Lean Six Sigma

2549
ISBN 974-19-0840-7

: Lean Six Sigma

:

: .

: 2549

Lean Six Sigma

Six Sigma
Lean Six Sigma
4 1) 2)
3) Six Sigma
4) Lean Six Sigma
3 1)
2) 3)


Lean Six Sigma

57.4% 375.75%
30.4 % 120.7%

( 127 )
: Lean Six Sigma,
________________________________

Name
Thesis Title

: Mr.Sirasak Tepjit
: Evaluation Lean Six Sigma Implementation using System Dynamic
Modeling: Case study in the Hospital
Major Field : Industrial Engineering
King Mongkuts Institute of Technology North Bangkok
Thesis Advisor : Dr.Vithaya Suharitdamrong
Academic Year : 2006
Abstract
The objective of this research is to study the behaviors of the service process of the hospital
when the improvement policy, lean six sigma, will be implemented. The research methodology is
to use system dynamics for simulating the behaviors of the hospital system. The system consists
of appointment systems, medical units, outpatient department (OPD). The system dynamic model
presents how to integrate lean six sigma and guide the way to implement lean six sigma to the
service process of the hospital. The behaviors of the system studied were generated by four
policies. There are 1) current operation 2) implementation of lean production system to the
processes 3) implementation of six sigma quality management to the process and 4)
implementation of lean six sigma approach to the processes. The processes were evaluated by 1)
rate of process flow, the key performance indexes are operation cycle times and flow rate ratio 2)
productivity of staffs, the key performance index is productivity and 3) quality of service, the key
performance indexes are quality of service and perception of quality. The results of simulation of
system dynamics model are shown by graphs of the system behaviors. As the results shown,
average operation cycle time is reduced 57.4%, flow rate ratio be increased 375.75%, productivity
be increased 30.4%, quality of service be increased 120.7% from current operation by lean six
sigma approach. In conclusion, the system dynamics model can assist the administrators of the
hospital to make appropriate decisions on improvement policy deployment.
(Total 127 Pages)
Key words : Lean Six Sigma, System dynamics model

______________________________Advisor

. .
.

1
1.1
1.2
1.3
1.4
1.5
2
2.1
2.2
2.3 Six Sigma
2.4 Lean Six Sigma
2.5
3
3.1
3.2 Lean Six Sigma
3.3
3.4
3.5
3.6
4

1
1
2
2
2
3
5
5
19
34
43
47
57
57
57
60
67
72
74
77

 ()
4.1
5
5.1

5.2

6
6.1
6.2

77
87
87
94
109
109
110
111
117
125

2-1
2-2 Sigma
2-3
Six Sigma
2-4 Six Sigma
2-5
3-1 Core Disciplines
3-2 Consolidation
4-1

5-1 Cycle Time 4

1 48
5-2 Cycle Time
4 12
37 48
6-1

34
37
43
44
54
59
59
84
96

97
109

1-1
2-1
2-2
2-3
2-4
2-5
2-6
2-7
2-8
2-9
2-10
2-11
2-12
2-13
2-14
2-15
2-16
2-17
2-18
2-19
2-20
2-21
2-22
2-23
2-24
2-25
2-26

Casual Loop Exponential Growth

Exponential Growth
Casual Loop Exponential Decay
Exponential Decay
Casual Loop Goal-Seeking
Goal-Seeking
Casual Loop S-Shaped
S-Shaped
Casual Loop Oscillation
Oscillation
Casual Loop Diagram
Casual Loop Diagram
Stock and Flow Diagram
Stock and Flow Diagram

Kanban
Value Stream Map

3
5
6
7
9
9
10
10
10
11
11
12
12
12
14
14
15
15
17
19
20
21
23
24
28
32
35

 ()

2-27
2-28
2-29
2-30
2-31
2-32
2-33
2-34
3-1
3-2
3-3
3-4
3-5
3-6
3-7
3-8
3-9

Three Sigma
1.5
Sigma
Six Sigma

Lean Six Sigma

Lean Six Sigma

Process Loop
Operation Cycle Time Loop
Quality of Service Loop
Workload Loop
Workload/Staff Loop

3-10
3-11
Patients/Tasks Flow Structure
3-12
Hospital Management/Human Resource Structure
4-1
4-2 Patients/Tasks Flow Structure
4-3 Hospital Management/Human resource
Structure

35
36
36
41
42
43
47
48
58
60
61
62
63
64
65
66
67
69
70
71
78
79
80

 ()

5-1
5-2
5-3
5-4
5-5
5-6
5-7
5-8
5-9
5-10
5-11
5-12
5-13
5-14
5-15
5-16
5-17
5-18
5-19

(Current Run)
Cycle Time Workload Ratio
Cycle Time Workload

(Lean Run)

Six Sigma (Six Sigma Run)

Lean Six Sigma
(Lean Six Sigma Run)
Cycle Time
Flow Rate Ratio
Flow Rate Ratio
Outflow Rate
Productivity
Productivity
Productivity Workforce
Quality of Service
Quality of Service
Perception of Quality
Perception of Quality
(Net income)
Net income

88
89
89
90
91
93
95
97
99
99
100
101
101
102
104
105
106
107
107

1.1

Lean Manufacturing
(Toyota Production System)
5 1) 2) (Value Stream) 3) (Flow)
4) (Pull System) 5) (Perfection)
(Muda)

Six Sigma
Six Sigma (Variance)
Six Sigma

Six Sigma
Six Sigma

Toyota, General Electric, General Motor Motorola
(System Dynamics Model)


Six Sigma
Lean Six Sigma

4
1) 2)
3) Six Sigma

2
4) Lean Six Sigma
3 1) (Cycle Time)
(Flow Rate Ratio) 2)
(Productivity)3)
(Quality of Service) (Perception of Quality)

1.2

Lean Six Sigma

1.3
1.3.1 (System Dynamics Model)


1.3.2 Vensim
Dss Version 5.0b
1.4
1.4.1 Lean Six Sigma

1.4.2

1.4.3 (System Dynamics Model)

1.4.4

1.4.5
1.4.6
1.4.7
1-1

Lean Six Sigma

1-1
1.5
1.5.1


1.5.2 Lean Six Sigma

1.5.3
Lean Six Sigma

1.5.4

2.1
2.1.1


(, 2538)
(System Boundary) (Subsystem)
(Input) (Process) (Output)
(Feedback) (StairReynolds, 2001)

1. (Input) , , ,

2. (Process)

3. (Output)
4. (Feedback)


2-1

2-1 (Stair Reynolds, 2001)

6
Anbari (2004)

2-2

2-2 (Anbari, 2004)

1. (External supplier)
(Internal supplier) Input Supplier
Supplier
2. (Input)
hardware software
3. (Process) Input ,

4. (Output) ,
Application software
5. (Customer)

6. (Feedback)

2
1. (Static System)
Monte Carlo Simulation

7
2. (Dynamics System)

3
1. (Continuous System)

