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  • This topic has 38 replies, 18 voices, and was last updated 15 years ago by BC.
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  • #47287

    Jose
    Participant

    Hello everyone.  Thanks so much for your help and opion about Six Sigma.  I want your opion and advise about this:
    I am perfoming a Research based on 6Sigma to reduce the Waiting Time in a Hospital.  I am perfoming a Survey.  One survey will be applied to the Patient and other to the Hospital Management.  What kind of questions and what question do you consider appropiate and why ?
    Of course, waiting time is the Core point but what else do you consider ?.
    What kind of question should I apply to the Hospital Management ?.  In addition I want to know the knowledge of Six Sigma of the Hospital`s Administration .  What do you think ?
    Thanks so much for your opions.
    Jose

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    #157565

    steved4
    Member

    Sounds like a lean project to me – not Six Sigma at all.

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    #157566

    annon
    Participant

    Jose,
    Your question indicates that you are not experienced practicioner….If this is the case, you need to find a basic skill set to work with…if you are thinking of applying sigma, stop now.  A basic project management approach or a lean approach *as mentioned earlier* is not a bad way to address your problem…Look to Value Stream Mapping, 5S, WorkOut, etc….You are dealing with improving the throughput rate / cycle times of patients through the medical process…work from that perspective….Good luck.

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    #157571

    Mike Carnell
    Participant

    Jose,
    You can work it as a lean or Six Sigma project it doesn’t matter. Do what makes sense to you and what you are comfortable doing.
    To get better answers to your questions you might try posting this on the sister website for healthcare. You probably have a better chance of bumping into someone who has already done it.
    Good luck

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    #157578

    Groll
    Participant

    “You can work it as a lean or Six Sigma project it doesn’t matter”
    That is an incredibly presumptuous statement. The foundation of 6s is the use of stats and some fairly intimidating tools to the uninitiated. How he approaches it is of utmost significance. It DOES matter. Flippantly saying it doesn’t matter makes it sound like 6s is easy to do. It is not and often times fails because critical elements are not present: top down support and understanding, ability to cope with conflict and change management issues, etc.
     

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    #157581

    ShootMeNow
    Member

    Mike was referring to the capability of the skill sets, not the practicioner….need a little SA out of you, puddin´

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    #157592

    Mike Carnell
    Participant

    randy,
    You need to read the answer from Shootmenow and then go back to my post and catch the part that says whatever you are comfortable with.
    Presumptuous would be the fact that you are intimidated by the stats and therefore others are intimidated by stats. Maybe the rest of us haven’t gotten ourselves into such a state that we are so afraid to make a mistake that we can be intimidated by statistics. That must make your day to day life pretty interesting.
    You do have and intersting perspective. The stats are intimidating so lets avoid using them. That should fix the problem. Maybe you need to spend a little time with a thing called Blooms Taxonomy and understand an adult learning model You may actually begin to understand why someone would try to use something that they may not completely understand, but are trying to.
    We won’t even go into the insinuation, from your post, that when you lack top management support, can’t cope with conflict and change management issues then you use Lean? That has to be a fairly bizarre conversation.
    Just my opinion.

