutions?

_ What were the underlying assumptions

on the cost-benefit analysis?

_ Are there any constrains (technical,

political, cultural or otherwise) that would

inhibit certain solutions?

_ Was a pilot designed for the proposed

solution(s)?

_ Describe the design of the pilot and what

tests were conducted, if any?

_ What conclusions were drawn from the

outcome of the pilot?

_ What lessons, if any, from the pilot were

incorporated into the design of the full-

scale solution?

• Designing the implementation plan

_ Is the improvement plan best served by

using the DFSS approach?

_ What is the implementation plan?

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13 HealthCare 2010

_ What poka-yoke or error proofing will be

done to address some of the discrepancies

observed in the ‘as is’ process?

_ What does the ‘should be’ process map/

design look like?

_ How does the solution remove the key

sources of variation discovered in the

analysis phase?

_ What attendant changes need to be made

to ensure that the solution is successful?

_ What communications are necessary to

support the implementation of the

solution?

_ How will the team or the process

owner(s) monitor the implementation plan

to see that it is working as intended?

_ What is the team’s contingency plan for

potential problems occurring in

implementation?

_ How will the organization know that the

solution worked?

_ What tools were most useful during the

improve phase?

Deliverables:

• Documented and implemented

monitoring plan, standardized process,

documented procedures, response plan

established and deployed, transfer of

ownership (project closure).

Checkpoints for completion:

• Monitoring plan

_ Control plan in place for sustaining

improvements (short and long term)

• Process standardization

_ New process steps, standards, and

documentation are ingrained into normal

operations

• Documented procedures

_ Operating procedures are consistent

_ Knowledge gained on process is shared

and institutionalized

• Response plan

_ Response plans established, understood,

and deployed

• Transfer of ownership (Project closure)

_ Transfer ownership and knowledge to

process owner and process team tasked

with the responsibilities

Questions to determine appropriate

application:

• Monitoring plan

_ What is the control/ monitoring plan?

_ How will the process owner and team be

able to hold the gains?

_ What key input and outputs are being

measured on an ongoing basis?

_ How will input, process, and output

variables be checked to detect for sub

optimal conditions?

_ How will new or emerging customer

needs/ requirements be checked/

communicated to orient the process toward

meeting the new specifications and

continually reducing variation?

_ Are control charts being used or needed?

_ How will control chart readings and

control chart limits be checked to

effectively monitor performance?

_ Will any special training be provided for

control chart interpretation?

_ Is this knowledge imbedded in the

response plan?

_ What is the most recent process yield (or

sigma calculation)?

_ Does the process performance meet the

customer’s requirements?

• Process standardization

_ Has the improved process and its steps

been standardized?

• Documented procedures

_ Is there documentation that will support

the successful operation of the

improvement?

_ Does job training on the documented

procedures need to be part of the process

team’s education and training?

_ Have new or revised work instructions

resulted?

_ Are they clear and easy to follow for the

operators?

• Response plan

_ Is a response plan in place for when the

input, process, or output measures indicate

an ‘out of control’ condition?

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14 HealthCare 2010

_ What are the critical parameters to

watch?

_ Does the response plan contain a definite

closed loop continual improvement scheme

(e.g. PDCA – plan-do-check-act)

_ Are suggested corrective/ restorative

actions indicated on the response plan for

known causes to problems that might

surface?

_ Does a troubleshooting guide exist or is

it needed?

• Transfer of ownership (Project closure)

_ Who is the process owner?

_ How will the day-to-day responsibilities

for monitoring and continual improvement

be transferred from the improvement team

to the process owner?

_ How will the process owner verify

improvement in present and future sigma

levels, process capabilities?

_ Is there a recommended audit plan for

routine surveillance inspections of the

DMAIC project’s gains?

_ What is the recommended frequency of

auditing?

_ What should the next improvement

project be that is related to the process?

_ What Quality tools were useful in the

control phase?

• Integrating and institutionalizing

improvements, knowledge and learning’s

_ What other areas of the organization

might benefit from the project team’s

improvements, knowledge and learning?

_ How might the organization capture best

practices and lessons learned so as to

leverage improvements across the

business?

_ What other systems, operations,

processes, and infrastructures (hiring

practices, staffing, training, incentives/

rewards, metrics/ dashboards/ scorecards,

etc..) need updates, additions, changes, or

deletions in order to facilitate knowledge

transfer and improvements?

References

Author Geert Appeltans is working as a

Continuous Improvement Manager at DHL

Supply Chain business line HealthCare in

Opglabbeek (B). Geert started his career in

1985 and has 25 years of experience in

operations, logistics and supply chain

management in different industries. ‘The

variety of business experience helps me to

better understand the need to improve on

all levels throughout an organization.’

‘Feeling the business and customers needs

is as important as looking at figures,

anyway I doubt them.’

This document might serve as a primary

input, but does not aim to be a complete

study.

geert.appeltans@dhl.com