2. (Discrete System)

3. (Combined System)

2-3

2-3

(Stair Reynolds, 2001)
1. (Variables) (Decision Maker)

2. (Parameters)

2.1.2
(Characteristic) (Behavior)
(System Dynamics)
2

8
1. 2

1.1

10 -
1.2
(Feedback)
2. (Formal Model)

(Computer Simulation)
Forrester (1961) (System Dynamics)
(Characteristics) (Information Feedback)
(Model)



Coyle (1979)



(Feedback)
(System Thinking)
(Feedback)
(Loop)
2.1.3
(System Structure)
(Event)
(Sterman, 2000) 4
1. Exponential Growth
Exponential 2 Exponential Growth

9
10%
100 2 110 3 122.1 7
200 7 2 Exponential
100 2 2-4
2-5

money
interest rate

interest

2-4 Casual Loop Exponential Growth

Money
2M
1.5 M
1M

500,000
1

10

Money : Current

20

30

40
1

50 60
Month
1

70
1

80
1

90
1

100
baht

2 -5 Exponential Growth
2 Exponential Decay Exponential

2-6 2-7

10

Radioactivity
Separated Rate

attrition

2-6 Casual Loop Exponential Decay

Radioactivity
100
75
50

25
1

10

15

20

25

Month
Radioactivity : Current

Dmnl

2-7 Exponential Decay

2. Goal-Seeking
2-8
2-9
contracting time
clients becoming active

active clients
clients departing

average tenure
Clients
contracting

billable work
average caseload

marketing effort
marketing effort required

total hours

2-8 Casual Loop Goal-Seeking

11
Clients contracting
60
1

50
40
30

1
1

10
Year

20
0

Clients contracting : Current

12
1

14
1

16
1

18

20

Company

2-9 Goal-Seeking
3. S-Shaped S
Exponential

2-10 2-11
max net new mice rate

Mice

normal carrying capacity

net new mice

effect of density on survival

effect of density on survival function

2-10 Casual Loop S-Shaped

12
Mice
800
1

600

1
1

400
1

200
0

12

Mice : Current

18

24
1

30
36
Month

42

48
1

54

60
Mice

2-11 S-Shaped
4. Oscillation - (Cycle)
Sin ,
2-12 2-13
spring constant

position

force

Velocity

mass
acceleration

2-12 Casual Loop Oscillation

position
20

10
0
-10
-20
0

position : Current

12
1

16
1

20
24
Second

28

32
1

36
1

2-13 Oscillation

40
1

cm

13
2.1.4 (System Thinking)
(Information Feedback System)

(Forrester, 1961)
(System Dynamics)
(Feedback), (Stock) (Flow)
(Time Delays) (Non-linearity)

1) Feedback Structure 2) Casual Loop Diagram 3) Stock and Flow
Diagram
1. Feedback Structure

2. Casual Loop Diagram

(Coyle, 1979) Casual Loop Diagram Feedback Structure
4
1 (Variable)
2 Casual Link
3 (+) ()
4 Loop Loop Positive Loop Negative Loop
(Sterman, 2000)

14
Casual Loop Diagram 2-14

+
Populat ion

Birth Rat e
+

Deat h

Fractional Birth Rt ae

Av erge Lift ime

2-14 Casual Loop Diagram

Casual Loop Diagram 2-15
Casual Link1

Birth Rat e

+
Population

Loop
Positive (Reinforce) Loop
Loop
Negative (Balancing Loop)

2-15 Casual Loop Diagram

(Positive Loop)

2-14 Loop (Loop )

(Negative Loop)

15
2-14 (Loop )

3. Stock and Flow Diagram

Casual Loop Diagram Capture, Stock Flow
Dynamics System Theory Stock
Flow
Stocks (Accumulations)
Stock (Inflow)
(Outflow)
Stock and Flow 2-16

Inflow

Stock

Out flow

2-16 Stock and Flow Diagram

Stock

Inflow

Pipe Stock

Outflow

Pipe Stock
Valve
Sink Source Stock
Inflow
Outflow
Stock Stock and Flow diagram 2-17

pat ient

Inpatient

Discharge or deat h

2-17 Stock and Flow Diagram

16
2.1.5
1. Integration
Stock
Integration Integration

2. Differentiation
Calculus Slope
Y Stock Slope

3. Differential Equations
Differential Equations (Differential Equations)
Y = f(X)
First Order, Second Order, Third Order
Equations Laplace

2.1.6
Coyle (1979) 5

1 (Recognize Problem)

2 (Definition of Problems and System)

Casual Loop Diagram
3 Bright Idea Pet Theory

4 (Simulation Modeling)
5 (Sensitivity)
2
5A
5 B (Optimization)
2-18

17

2-18 (Coyle, 1979)

Sterman (2000) 5
1. (Problem Articulation)
1.1 (Theme selection)
1.2 (Key variables)
1.3 (Time horizon)

1.4 (Dynamics Problem definition)

18
2. (Formulation of Dynamics Hypothesis)
2.1 (Initial hypothesis generation)

2.2 (Endogenous focus)

(Feedback Structure)
2.3 (Mapping)
(Key Elements) , Model
boundary diagrams, Subsystem diagrams, Causal loop diagrams, Stock and Flow diagram, Policy
Structure diagrams
3. (Formulation of a Simulation Model)
3.1 (Specification) ,
3.2 (Estimation) ,

3.3 (Tests)
4. (Testing)
4.1 (Reference modes)

4.2 (Extreme conditions)

4.3 (Sensitivity)

5. (Policy Design and Evaluation)
5.1 (Scenario Specification)

5.2 (Policy design) ,

5.3 What if
5.4 (Sensitivity analyze)

19
5.5 (Interactions of policies)

2-19

2-19 (Sterman, 2000)

2.2 (Lean Manufacturing)
2.2.1
1940s
Taichi Ono Shigeo Shigo
(Just-In-Time: JIT) (Toyota Production
System: TPS)


Ford Herry Ford ..1900 John Craffic

20
Lean Manufacturing Sloan Management Review .. 1988
..1990 Jim Womack


Machine that Changed the World 5
1) 2) (Value Stream) 3) (Flow) 4)
(Pull System) 5) (Perfection) (Womack, 1990)
2-20

2-20 (Lee, 2003)

2.2.2 (Lean Perspective)


3

21
1. (Value Added Activity: VA)
5%
2. (Non Value Added Activity: NVA)
60%

3. (Necessary Non Value Added)

35%
2-21

Typical
Process

VA

NVA

Tradition ProcessVA
Improvement
Lean Thinking
Improvement

VA

NVA

NVA

Minor Improvement

Major Improvement

Time

2-21
(Tradition Process Improvement)
(Operation)



Waste Muda 7
1. (Overproduction)
Safety stock (Work-In-Process)

22
2. (Waiting)

(Just-in-time) .
3. (Transportation)

4. (Non Value Added Processing)

(Reworking)
(Debarring)
(Inspecting)

5. (Excess Inventory)

6. (Defects) 4

7. (Excess Motion)
,

2.2.3
Machine that Changed the World James Womack
5

The Nation Institute of Standard and Technology Extension Partnerships Lean Network
(Kilpatrick, 2003) A systematic approach to
identifying and eliminating waste through continuous improvement, flowing the product at the
pull of customer in the pursuit of perfection
5
1. (Value)

23
2. (Value Stream)

3.