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    #157607

    Six Sigma Pariah
    Member

    I think Randy’s point is that many, many companies struggle with 6s (or lean for that matter) because of lacking critical elements for success. 6s has, currently, such critical mass that companies partake the journey just because it is de rigueur – not really knowing what it takes to make the quality effort succeed. After they make the investment in training, an instant expectation is created that X number of projects will be completed saving $XXXXX dollars (kind of a weird twist of Blanchard’s Leadership Pill). This in turn creates Deming’s Red Bead Experiment within the organization. I have seen it in action at a Fortune 100 Company and at a high profile university. While sitting in the audience during a presentation by the university’s VP that suggested and implemented the 6s effort – I asked a simple question. “Who post-audits the projects you say are saving big money?” The answer was, “I do” – from the VP. In the circles I frequent, that would be called conflict of interest. Can you imagine the political ramifications (and career) if  6s did not succeed? After the presentation, I politely had a conversation with the black belts present. The reality was, they told me during drinks that evening, 6s savings at the university were not real. At best, the projects put a thumb over a leak in the dam but a another leak started immediately somewhere else. But no one would admit it.
    Six Sigma creates too many political issues (so can Lean), certifications can be a joke (my project certification was from a prominent firm that advertises on this website), and I agree the heavier stats create an aire of “don’t question the black belt” because the average employee will never have the chance to understand Box Cox Transformations or even Regression for that matter. Simple metrics move employees to action.
    Other people say on this forum a lot and I agree – stick with the 7 basic problem solving tools – which are quite simple but powerful and implement a PDCA cycle. You will solve over 90% of a business’ problems using that methodology. Save the 10 grand you would spend to train a few belts and spend it instead on good quality training for as many people in the organization as you can. I do this everyday in consulting with business’ all over the Midwest US and have great success with about 1/10th the cost of training a bunch of belts. Given the choice and limited budget for training – I will train as many as possible on the basic 7 – than a couple belts.
    Don’t get me wrong, I believe 6s can and does work when the elements are right. But the elements are many times not right. Six Sigma failures are out there and they are more common than anyone here would want to admit. Its kind of like those late night infomercials on get rich quick schemes. All they show you are the great successes. But the fine print at the bottom states the truth “results not typical”.
    I believe, in time, that Six Sigma will be viewed as it should be – a splinter religion or cult from the more mainline quality programs – kind of like the Mormons.
    Just my opinion.
     
     

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    #157621

    Mike Carnell
    Participant

    Six Sigma Pariah,
    “Other people say on this forum a lot and I agree – stick with the 7 basic problem solving tools – which are quite simple but powerful and implement a PDCA cycle. You will solve over 90% of a business’ problems using that methodology”
    I don’t believe I have seen that said “a lot.” How many is that and do you have some links? I can only think of one guy.
    I will make you the same offer as I made the last person who claimed they could solve 90% of the projects with the 7 Basic Tools. I will give you the Original 23 projects from the last deployment (Wave I – 23 projects) and that means you can solve 21 of them with just the 7 basic tools. Just a hint it won’t happen – I can hand pick 3 that I know you can’t get with the 7 basic tools and that makes your statement BS. We have the answers to the problems so the ball is in your court.
    Results – Between Stan and I we can give you a string of verifiable benefits that goes back to 1995. Now I don’t think I will throw that out the window for a conversation you had over drinks.  By the way our post audits – Earnst and Young and Price Waterhouse Coopers.
    I am very happy that you do this every day in the Mid-West. I am sure that gives you a very wide perspective on the world – enough to make a statement that SS is a cult (I’ll let you fight it out with the Mormons – that was a pretty ignorant comment). We have been at this since the mid 80’s, consulting since 1995, done deployments in 18 countries outside the US and on 6 continentsand (that includes Japan). Perhaps you need to try ranging a little wider before you chose to speak for the world – unless of course you believe “As goes the Mid-west so goes the world” -paraphrased from a GM quote.
    You sound more like resistance to change than the lone voice of quality. I assume you are familiar with the story of the Man from La Mancha. Tilting a few windmills and not aware that the world has passed you by.
    Just my opinion.

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    #157624

    Chad Taylor
    Participant

    Mike, as always, you are right on. Todays, six sigma is more mature than years past. Financial Audits are an everday occurance and the proof is the bottom line. If Six Sigma was a cult or hoax, why the very best business’s in the world still be implementing?
    I think what many people (skeptics) fail to see is that Six Sigma is not just a way to solve complex problems, but culture of quality that exceeds the just do it quality of the past.
     
    Six Sigma Pariah
    I was at that conference, and the VP was speaking to his responsibility of audits of the six sigma program, not he is the one who audits it.
     
    Just my Opinion

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    #157625

    annon
    Participant

    Ohhhhhh……my head………….try this logic…….the best and brightest minds from the most revered  universties around the world go to the universally recognized best companies, with state of the are onboarding and management development programs…….Now I dont know any, havent met any……but I am deducing their practices and methodologies are probably pretty good…odds are, better than those of us who are relentlessly chasing mediocracy….better to keep your mouth closed and have everyone think you an idiot than open it and prove it. 

