PRESENTERS:

Rachana Shetty(PA- 14) Sagar Patel(PA-16) Vipul Patil(PA- 20) Nilesh Visave(PA- 10) Neelam Upadhayay (PA-09)

Sneha Ushir (PA-18)

Krina Desai (QA-06) Pooja Goswami (PS-11) Kruti Trivedi (QA -07)

IMPLEMENTATION OF SIX SIGMA TO DR. L.H HIRANANDANI HOSPITAL Presenters:

M.Pharm(Pharm Analysis) + MBA Rachana Shetty(14) Sagar Patel(16) Vipul Patil(20) Nilesh Visave(10)

Sigma is a letter in the Greek Alphabet.

Sigma is defined as "a statistical unit of measurement that describes the distribution about the mean of any process or procedure" . As the sigma value is raised, the variation around the mean value decreases, eventually approaching zero variation, mythically known as "zero defects".

Six Sigma is defined as a type of business improvement methodology.

Its main objective is to implement a vigorous process to systematically eliminate defects and inefficiency. It was originally developed by Motorola in the early 1980's .

Six Sigma's main purpose or objective is to deliver high performance, value and reliability to the customer.

Business Definition
A break

through strategy to significantly improve customer satisfaction and shareholder value by reducing variability in every aspect of business.

Technical Definition
A statistical term signifying 3.4 defects per

million opportunities.

Quality Levels
Sigma Level 1 2 3 4 5 6 Defects Per Million Opportunities 690,000 308,000 66,800 6,210 230 3.4 Rate of Improvement NIL 2 times 5 times 11 times 27 times 68 times
6

Motorola company that invented Six Sigma.

The term Six Sigma was coined

by Bill Smith, an

engineer with Motorola

Late 1970s 1987

Motorola started experimenting with problem solving through statistical analysis - Motorola officially launched its Six Sigma program more than $ 15 billion in the first 10 years of its Six Sigma effort

Motorola saved

Service
Administration Design

Six Sigma Methods

Management Production

IT

DMAIC APPROACH This is organisation based

DMADV APPROACH This is based on customer needs and satisfaction.

It approach undertaken to improve existing business process

CONTRL

IMPROVE

DEFINE

ANALYSE

MEASURE

1.Define high-level project goals and the current process. 2.Measure key aspects of the current process and collect relevant data. 3.Analyze the data to verify cause-and-effect relationships. Determine what the relationships are, and attempt to ensure that all factors have been considered. 4.Improve or optimize the process based upon data analysis using various tools 5.Control to ensure that any deviations from target are corrected before they result in defects.

This approach is undertaken when there is a need to create new design or product:
VERIFY DEFINE

DESIGN MEASURE ANALYZE

Define design goals that are consistent with customer demands and the enterprise strategy.
Measure and identify CTQs (characteristics that are Critical To Quality), product capabilities, production process capability, and risks. Analyze to develop and design alternatives, create a high-level design and evaluate design capability to select the best design. Design details, optimize the design, and plan for design verification. This phase may require simulations. Verify the design, set up pilot runs, implement the production process and hand it over to the process owners.

DMADV is also known as DFSS, an abbreviation of "Design For Six Sigma

At least 25% of the fortune 200 claim to have a serious six sigma program. Financial - Bank of America, GE Capital, Electronics - Allied Signal, Samsung, Sony.

Chemicals - Dupont, Dow Chemicals.

Manufacturing - GE Plastics, Johnson and Johnson, Motorola, Nokia, Microsoft, Ford. Airline - Singapore, Lufthansa, Bombardier And hundreds of others in Americas, Europe, Sub Continent.

Company Motorola General Electric JP Morgan Chase Johnson & Johnson Honeywell

Annual Savings $ 16 billion (*since inception in 1980s) $2.0+ billion *$1.5 billion (*since inception in 1998) $500 million $600 million

Dr LH Hiranandani Hospital, Mumbai is a 130 bed multi speciality tertiary and quaternary care hospital. It is the first hospital in the city of Mumbai and the western region of India to have received the prestigious National Accreditation for Hospitals and Healthcare Providers (NABH). Among other specialties, the hospital has energy efficient structure design to achieve day light harvesting and to reduce HVAC load, rain water harvesting system and integrated building management system (IBMS).

The Need
The hospital is in the process of expanding from current 130 beds to additional 71 beds to cater to its growing patient base by constructing and adding additional six floors of 90,000 sq feet space.

The senior management of the hospital felt that it would be crucial to control and reduce its utility costs with the current expansion plan to meet its strategic objectives that included providing ultimate patient services.

Therefore, it was decided to implement the Six Sigma methodology in its engineering operations and maintenance services to control and contain the operations and maintenance budget.

Approach: The six sigma DMAIC methodology was used for achieving the desired improvement in engineering system reliability and utility costs. Phase-I: Defining the Opportunity for Improvement Phase-II: Measure: Monitoring and Measuring Day to Day Performance

Phase-III: Analyse

Phase-IV: IMPROVE

Phase-V: CONTROL

Phase-I: Defining the Opportunity for Improvement

Started with deciding and defining the metrics to be improved.

The engineering team of the hospital decided to improve the power consumption and water consumption (both flushing and drinking). In terms of engineering system reliability, the team decided to reduce the no. of engineering complaints received per day.

Metrics and Key Performance Indicators

The table shows the various metrics and their associated key performance indicators that were targeted for improvement.
Project Objectives Utility Consumption Metrics Water and Power Consumption Engineering complaints DWS= Drinking water supply, Units KL and KWH KPI FWS/PO, DWS/PO, KWH/PO No. of complaints /day PO= Patient Occupancy

Engineering System Reliability FWS= Flushing water supply

No. of complaints KWH=Kilo-watthour,

The team felt that it would be more appropriate to measure and monitor the metrics in terms of per patient consumption.