4. (Pull System)
downstream

5. (Continuous Improvement)
Benchmark
Balance Score Card
2-22
Act. 1

Source

Act. 2

Act..n

Final Customer
Customer Order

Pull

Pull
Pull
Generate Flow

Pull

Time

2-22
2.2.4 (Lean Tools)
(Lean Tools) Green (2000) Toolkit
27 4

1. (Flow) Pull Production SchedulingKanban,
One piece Flow, 5s, Standard work, method sheet, Visual control, Total preventive maintenance,
Reliability maintenance, Preventive maintenance, Predictive maintenance
2. (Flexibility) Set up reduction,
Mixed model production, Smoothed production, Cross Trained workforce

24
3. (Throughput rate) Flow cell, Point of used
storage, Autonomation, Mistake Proofing, Self check Inspection, Successive check Inspection,
Line stop
4. (Continuous Improvement) Kaizen, Design of
Experiment, Root cause Analysis, Statistical process control, Team Based Problem Solving
Lean Toolkit 2-23

2-23 (Green, 2000)

2.2.4.1
1. 5 . Lean
(Work place)


.1

.2

.3
.4
.5

25
5.
, , Change Over,

2. (Set up Reduction)

3. (Production to Takt Time)

(Cycle Time) Takt Time Takt Time

Takt Time 1
(Customer Demand)
(Available time) Takt Time Standard Work
(Operator Cycle Time)
1 , /
(Load/Unload),

Takt Time

Takt Time 2-1
Takt Time =

Available Time
Customer Demand

(2-1)

Takt Time
8 480 30
10 5 435 60
26,100 450 Takt
Time 58

26
8

480

-30
()
-10
()
-5
()

435

435 x 60
= 26,100

26,100/450
= 58

Takt time
= 58

4. (Standardize Work)
,


Standard Work
(Work-in-process) (Lead Time)
WIP Visual
Management
5. (Method Sheets)

6. (Flow Cells)
Cycle Time
(Cell) (Line
Balancing) Cycle Time
Cycle Time
7. (Visual Control)

(Visual factory) (Display)

(Visual control)

27
(Visual tool)

(Shop floor) 5 .
Visual display


Lean Manufacturing
Visual
Control display

(Audio signal)


8. (One Piece Flow)
Cycle Time

9. (Mixed Model Production)

10. Point of Used Material

11. (Kanban) Pull Scheduling (Signal)

(Just-In-Time)
(Flow)
Kanban Lean

(Pull System) Kanban (Card), ,

(Container)
, , Kanban

28
(Project Flow)
Kanban
Kanban 2-24
KANBAN
Cell.###
Dep. A to Dep. B
Model xxx
Kanban size = xxx Pcs

2-24 Kanban
Kanban
(Visual pull system)
12. (Cross Trained Work Force)

13. (Mistaking Proofing) Poka Yoke

Poka Yoke
Poka Yoke
, limit switch checklists
14. (Autonomation)

15. Line Stop

16. (Self Check Inspection)

29
17. (Successive check Inspection)

18. (Smoothed Production Scheduling)

19. (Team Based Problem Solving)

20. (Continuous Improvement) Kaizen

Kaizen

(Innovation)

Kaizen
21. (Preventive Maintenance)


22. (Predictive Maintenance)

30
23. (Reliability Centered Maintenance)
Failure Modes and Effects Analysis

24. (Total Productive Maintenance: TPM)

(Overall Efficiency)



TPM
(Zero Break down)
(Zero Defect) (Zero Accident)
8 TPM
1. (Individual Improvement)


2. (Autonomous Maintenance)

3. (Planed Maintenance)

4.

5. (Initial Phase Maintenance)

6. (Quality Maintenance)

31
7. TPM

5 TPM

8. (Safety, Hygiene and Environment)

TPM

25. (Design of Experiment: DOE)

26. (Root Cause Analysis)

5 Whys
27. (Statistical Process Control)


27

Value Stream Mapping (VSM)

(Cycle times) (Down times)
(In-process inventory) (Material moves)
(Information flow path) (Current state)

32
(Future desired state)
VSM ,
(Womack , 1990)
Current state
Future state
Lean Value Stream Mapping
(Production associate)
(Operation schedulers) Supplier (Customer)
(Waste)
(Identify) (Eliminate)

2-25

2-25 Value Stream Map

2.2.5
(Kilpatrick, 2003)
3 (Operational) (Administrative)
(Strategic Improvement)

33



1. NIST Manufacturing Extension Partnership
40 Lean
1.1 Lead Time 90%
1.2 Productivity 50%
1.3 Work In Process Inventory 80%
1.4 80%
1.5 75%
2.
2.1
2.2
2.3 office
2.4 ,

2.5 Out-Sourcing
2.6 Turn over
2.7

3.
Lean

14 4
7
10 7
10% 20%
30% 40% Overhead
cost 11
(Cash Flow)

34
2.3 Six Sigma
2.3.1





2-1
2-1 (Snee, 2003)
Year (..)
1910
1920s
1930 1940s
1950s
1960s
1970 1980s
1980 1990s
1990 2000s
1990 2000s

Methodology
Principle of Scientific Management, Frederick
Taylor
Shewhart Quality Control
Sampling Inspection
Quality Circles
Quality Assurance
Statistic Process Control
Total Quality Management, ISO 9000
Process Reengineering
Six Sigma

Six Sigma
Motorola Corporation 80
Mikel Harry Bob Galvin
(Variance)

Six Sigma


(Cherry Seshadri, 2000)

35
Sigma () (Standard Deviation)
Sigma
(Normal Curve) 2-26

2-26 (Normal Curve)

20s Walter Shawhart Three Sigma
Zero defects
Three Sigma 2-27

2-27 Three Sigma

Six Sigma
(Shift) 2
1.5 (Breyfogel, 2003) 2-28

36

2-28 1.5
Sigma
Sigma 2-29

2-29 Sigma
Sigma
(Breyfogel , 2001) 2-2

37
2- 2 Sigma

Sigma
1
2
3
4
5
6
7

170
25
1.5
1 30
1
1
1

Six Sigma
Six Sigma (Anbari, 2004),
Six Sigma 3.4 defects per million
opportunities (DPMO) 99.9999966% Six sigma

(Organizations) (Technology) (Operation) (Process)
(Project) (Lucas, 2002).
Six Sigma
(Han Lee, 2002) (Key Idea)
(Standard Deviation, )
2