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    #157626

    TPS
    Member

    Okay, I get it now. If someone feels Six Sigma isn’t the cure all or points out problems with it, belittle them. I work for a large mulitnational company that is struggling with Six Sigma for some of the reasons this pariah mentions. There is no one, including Mr. Carnell in all his grandeur, that can right the ship – for reasons only employees of a company can understand. You can go ahead and belittle that too – but the fact is politics can be quite ugly in companies with silo mentality.
    We too have Ernst and Young do the audits. The problem is that they can audit the numbers but have no way of really knowing if the numbers are real. Whether you want to admit it or not, Mr. Carnell, there can be tremendous pressure to have successful projects. Whenever that happens, two things can occur: 1)contrivance, and 2) loss of trust. I would like to see a book written about Six Sigma failures. Pareto the reasons, I bet it would be interesting if you can get to the true root causes.
    To those that don’t have a dog in the quality fight between methodology, there are other methods beside Six Sigma that are  effective and can be implemented less expensively. All you hear on this forum are people that have so much invested in it they have scotomas in place.
    FYI, I was at the conference with the university VP too – it was a female not a male.
     
     
     

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    #157630

    xSigma
    Member

    I have sat back and let this conversation roll on by. But now I am going to chime in. I work for a company that makes huge claims about Sigma. Had a consultant come in and pay them big bucks. At the end of the day they all self pleased and claimed great success. In reality, they picked an easy project (that should have been done without a 6s project) and left. 
    Take what any consultant says with a grain of salt. Many times they are all sizzle and no steak – ask a consultant about failed Sigma efforts they were involved in. They will either look away sheepishly or blame it on the company. But they will never admit Sigma wasn’t the right quality effort for the situation.
    Long live the Toyota Production System. Less expensive and superior in so many ways.
     

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    #157632

    Mike Carnell
    Participant

    TPS,
    I see this a little differently than you do. The issue began as it being Lean or SS and when someone takes the position that it doesn’t matter then it becomes a consultant issue.
    Life is much easier when we subscribe to conspiracy theories that way you can rationalize sitting on your but in all your grandeur and say I told you they we screwing it up.
     

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    #157633

    Mike Carnell
    Participant

    Chad,
    I can’t think of a single deployment where there wasn’t someone making some effort to make sure the financial accounting had integrity in it. You are correct I do see more and more people using the third party audits to verify.
    As far as a cult this is just the iteration of the same people who used to refer to it as a latest fad. After 20 years it is difficult to make that stick. Not we throw it in with the David Koresh’s of the world.
    It is interesting how frequently you have no issue discussing the lean and/orTPS aspect of a project with someone who has been trained in SS and you have very little issue. Try that with the Lean folks and it is a 50/50 deal if it blows up on you. I think the issue was highlighted pretty well in another string where they made the distinction that TPS equals Lean but Lean does not equal TPS since lean has choosen to drop the problem solving tools. Maybe they would be a little less sensitive if they carried a full quiver or maybe they just chose to leave out the intimidating tools.
    Regards

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    #157634

    Reality Check
    Participant

    Let’s get a reality check here: The field of business administration has been around for about 100 years old now and 6 sigma has been around for 20 years. There is not much innovation going on in the general field of business administration other than the constant back and forth between scientific and softer types of management. Quality is a key ingredient of business no matter how you turn it as is throughput, employee satisfaction, strategy and all the other tool kits in the business administration box. . The question is not “what needs to be done” (we know what needs to be done from strategy formulation down to process control and improvement). The question is “how well is it done”. Don’t expect any major revolutions in the sphere of business administration over the next few years: It just won’t happen. Enjoy six sigma and the other tool boxes of operations management … there’ll be not many new toys to choose from in the foreseeable future.