Opportunity Statement for Improvement

Benchmarks for each of the metrics were established based on historical data.

Table 1 shows the benchmarks established for power, water (flushing and water) and gas consumption.
The data shown in the table are reflective of average consumption per patient per month. Monthly KPI The table also shows the Average average KWH/PO 104 number of engineering FWS/PO 1.12 complaints received per day. DWS/PO 0.93 No. of engineering complaints 19

STDEV 12.1 0.3 0.2 5

Phase-II: Measure: Monitoring and Measuring Day to Day Performance

The second phase of Six Sigma involved mapping out the processes and then monitoring and measuring the performance indicators in a predefined and planned manner. Each of the above key performance indicators were tracked by the Six Sigma engineering project team on a daily basis.

Utility Consumption Monitoring

The Key Performance Indicators for utility consumption were monitored for stability using statistical process control (SPC) charts. Individual control charts were used on a daily basis. The control limits for the charts were established using historical process data. The team monitored the process performance using these charts on a daily basis. Monitoring of Engineering System Reliability Monitoring and measurement of engineering system reliability was done by monitoring the number of complaints received on a daily basis. Further the number of complaints receive on a monthly basis were stratified into various types of system complaints

The Table shows the stratification of total number of engineering complaints in the month of March'09 into various types of complaints TRADEWISE
ELECTRICAL HVAC PLUMBING CARPENTRY GAS OPERATION

TOTAL 263 52 96 35 34

PAINTING
PHONE

47
40

65 %of the engineering complaints in March'09 were of plumbing and electrical type. The total number of plumbing and electrical problems was further stratified (second level of stratification) into problems or complaints received from each floor.

The Pareto chart shows that about 65 of the complaints came from four floors, viz. 2nd floor, ground floor, 4th floor and 1st floor.
TRADE WISE Base 1ST men Ground 2ND FL 3RD FL 4TH FL 5TH FL 6TH FL FL t

ELECTRIC AL

40

58

43

68

28

33

30

18

PLUMBING

13

10

12

13

26

In other words, almost 65 per cent of the complaints can be reduced by focusing improvement and efforts on these four floors only..

Phase-III: Analyse

The purpose of this phase of Six Sigma methodology is to analyze the root causes of process deficiencies in an effort to completely eliminate them or at least reduce the effect of the root causes on process parameters.

Utility Metrics

In the initial phases of the project, the team focused on understanding and

investigating the reasons for day -day-variations observed in the

performance of the utility metrics as shown by the control charts. The intent was to understand and eliminate all sources that caused unusual variation in day-do- day performance of the key performance indicators showing utility consumption i.e. power, gas and water.

A close watch was kept on the Moving Range chart to observe the variation
in performance between two consecutive days of operation

System Reliability

The Six Sigma team also investigated and brainstormed various factors and root cause(s) resulting in higher plumbing and electrical complaints coming from ground, first, second and fourth floor.
Electrical Problems Common complaints Central Monitor Problem Tube light problem Call Bell Problem Power supply trip Root Cause (s) Biomedical work Reuse of Blast Misuse by user Overloading

Table beside shows the various electrical complaints and their root causes identified by the Six Sigma team.

Plumbing Complaints

Flush leakage Geyser problem

Algae/SIPON Incorrect thermostat setting

Phase-IV: IMPROVE
Once the root causes were identified, then team moved on to the next phase of Six Sigma i.e. improvement phase. The purpose of this phase is to plan and implement various measures to eliminate various root causes of problems identified in the analyse phase.

The team successfully achieved the following tasks in this phase of the project: a) Brainstorm various countermeasures to eliminate the root causes. b) Develop an implementation as well as contingency plan to implement the countermeasures. c) Plan and measure the improvement resulting from the implementation of the countermeasures. This phase took almost two months i.e. May-June.

Benefits Achieved As a result of the implementation in May and June, the team recorded significant improvement in almost all of the utility metrics consumption as well as engineering system reliability in the third quarter of 2009.

Key Performance Indicators KWH/PO FWS/PO DWS/PO

Q3-08 89.5 0.82 0.78 21

Q3-09 82.7 0.8 0.58 13

% Improvement 7.60% 2.40% 25.60% 38%

No. of engineering complaints per day

It can be seen from the above table that Six Sigma methodology implementation in a short span of six months has led to following improvement at the hospital:
a) Engineering complaints has reduced as much as 40 per cent per day. b) Drinking water consumption per patient has decreased as much as 26 per cent. c) Power consumption has decreased by almost 8 per cent per patient per day. d) Flushing water shows a marginal improvement only. The consumption has reduced by about 3 per cent per patient per day.

It must be noted that the above improvements i.e. reduction in utility consumption were achieved without any compromise on patient care services and patient satisfaction. As a matter of fact, in October 2009 the hospital has won the Malcolm Baldrige Quality Award (Asia Pacific) for its outstanding quality services to patients. This is the only hospital in India to have won this prestigious award.

Phase-V: CONTROL
Quality is dynamic and not static and hence Six Sigma pursuit is a journey and not an end result in itself.

The hospital management realises that the benefits achieved so far must be sustained by maintaining strict vigilance on the underlying systems and processes.
Therefore the team has successfully implemented several process control checks on the day to engineering operations and maintenance tasks. These checks includes detailed procedures audits training of operators training of end users measurement and monitoring of all the KPI's on process control charts on a daily basis.

CONCLUSION
So here we can conclude that the six sigma process was
successfully implemented in the hospital

L.H Hiranandani is one of the most famous hospital and

preferred by patients.