2-2
(y1 ,y 2,y3yn) = f(x1 , x2 , x3 ,xn )
(2-2)

f
yi
xi

(Dependent Variables)
(Independent Variables)

38
2.3.1
Six Sigma
Six Sigma (Behavior)
(Phenomena) (Problem-Solving Model)
Six Sigma DMAIC DMAIC
1. Define
1.1
1.2
1.3
1.4
1.5 (Milestone)

1.1
1.2 (Process Map)
1.3
1.4 (Project Plan)
2. Measure
2.1 (Defect) (Opportunity)
(Metrics) Critical- To-Quality (CTQ)
2.2 Defect /

2.3 Defect Opportunity

2.4 (Metric) DPOM (Defects per Million Opportunities)

DPOM

Defects
Opportunities

X 1,000,000

2.5 (Appropriate Areas)

2.6
2.7

(2-3)

39

2.1 (Metric)
2.2
2.3 (Current process signal level)
3. Analyse
3.1 (Hypothesis) (Casual)
3.2 (Vital Few)
3.3 (Validate hypothesis)

3.1 (Root causes)

3.2 (Gap)
4. Improve
4.1
4.2

4.3 (Standardize solution)

4.4 (Measure results)

4.1 (Solution definition)
4.2 (Implementation plan)
5. Control

5.1
5.2
5.3

5.1 (Best Practices)
5.2 (Process Capability)
2.3.2 Six Sigma

40
2.3.2.1
(Lehmann ,
1998) (Framework)

(Probability)
(Random Variation)
(Actual Data Set)





Six Sigma
Statistical Process Chart (SPC) Gauge
repeatability and reproducibility (Gauge R&R) Design of Experiment (DOE)
Failure Mode Effect Analysis (FMEA)
(Causes and Effect Diagram) (Emturk Yazici, 2000)
2.3.2.2 Six Sigma
Six Sigma
Total Quality Management (TQM) Continuous Quality Improvement (CQI)
Six Sigma
(Anbari, 2003)
Six sigma = TQM (or CQI) + Additional Data Analysis Tools + Stronger Customer Focus
+ Project Management + Financial Result
(2-4)
Six Sigma

(Breyfogle,
1999)
Six Sigma

41

(Linderman , 2003)
Cross Function Green Belt, Black Belt, Master Black Belt

Six Sigma 2-30

2-30 Six Sigma (, 2546)

2.3.3 Six Sigma (Key Elements of Six Sigma) 2
(HanLee, 2002)
2.3.3.1 Cost of Poor Quality (COPQ)
COPQ

2 10 5
5 Five Pieces Loss COPQ

42
(Rework) (Reject) (Scrap)
(Inspection) (Warranty) COPQ 4-8%
(Long Cycle times)
) (Over Quality)
(Late Delivery) 15-30 %
2-31

2-31 (HanLee, 2002)

2.3.3.2 Critical to Quality (CTQ)
CTQ
(Measure), (improvement)
(Control) COPQ
CTQ
2.4 Lean Six Sigma
2.4.1 Six Sigma
Six Sigma
2
,
5

43
Lean Six Sigma

Six Sigma Six Sigma

Six
Sigma 2-3
2-3 Six Sigma
(, 2547)
Lean

Six Sigma

1.
(Watse)

1.

2. (Value Stream)

2.
(Cross
Function)

3.
4.
5.
6. ,

7.

3.

4.
5.

6. 7

7.

44
2-3 ()
1.

2.

3.

1.

2.

3.

Six Sigma

2 2-4
2-4 Six Sigma (Rath
Strong, 2003)
Lean

(Best Practice)

2 6

1 3

Six Sigma

45
2-4 ()

DMAIC

2.4.2 Lean Six Sigma

Six Sigma
Lean Six Sigma (Rath Strong, 2003)
1. Value Stream Mapping
Lean Six Sigma
2. Lean Six Sigma

3.
5 .

Lean Six Sigma 2-32

2-32 Lean Six Sigma (Rath Strong, 2003)

46
Lean Six Sigma

DMAIC Six Sixma

1. Define
5
2. Measure Savser Al Jawini (1995)
3 1)
(Throughput rate) 2) (Work in process inventory) 3)
( Station utilization)
(2545) Lean
4 1) (Reliability) 2)
(Flexibility& Responsiveness) 3) (Asset)
4) (Cost)
3. Analyses Six Sigma
(Value Stream Mapping)
8
(Zinkgraf Snee, 1999)
1. Process Map
2. Cause Effects Analysis
3. Capability Analyses
4. Hypothesis Testing
5. Multi-Variable Analysis
6. Designs of Experiments (DOE)
7. Failure Modes and Effects Analysis (FMEA)
8. Control Plan
4. Improve
2.2.4
5. Control

47
2.4.3 Lean Six Sigma
Lean Six Sigma
2-33

2-33 Lean Six Sigma (George, 2002)

Lean

Lean Only Six Sigma

Six Sigma Only
Lean Six Sigma

2.4 (Literature Review)

Ahlstrom (1998)

(parallel) (Sequence) 3
1)
Zero defects 2) (Core Disciplines)
cell Multifunctional Team 3)

48
Functional
Team Continuous Improvement 2-3
Elimination of Waste
Multifunctional teams
Pull Scheduling
Vertical Information systems
Team Leader
Zero
Continuous Improvement
defect Delayering
Time spent adopting Lean production

2-34 (Ahlstrom, 1998)

27 (Green,
2000) 4


(, 2548)


(Arbos, 2000)






Productivity


An
Axiomatic Model (Houshmand Jamshidnezhad,
2005) (Process Variables:PVs)
Functional

49
Requirements(FRs) Design Parameters(DPs) An Axiomatic
Model


Six Sigma


(Goege, 2002)
Six Sigma
(Anbari, 2004)
Six Sigma Six Sigma
(Plant Operation System)

(Information System)( Han Lee , 2002)

Intelligent operation support system
Platform information system, Multivariate statistical process, Object-oriented
programming, data mining Internet Technology
Six Sigma


(Goal-Theoretic Perspective) (Linderman , 2003)
Six Sigma
Six Sigma (Measure- Analyse Improve - Control )
Operationalization Exploration Elaboration -Conclusion (De Mast, 2003)

50
Lean Six Sigma

4 (Djallal Gallouj,
2005) 1) 2)
- 3) 4)



(Output)

Lean
Six Sigma
(Gonzalez , 1997)
Perea TQM
Teamwork
(Simulation)
(Animation)



setup


(Sobeck Jimmerson , 2002) 2


admit
2

51

3


(Laursen, 2003)
Workload
25% 75%
31%

Lean Six Sigma

(Sterman, 2000)

Patient-centered simulation tools (Moreno ,1999)
3

(Holistic)
(Knowledge Management)

(Yim ,2004)
(Mental Model)





(System Dynamics)


(, 2002) 5
1) Supply Chain Delivery Reliability 2) Supply chain Responsiveness 3)Supply Chain