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    #157635

    Chad Taylor
    Participant

    “Less Expensive” “Superior” not sure how to address that, so I’m just going to say this. I believe in a Total Quality System, not to be confused with TQM, I believe in a system that utilizes the very best tools to solve problems whether it be from Lean, Six Sigma, or TPS, hell even through in some Shanin techniques or an effing combination of all. A system that monitors the process, and has the ability to be flexible to meet the customers needs.  I personally can’t believe anyone would attempt to implement Six Sigma in manufacturing without having Lean as the backbone for implementation criteria. Just my opinion and will not waiver from it. Is Six Sigma the end all cure all, NO. But it will get the job done. The biggest problem with corporate america is that somewhere someone said every project is a six sigma project. That is simply not the case. RULE #1 for six sigma project. If a solution to the problem is known, then it is not a six sigma project. If your running your projects this way, then no wonder you have anamosity among the troops. NOTE: I said “a” solution, is it “the” best solution, don’t know but if it gets the intended results so be it. 4 of the 5 companies I have worked for over the past 20 years have used Six Sigma in one form or another, either all out deployment or a couple black belts working on projects in the back ground. Six Sigma was the culture and lean was the focus of that culture in every case.
    I for one choose to use Six Sigma and my team is getting ready to Implement Six Sigma in a processing plant for Ethanol. I cannot wait to get started, the possibilities are endless.
    Hope you guys have a nice day
    Chad Taylor

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    #157637

    Mike Carnell
    Participant

    Reality check,
    I don’t know of anyone who has ever said SS carried new tools. You should be able to find many post from me that say specifically that there aren’t and new tools. It did take old tools and put together a methodology so that the infamous toolbox had some structure.
    Does the methodology create the successes we hear so much about? No those come from the deployments and those deployments use the same methodology as those that are labeled as “failures.” So if we have a common methodology and some are a “success” and some are a “failure” it would make sense to have people saying that SS doesn’t work. The alternative would be to admit that the deployment that they put together didn’t work. Much easier on their egos to go with the methodology.
    I believe there was someone around the turn of the century that made the comment “Everthing that can be invented has been invented.”
    Good luck

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    #157638

    Reality Check
    Participant

    Mike,
    I absolutely agree with you. I meant tools in terms of: cost accounting (1920), employee involvement (1930s) quality (1940s), market orientation (1950s), strategy (1960s), supply chain (1970s), globalization (1980s). Within those bigger tool boxes, you have the smaller tool boxes that you mentioned (QC, TOC, TPS, lean, value stream mapping, six sigma …). The challenge is to align the big boxes first, then you find the tools within each of them. The small tools in quality don’t help much unless you have a strategically aligned deployment including a strategy that supports quality. I hope this clarifies my position.

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    #157640

    Mike Carnell
    Participant

    Reality Check,
    I think we are in agreement.
    Take a look at a book called “Leading With Safety.” It has some very interesting ideas in terms of driving improvement and you begin that process with a safety focus. It is particularly interesting for me because if you have read the iSixSigma Magazine article on Lonmin the CEO, Brad Mills, does the very same thing when he begins to transform a company. It is an interesting approach.
    I have watched Brad do the big boxes a couple times. I am quite content to make sure my little boxes are supporting the big boxes he moves.
    Regards

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    #157642

    Reality Check
    Participant

    Mike,
    Thanks, I will defnitely look at these books as they seem to caputure something that we are all struglling with on a daily basis. Again thanks!

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    #157649

    Ward
    Participant

    Lean, Six Sigma, TQ who cares? Give it any name. They all represent Continuous Improvement. Six Sigma does depend on statistics with a great appreciation for “BASIC statistics” You must understand the average and variability (all very basic statistics) of the patient wait time, so that you can baseline and subsequent improvement.

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    #157650

    Ward
    Participant

    Mike,I am a big fan of Ishikawa’s quote, “95% of quality-related problems can be resolved with the basic tools” I am on the road and do not have his book with me, so I can’t cite the quote exactly. My concern is we encourage techniques such as hypothesis testing when a stratified dot plot answered the question and was a helluva lot easier to present and explain. Hypothesis testing, regression, DOE and RSM certainly have their place, but the value of the seven basic tools can’t be overstated.

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    #157651

    Ward
    Participant

    Not sure how much success you had with Health Care site, but you can also think of it as a queuing project. Many industries deal with a reduction in wait time.