52
Flexibility 4)Supply Chain Cost 5)Supply Chain Asset Management Efficiency

(Van Ackere, 1997) 10 (1976-1986)
soft variables
hard model what if


Dynamics Lean Scorecard ( , 2003)
Balance Scorecard
Six Sigma
CMMI ( , 2005)
(Discrete-event) (Reiner, 2005)
Supply Chain
Supply Chain
(Customer-Oriented)

Supply Chain

(Postponement)




Feedback Loop

(Knowledge-based innovation) (MartinezMoyano Wadhwa, 2002)

53
Feedback process Employee
Workload, Employee Productivity, Perceived Quality Net Earning

54

x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x

x
x

x
x
x
x
x
x
x
x
x
x
x
x
x

x
x
x

Supply Chain

x
x
x
x
x
x
x
x
x

x
x

x
x
x

x
x
x
x
x
x
x
x
x
x
x

System Dynamics

Year
1996
Braiden&Morrison
Mabry& Morrison 1996
Reddy
1998
Naylor et.al
1999
Roberts
2000
White
2000
Perez&Sanches 2000
Blakemore
2001
Hines
2002
Herer
2002
Crute et.al.
2003
Laursen
2003
Bruun&Mefford 2004
Warnecke&H i i s e r b 1995
Kosonen&Buhanist 1995
Ahlstrom
1998
Reid&Koljonen 1998
Chethan
1999
Ayesh
2001
Sullivan et.al.
2002
Lian&Van Landeg 2002
Adrian&Coronado 2002
Momme
2002
Rasch
1998
Shah&Ward
2000
Arbos
2002
Laursen et.al.
2003
Kojima&Kaplinsk 2004

Six Sigma

Author

Process Improvement method

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

2-5

Lean

x
x

x
x

x
x
x
x
x

x
x
x
x
x
x
x
x

x
x

x
x

x
x
x

55

56
57

x
x

x
x

x
x

x
x
x

x
x
x

2002

x
x
x
x
x
x

x
x
x
x
x
x

x
x
x
x
x

x
x

x
x

x
x
x
x
x
x
x

x
x
x
x
x

x
x
x

x
x

x
x
x

x
x
x

2003

2005

2005

x
x

x
x
x
x

x
x

x
x

x
x
x

x
x

Supply Chain

&

x
x

x
x

System Dynamics

x
x
x
x
x
x
x
x
x
x

54

x
x

Six Sigma

Year
Hill
1997
2000
Woitas&Willemson
Enturk&Yazici
2000
Barringer
2000
Han&Lee
2002
Linderman
2003
Kaliher
2003
Abdelhamid
2004
Anbari
2004
Rauner et.al.
2002
2003
Martinez&Wadhwa
Caulfield&Maj
2002
Harris
2000
Matsumoto
1999
Angerhofer&Angelides
2000
Sobeck&Jimmerson 2002
Houshmand&jamshidezhad
2005
De mast
2003
Gonzalez et.al.
1997
Djallal&Gallouj 2005
Van Arkere
1997
Reine
2005
Yim et.al..
2004
Lane et.al.
2001
Wolstnholme et.al. 2004

55

Author

Process Improvement method

No.
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53

Lean

2-5 ()

56

3.1
3.1.1 Lean Six Sigma

3.1.2
3.1.3 (System Dynamics Modeling)
3.1.4

3.1.5
3.1.6
3.1.7
3.2 Lean Six Sigma
(2005) 27 (Green, 2002)

3-1

58

Strategic Level
Tactical Level
Production To Takt Time

One-Piece-Flow

Flow cells

Point of used material storage

Pull Production Scheduling

Dynamics System

Autonomation Mistake Proofing Self Check Inspection Successive Check Inspection

Line Stop

Set up Reduction

Smoothed Production Schedule

Operation Level
Mixed Model Production

Reliability Centered Maintenance

Predictive Maintenance

PM

TPM

Cross Trained Workforce

Static System

Root Cause Analysis

5S

DOE

SPC

Team Based Problem Solving

Kaizen

Method Sheets

Standard Work

()
Six Sigma Principle D-M-A-I-C

3-1 (, 2000)

Visual Control

59

Six Sigma
Lean Six Sigma 3
1 Core Disciplines Lean
Lean 3 31
3-1 Core Disciplines

1. (Pull System)
Pull Scheduling (Kanban)
2. (Continuous Flow)
One piece flow, Flow cell, Self check
Inspection, Successive Check Inspection
3.
Set up Reduction, Smoothed Production
(Flexibility)
Schedule, Point of Used material, Mixed
Model Production, Mistake Proofing, Cross
trained Workforce
2 Consolidation
3-2
3-2 Consolidation

1. (Standard Work)
5s, Standard work, Method sheet, Visual
Control, Takt Time
2. (Stability)
Six Sigma Tools- Process map and Metrics,
2.1.
Cause effect Analysis, Capability Analysis,

Design Of Experiment Hypothesis Testing,

Failure Mode Effect&Analysis, Multi Variable,
Control plan
2.2 Total Preventive Maintenance, Reliability

Centered Maintenance, Preventive

Maintenance, Predictive Maintenance

60
3 Continuous Improvement Kaizen, Team
based Problem solving, Six Sigma Method
3.3
3.3.1 (Causal Loop Diagram)

3-2

Patient's
satisfaction +

+
Trust of process

R1

Treated patients

+
Incoming Patients

Patient in
Process

3-2 Process Loop

Loop R1-Process Loop
(Incoming Patients)
(Patient in Process)
(Patients satisfaction)

(Trust of process)

61
1
(Operation cycle time) 3-3
Patient's
satisfaction +
+
Trust of process
R1

Treated patients
+
-

+
Incoming Patients
+

Patient in
Process
+

Tasks per patient

+

Tasks in
process

B1

Operation cycle
time
+

+ Workload

3-3 Operation Cycle Time Loop

Loop B1- Operation Cycle Time
(Tasks in process)
Workload
Workload

Process Loop
Workload

62
2 (Quality of services)
3-4
Patient's
+ satisfaction +
+
Trust of process
R1
Perception of
services
+

Treated patients
+

+
Incoming Patients
B2

Quality of service
-

Patient in
Process
Tasks per patient
+

Workload +

Tasks in
process

3-4 Quality of Service Loop

Loop B2-Quality of Service
Workload


Workload

3-3 3-4 2 Process Loop

Workload Operation Cycle Time Quality of Service
3-5

63
Patient's
+ satisfaction +
+
Trust of process
R1

Perception of
services
+

Treated patients
+

Incoming Patients
B2

Quality of service
-

Patient in
Process
Tasks per patient
+
+ Tasks in

B1

Operation cycle
time
+

process
+
Workload

3-5 Workload Loop

Workload (Key Element)
Operation Cycle Time Quality
of Service Workload
([Martinez-Mayano Wadwa, 2001)
Workload 3-6