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    #157654

    BritW
    Participant

    Another disgruntled agenda…
    1.  You are to blame for letting the consultant walk out.  Never let the answers be unanswered and the plate left empty in a consulting experience.  You need to be able to function on your own after s/he leaves.  Again – your fault.
    2.  The choice of the project was management’s responsibility and again, your fault.  Someone in the thread listed the criteria for choosing a project, and obviously, that wasn’t followed.
    3. If a consultant can’t admit a failure or give reasons why – don’t hire them. Again, your fault it didn’t work.
    4.  Anyone who says only one set of tools or one system of improvement is right is doomed to mediocrity.  SS has its place as does Lean, Shanin, Taguchi, etc. etc.
    5. The money people spend on deployment boggles me.  The insinuation that it has to be expensive is rediculous.  There are cost effective means to get the implementation done.  It is a matter of time and leadership.   If you are willing to spend some extra time up front, then the experience does not have to be relatively expensive.  I have done SS implementations for less than $50,000, which included the GB training.
    I am not a consultant, but was one and have used many.  Your job is to do the due diligence.  There job is to deliver results.  If you pay the big bucks and don’t get the results, again, your fault.
    The reason six sigma, lean, et al fails is because the company lets it fail.  If the process, design and functionality are the same for an improvement system and some initiatives succeed and some fail, then it isn’t really the tools at all.  Start looking inward.

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    #157656

    BritW
    Participant

    Jose – I hope you decide to include others in the employee ranks other than management.  Nurses and registraton could be resources.  Your results will be more inclusive.
    Your task is large and I hope you are prepared for many different answers, depending on how you pose yoru questions.  The reason, waiting time in a hospital is a classic push/pull scenario.  Majority push patients through the system, while successful LOS measurements, including wait time, are found to be the cause of internal functions.  There are over 500 variables that could be considered, depending on the diagnosis.  To examine this via a survey and not inside a hospital is going to be tough, so I suggest yo uspend time in the environment first.
    Finally – wait time is a customer perception problem in healthcare.  The real issue to be examined is Length of Stay, which includes wait time.  Also, the perception between patient and Length of Stay.  most people think that if yo ustay longer in the hospital, the hospital makes more money, which is opposite of fact.  The doctor might make more money, but the hospital only gets reimbursed  via medicaid/medicare for the particular diagnosis.  Some community hospitals have 60 – 70% of revenue from medicaid/medicare.  If they can do it for less money, they get more margin.  Ig the patient stays longer, it costs more, thus the hospital loses money.
    Knowledge of SS in healthcare is limited.  Anectodally, about 10% of US hospitals practice it.  It has grown significantly over the past 5 years, but still limited.

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    #157659

    Mikel
    Member

    Please tell us about your personal successes with TPS.

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    #157664

    50K
    Participant

    Britw, how did you get hospital administration to spend 50K on six sigma? I’m looking more at $5000 for 20 + projects :-).

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    #157671

    Nik
    Participant

    Jose,

    Surveys – Surveys are a very difficult to construct. Mainly because their success lies heavily on how the question is structured and what you want to know. Some guidelines for any data collection system:

    What does the data tell you to do? Are you asking something you can act on? What does a 1 in customer satisfaction tell you? or a 5? or a 3?
    “Kitchen Sink Syndrome” – be selective about what you ask, don’t ask everything. People don’t want to fill out a 100 question multiple choice survey. They might have great ideas for you, or know what they value, but if you ask them 100 close-ended questions, you’re unlikely to find out what you want to really know.
    What is the goal? What do you really want to know? What pain are you trying to avoid for your company?
    If your goal is to reduce wait time, find out where the time is being spent. A team could create a quick macro map and you could gather data by:

    Sampling – randomly shadow several patients through the process.
    Surveys asking “how long did you wait before (the next step)?” and “which of the following steps is most important to you?” or “which step(s) would you rather do with out?”
    Last resort – Asking the team for ball park figures – It’s not hard core “Six Sigma” but if data doesn’t exist and you don’t have the time to gather it, this will at least highlight the major opportunities. (This will likely generate some hate mail from the statisticans and Six Sigma die hards, but Patton said “a good plan violently executed now is better than a perfect plan executed next week.” and Six Sigma programs fall apart when there isn’t enough action and results)
    Additional resources

    Lean Thinking – Womack (even though either methodology can help, this is a great book for understanding value and flow, and the first couple of chapters have great stories from the medical field).