64
Patient's
+ satisfaction +
+
Trust of process
R1
Perception of
services
+

Treated patients
+ -

+
Income

Incoming Patients
B2

Quality of service
-

Tasks per patient

Patient in
Process
+

B1

Tasks in
process
+

Time to change
inexperience to
experience

+ Workload
-

+
Ability to Train
Operation cycle
staffs
time
+
R2

Total staffs

Experienced staffs
R3
devoated to training
+

3-6 Workload/Staff Loop (MartinezMayanoWadhwa,2001)

3-6 Workload
(Staff)
(Income)
Workload
Operation Cycle Time Quality of Service
3.3.2 (System Dynamics Modeling)
Moreno (1999)
Reduction techniqueSubsystem Modeling
3
1 (Dynamics Model)
2

65
3 (Hospital
Management)
2 (Human Resource Management)
3 (Hospital Management)
3-7
Input
(Patient)

Input
(Contract)

Dynamic model of the

hospital
Static model of
human resource

(Patient flow through

hospital units)

Subsystem 1

Subsystem 2

Control
actions
Up date

Output
Interal system
variable

Hospital
Management

Output (Staff)

Subsystem 3

3-7 (Moreno, 1999)

Martinez-Mayano Wadhwa (2001)
5 (Sector)
1. (Operation)
(Administrative and operational standards) (Capacity)
(Quality of Service) (Resource load Balance)

66
2. (Community)
(Reputation and trust) (Quality Perception),

3. (Human factor)

4. (Financial)
5. Knowledge-Based
Innovation Projects 3-8
3-9
Operation
Administrativ
e and
operational
standards
Capacity
Quality of
Service
Resource load
Balance

Human Factor
Administrative staff
Doctors
Skills&Knowledge
Stress&Motivation
Training
Workload &
Productivity
Culture

Community
Satisfaction Service
New Insights

New Knowledge

Development Project
(Knowledge-Based Innovation)

Patients
Referring Doctor
Insurance co.
Reputation and
trust
Quality
Perception
Professional
Assoc.

Change Programs
Administrative
Improvement
Doctors involvement
Intensity of projects
Intelligence generation

Financial
Synergy
Funding
Capacity

Cash flow
Investments
Profitability
Sustainability

Recognition of Effort

3-8 (Sector Diagram) (Martinez

Mayano Wadhwa,2001)

67
Cash on
hand

Cash in
Potential Investment
in Capacity

Cash out
Variable
operation costs

Income
Total Number of
Procedures/quarter

Capacity
Unhappy Patients

Unsatisfied
patients

Total Number of
Patients Served

Patients
incoming patients
Completion of
pateints

Satisfied
patients

bad word of
mount
Word of Mount

Trust
Patients per unit of
capacity

Net incsease in
referal Base

Refering
Doctors

Effect of Trust

Net trust Change

Trust Normal
Time for trust to
breakdown

3-9
(Martinez-Mayano Wadhwa,2001)
3.4

..
2544 3,000
1,200 400-500
- 400-500 200-250
200-250 350-400 250-300

68



7.00 . 12.00 . -
600 25-30
40 3-13
30
120

3
1 4
1.

2.
3.
4.
2 4
1
3
3-10

69

Check in

Check in

Lab

Lab

3-10

(Martinez-Mayano Wadhwa, 2001) 3-9

(Patients/Tasks Flow Structure)

(Co-Flow) Workload

70
Cycle Time
3-11
(Hospital Management/Human Resource Structure)
3-12
Patients in
Process

Inflow Rate

Outflow Rate

Incoming Patients

Avg.PIP to
tasks

Avg.Tasks/patient

Tasks
Incoming Task

Total productive
staffs

Completion rate

Workload
Cycle Time

Workload Ratio
Normal Workload

Effect of Workload
on Cycle time

Initial cycle time

3-11 Patients/Tasks Flow

Structure (Martinez-Mayano Wadhwa, 2001)
Patients/Tasks Flow
Structure
(Co-Flow) (Inflow Rate)
(Incoming Tasks)
(Stock) Tasks Workload
(Cycle Time) Cycle Time (Completion Rate)
Completion Rate
Feedback Loop

71
Cycle Time, Completion Rate, Tasks, Workload, Workload Ratio, Effect of
Workload on Cycle time Cycle Time
Increase staff
Avg.time to get
Providing Training
experince/staff

Total productive
staffs

Inexpereince
Staff
New hiring

Gaining
Experiance

Experienced
Staff

Pressure to
reduce Staff

Reduction in Staff
Training

Staff moving to
training function

Experiented
Staffs
(Training)

Quitting
Total Staffs

Raito of Avg.
Quarterly to Min
Reqd

<Total productive
staffs>

Lenght of
Employment

Avg. Quarterly
Profit
Net Change in
Quarterly Porfits

Total Staff Cost

Other Cost
Net income

Min. Reqd
quarterly profit

Adjustment time for

Quarterly Profits

Estimated
Quarterly Profits

Total Revenue

Months Per
Quarter
Baht/Patient

Avg.Salary per staff

per month

<Outflow Rate>

3-12 Hospital
Management/Human Resource Structure (Martinez-Mayano
Wadhwa, 2001)
Hospital
Management/Human Resource Structure
Stock and Flow
(New hiring)
(Inexperience Staffs)

(Experienced Staffs)
(Quitting)
Experienced Staffs
(Training) (Experienced Staff(Training))
Inexperienced Staffs Experienced Staffs
(Total Productive Staffs)
Total Productive Staffs Workload

72
Patients/Tasks Structure Feedback Loop Loop
Experience Staffs Experienced Staff, Quitting, New hiring, Inexperienced
Staffs, Gaining Experienced Experienced Staffs
3.5
(Stock)
(Forrester,1961)
(Sterman,
2000)
1. (Stock)
Integration
(Inflow Rate) (Outflow Rate)

(Stock) = INTEG(-,
)
(3-1)
INTER(Inflow rate-Outflow rate,0)
2. (Flow)(Auxiliary)

2.1
= *
(3-2)
Current Quality of Service = Quality of Service normal*Effect of Workload
On Quality
2.2
= /
(3-3)
Workload ratio = Workload/Workload normal
2.3
= /
(3-4)
Gaining Experience = Inexperience staff / Avg. time to get experience/staff
2.4
= (1)+( 2)
(3-5)

73
Total Productive staff = Experience staffs + Inexperience staffs
2.5
= (1)-( 2)
(3-6)
Net income = Total revenue-Total staff Cost
2.6
= (1)*( 2)
(3-7)
Incoming tasks = Inflow rate * Avg.tasks/patient
2.7
= (1) / (2)
(3-8)
Workload = Tasks/Total productive staffs
2.8 (Fuzzy Min Function)
1
= MIN( (1),(2))
(3-9)
2.9 (Fuzzy Max Function)
1
= MAX( (1),(2))
(3-10)
2.10
= XIDZ( (1),(2)(1)/(2)
(2) = 0)
(3-11)
Avg.tasks/patient = XIDZ (Avg.tasks/patient normal, Number of tasks/cell,
Avg.tasks/patient normal)
2.11 (IF THEN ELSE)
= IF THEN ELSE ( ,,) (3-12)
No.Service Channel = IF THEN ELSE (Number of Tasks per cell=0,1,3)
2.12 Table Function
(Nonlinear
Relationship) Table Function Lookup
y = Effect X on Y
(3-13)
Effect X on Y = Table for Effect X on Y(x)

74
f

Effect X on Y(x) = (X1,Y1),(X2,Y2)(Xn,Yn)

Effect of workload on Quality = f effect of workload on Quality(Workload)

f effect workload on Quality=[(0,0)-(20,2)](0,1.2),(2,1.2),(4,1.17),..(20,0.15)
3.6
3.6.1 (Sterman, 2000)
1. (Unit)

2.


Simulation
3. Integration
Stock
4. Integration Integration
2 Euler Integration Runge-Kutta Integration
Euler

Runge-Kutta Integration

3.6.2



Forester (1961)
A correct model does not a valid model



1.

75
2.
3.
4.
4.1
4.2
4.3
5.
6.
7.
7.1
7.2
7.3
8.

Vensim Dss Version 5.0

1.

2.

4.1

5 sector (Martinez-Mayano
Wadhwa, 2001) 3 (Moreno, 1999)
(Reference Model)


(Patient Flow) (Perception of Quality) Key
elements 1.Operation Cycle Time 2.Workload Ratio 3.Flow Rate Ratio 4.Quality of
Service
1 (Dynamic model of the hospital)
1. (Operation) (Capacity) ,
( Quality of Service) (Patients Flow) 2.
(Community)
2 (Human resource) 1.Human factor
(Training), (Skills & Knowledge)
Workload
3 (Hospital Management)


, Six Sigma Lean Six
Sigma

78

Input Patients
Human Resource

Dynamic Model

Human factor

Operation

Training
Skills&
Knowledge
Workload

Productivity
Cycle Time
Quality of
Service
Patient Flow

Subsystem 2

Subsystem 1

Hospital Management
Development Project

Subsystem 3

Implementation of Lean Six

Sigma policy
Implementation of Lean
manufacturing
Implementation of Six
Sigma quality management

4-1 (Reference Model)

4-1
Patients/Tasks Flow Structure 3-10

4-2
Patients/Tasks Flow Structure
Six Sigma 4-3
Hospital Management/Human resource Structure
(Capacity)

Patients in
Process

Incoming Patients
Inflow Rate

Outflow Rate

Adjustment Flow
Rate

Flow Rate Ratio

Avg.task/pateint
normal
<Experienced
Staff>

Number of Tasks
per cell

<Inexpereince
Staff>

Avg.PIP to
tasks

Avg.Tasks/patient

Adjustment time for

improing Flow rate

Tasks
Incoming Task

Total productive
staffs

Completion rate
No.of Service
Chanels

Workload

Cycle Time

<Total Staffs>

Productivity
Productivity
Workforce

Perception of
Quality

Takt Time

Workload Ratio
f effecf of Total
Productive staff
toProducivity

Adjustment Time For

Perception of Quality

Effect of Workload
on Cycle time

Initial cycle time

Quality of services

Quality Services
Normal

Effect of Workload
on Quality

Normal Workload
<Working hours>

<f Effect of workload

on Quality>

4-2 Patients/Tasks Flow Structure

<Raito of Avg. to
Desired Level of
Training>

pressure to increase
training staff
f pressure to increase
Avg.time to get
training staffs
experince/staff

Staff moved to
Training

Adjustment time
for moving staff

New hiring

Gaining
Experiance

Experienced
Staff

Min. Reqd
quarterly profit

Staff moving to
training function

Raito of Avg. to
Desired Level of
Training

Experiented
Staffs
(Training)

Initial Staffs
training
Lenght of
Employment

Avg. Quarterly
Profit
Net Change in
Quarterly Porfits

Other Cost

Adjustment time for

Quarterly Profits

Total Staffs

Staff Learning
Total productive
staffs

Total Staff Cost

Total Revenue
Months Per
Quarter
Baht/Patient

Level Staff of
Training

Increase in Training
benefits

Net income

Estimated
Quarterly Profits

<Training Benefit lost

when staff leaves>

Avg. Training per

employee

Quitting

Pressure to
reduce Staff

desired Training
Level

Pressure to Reduce
Training Staff
Reduction in Staff
Training

Increase staff
Providing Training
Inexpereince
Staff

Raito of Avg.
Quarterly to Min
Reqd

Total experienced
staffs

fraction of experienced
staff in Training

fraction of experienced
staffs desired in training

<Trainer training
Productivity>
Avg.Salary per staff
per month

<Outflow Rate>

<Time for Learning

to sink in>

Trainer Cost per

level

Trainer Cost

4-3 Hospital Management/Human resource Structure

81
4.2
(Simulation) (Model)

(,
2002)

Lean Six Sigma

Six Sigma

4.2.1

4-2 4-3

1. (Current Run)
2. (Lean Run)

2.1 (Value
Stream)
2.2

2.3

2.4

82

3. Six Sigma (Six Sigma Run)

Six Sigma
3.1
D-M-A-I-C,

3.2
3.3 Six Sigma,

Six Sigma
,

4. Lean Six Sigma (Lean Six Sigma Run)

Lean Six Sigma
Six Sigma
4.1
,
4.2
D-M-A-I-C,
4.3 ,
,

4.4

(Cross Function)

83
4.5
Lean Six Sigma
,

4.2.2
1)
2) 3)

(Outflow Rate)
Completion Rate Adjust Flow Rate Feedback Loop
Completion Rate 81 Loop Loop
Completion Rate Completion Rate, Outflow Rate, Flow Rate Ratio, Perception of
Quality, Increase Staff Providing Training, Staff moving to training Function, Experienced Staffs,
Total productive Staffs, Normal Workload, Effect of Workload on Cycle Time, Cycle Time
Completion Rate

(Holistic) (Input)

1. No.Of Tasks per Cell
4
Lean
No. of Tasks per cell 4
Workload Cycle Time

2. Initial Staffs Training

3. fraction of Experienced staffs desired in training

Feedback Loop
(Perception of Quality) Lean Six Sigma

84
Feedback Loop
Perception of Quality

4. Desire Training Level

Lean Six Sigma 100%
0
5. Trainer Training Productivity
Desire Trainer Training Productivity

4-1
4-1

Trainer
Desired
No.of Tasks Initial Staffs Fraction of
Training
Training
per Cell
Training
desired

Productivity
Level
in Training
Current Run

Lean Run

0.3

50

50

0.4

75

75

12

0.5

100

100

Six Sigma
Run
Lean Six
Sigma Run

4.2.3


3
1.

1.1 (Cycle Time)

1.2 (Flow Rate Ratio)

85
2.
2.1 (Productivity)

3.