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    #157674

    BritW
    Participant

    I showed value by doing a project important to thier bottom line.  I thnk it was pre-op scheduling and reduction of OP surgery cancellations.  Found about $720k/yr. 
    Actually – in my hospital, I have a dedicated department to it, so our expenses are much more.
    If you can do 20+ projects for $5,000, then I’d be surprised. Labor alone would be 10 times that.

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    #157681

    50K
    Participant

    so you’re saying you incur 50K including salaries … LOL?

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    #157683

    BritW
    Participant

    Uggh….My previous post is in italics below – comments are not:
    I showed value by doing a project important to thier bottom line.  I think it was pre-op scheduling and reduction of OP surgery cancellations.  Found about $720k/yr. 

    This was the hospital where the intiative cost them under $50,000.  I did that as a consultant about 5 years ago.  They are still using LSS and have audited savings of over $6.7M after I left ($6.7 + .72 = $7.42M total). For a community hospital – not too bad.  Not sure what they spend per year.
    Actually – in my hospital, I have a dedicated department to it, so our expenses are much more.

    You obviously mis-read my post on this one. This is the hospital I work for today.  The “much more” is budgetary – all included.  We have about an 8:1 ROI on budget vs audited project results. LOL
    If you can do 20+ projects for $5,000, then I’d be surprised. Labor alone would be 10 times that.

    You won’t be able to do this and have it stick.  And you won’t convince anyone that the cost will be $5k for doing 20 projects.
    Finally – doing 20 projects for 20 projects sake will kill your initiative as well.  If you don’t connect initial (or all) projects to the strategic direction ro burning platform, then it will get lost in the shuffle – especially with no financial investment.  I suggest getting 3 key projects selected by yoru CEO and sponsored by the VP/C-suite level. 

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    #157686

    50K
    Participant

    You’d be surprised to what degree you can get a solid SS program rolling without incurring major direct expenses (Of course, I don’t include salaries of employees who don’t report into me). Trust me, all projects are signed off by CEO, CFO, Six Sigma council etc.. and tied right into the strategic plan (10 champions, 15 GBs, 100 YBs). Every organization is different … that’s what Six sigma professionals sometimes forget. They have these standard ideas about how it should work … LOL, and still complain that it doesn’t :-). . Good luck with your projects. Looks like you’re on your track and I’m on mine :-).

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    #157703

    Mike Carnell
    Participant

    Pete,
    We don’t encourage the use of anything other than what is appropriate to do the job. We also do not discourage the use of tools like hypothesis testing. When you watch people go through the course and then begin to practice you can see that they become more efficient in the process they use as they gain experience – that would be logical since their decision making is operating on a larger experience base. That is why I have problems with the recipe type courses that try to create AI to get you to the correct tool.
    Maybe when Ishikawa was working this stuff he could get 95%. I don’t think that is true today in most industries that are on the increasing rate of change slope. I have no issue with using the 7 basic tools but I don’t buy the 90 and/or 95%. If I were running a deployment and that was happening I would have to believe one of two thing was happening 1. someone is picking easy projects and nobody is going to buy into the value of SS if you are fixing easy stuff – anyone can do that 2. the process is so screwed up that you can probably change lightbulbs and get an improvement.
    Just my opinion.

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    #157704

    Mike Carnell
    Participant

    Pete,
    Now we are in agreement on that.
    Regards

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    #157705

    Mike Carnell
    Participant

    Pete,
    We did a Kaizen on this type problem. Basically about a 2X improvement and it had nothing to do with the doctors (as you said it was queuing). One of our guys went through the process the Friday before the Kaizen event and then presented his experience on day one of the event.
    I think it was Honda that used to have a sign that read “You can’t talk about the problem unless you have seen the problem.” It is much easier than a survey (and possibly more basic than the 7 Basic Tools?).
    Regards

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    #157716

    Fake Gary Alert
    Participant

    You  will  get  good  results  by  applying  the Xbar-mR charts.
    good luck

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    #157717

    Fake Gary Alert
    Participant

    RSM stands  for  what?

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    #157741

    BC
    Participant

    RSM stands for truth, justice, and the Six Sigma Way.  (Sorry).
    Response Surface Methodology

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