3.1 (Quality of Services)
3.2 (Perception of Quality)

86

Vensim Dss version 5.0b 4

1) 2)
3) Six Sigma
4) Lean Six Sigma
2 1
2

5.1
(Key Elements)
1) (Flow Rate Ratio) 2) (Workload
Raito)3. (Cycle Time) 4. (Quality of Services)
5.1.1 4 (Current Run)
5-1

88
Key Elements
2
100
30
2

Dmnl
Dmnl
Min
Quality

Dmnl
Dmnl
Min
Quality

2
1

Flow Rate Ratio : Current Run

Workload Ratio : Current Run
Cycle Time : Current Run
Quality of services : Current Run

1
3

0
0
0
0

12

18
1

4 1

4 1

24
30
Month

36

42

48

1
3

4
1

1
3

1
3

1
3

Dmnl
Dmnl
Min
Quality

5-1

5-1
1. Cycle Time 3 23- 25
Workload Ratio 2
Cycle Time 24.57
Cycle Time Workload Ratio 5-2
5-3
2. Workload Ratio 2
(Slope)
48 1.67 Workload Ratio 42 42%
Normal Workload
3. Flow Rate Ratio 1
0.0076 48
120
25.6
4. Quality of Service 4
5 0.15

89
Workload Ratio 18 0.01 Quality of Service
0.56
Normal Workload
Effect of Workload on Cycle time
Workload Ratio

Cycle Time

Initial cycle time

5-2 Cycle Time Workload Ratio

Cycle Time Initial Cycle Time Effect of
Workload on Cycle Time Effect of Workload on Cycle Time
Normal Workload Workload ratio
5-3
Cycle Time&Workload Ratio
30
30
150
150
150

Min
Min
Dmnl
tasks/(staff*day)
Dmnl

4
2

20
20
0
0
0

Min
Min
Dmnl
tasks/(staff*day)
Dmnl

4
3

2 3

5
3

12

18

24 30
Month

36

42

48

Initial cycle time : Current Run

1
1
1
1
1
1 Min
Cycle Time : Current Run
Min
2
2
2
2
2
Effect of Workload on Cycle time : Current Run
Dmnl
3
3
3
3
Normal Workload : Current Run
tasks/(staff*day)
4
4
4
4
Workload Ratio : Current Run
5
5
5
5
5
5 Dmnl

5-3 Cycle Time Workload

5-3 4 Normal
Workload

90
5 Workload Ratio
3 Effect Workload Ratio on Cycle Cycle Time
Cycle Time

5.1.2 4
(Lean Run) 5-4
Key Elements
2
100
30
2
0
0
0
0

Dmnl
Dmnl
Min
Quality
Dmnl
Dmnl
Min
Quality

4
3

Flow Rate Ratio : Lean Run

Workload Ratio : Lean Run
Cycle Time : Lean Run
Quality of services : Lean Run

1
1

4
1

12

18
24
30
Time (Month)

1
3

1
3

4
1

36

1
3

42

Dmnl
Dmnl
Min
Quality

5-4
(Lean Run)

5-2
1. Cycle Time 3 5-13
Workload Ratio Cycle Time
12.8
2. Workload Ratio 2 2-4
30 0.136 30 48
0.08 Workload Ratio 3.99 1%Normal Workload
3. Flow Rate Ratio 1
4 1 1 6

91
Cycle Time 2 6 18
Cycle Time 1 4 18 36
1 2 Cycle Time
4 115.54

4. Quality of Service Flow

Rate Ratio 4 1 1
3 2 3 18
Quality of Service 0.8 3
18 36 Flow Rate Ratio
4 36 48
Quality of Service 1 Quality of Service 0.9
5.1.3 4
Six Sigma (Six Sigma Run) 5-5
Key Elements
2
100
30
2

Dmnl
Dmnl
Min
Quality

3
4

0
0
0
0

3
4

3
4

Dmnl
Dmnl
Min
Quality

1
12

Flow Rate Ratio : Six Sigma Run

Workload Ratio : Six Sigma Run
Cycle Time : Six Sigma Run
3
Quality of services : Six Sigma Run

12
1

18
1

24
30
Month
1

1
3

36
1

42
1

48

Dmnl
Dmnl
Min
3
4 Quality

5-5 Six
Sigma (Six Sigma Run)

92

Six Sigma 5 -5
1. Cycle Time 3 17-22
6
6 Cycle Time
21.8
2. Workload Ratio 2
12
12 14 Normal Workload Workload
Ratio 12.58 27% Normal Workload
3. Flow Rate Ratio 1
Workload Ratio 24 1
99.4
4. Quality of Service 4
Flow Rate Ratio 3
3 24 24 48 1.2
Quality of Service 1.13
5.1.4 Lean Six Sigma
5-6

93
Key Elements
2
100
30
2

Dmnl
Dmnl
Min
Quality
3

0
0
0
0

Dmnl
Dmnl
Min
Quality

4
1

12

Flow Rate Ratio : Lean Six Sigma Run

Workload Ratio : Lean Six Sigma Run
Cycle Time : Lean Six Sigma Run
Quality of services : Lean Six Sigma Run

12

18
1

1
3

42
1

1
3

36

1
3

24
30
Month
1

48

Dmnl
Dmnl
Min
Quality

5-6 Lean Six Sigma

(Lean Six Sigma Run)
Lean Six Sigma
5-6
1. Cycle Time 3 5-15
6
36 48 Cycle Time 12.30 Cycle Time
10.9
2. Workload Ratio 2
6
4 Normal Workload Workload Ratio
4 1% Normal Workload
3. Flow Rate Ratio 1
2 1 12
2 12 1
Flow Rate Ratio 1.2 117
4. Quality of Service 4
Flow Rate Ratio 3 1
3 2 6 24

94
1 3 24 48
Quality of Service 1.4 Quality of Service
1.28

4 Cycle Time
Workload Ratio Flow Rate Ratio Quality of Service
Workload Ratio Cycle Time Flow Rate
Ratio Quality of Service

5.2

3 4.2
1.
1.1 (Cycle Time)
Cycle Time 4 5-7

95
Cycle Time
40
1

20

1 3

2 4

1 3

2 4

0
0

12

Cycle Time : Current Run 1

Cycle Time : Lean Run
2
Cycle Time : Six Sigma Run
3
Cycle Time : Lean Six Sigma Run

18
1

24
30
Time (Month)
1

1
3

1
3

36

1
3

42

1
3

48
1 Min
3

Min
Min
Min

5-7 Cycle Time

Cycle Time
4 5-7
1 (Current Run)
23-25 24.57
(Standard Deviation : SD) 0.68 12
37 48 Cycle Time
25.25 0.34
2 (Lean Run)
5-15 12.8
47.9 % 2.52



12 Cycle
Time 10.15 59.8 %
0.53

96
3 Six Sigma
(Six Sigma Run) 17-22
21.8 11.14%
0.93 Six Sigma

12 Cycle Time
21.4 15.2 %
0.05
4 Lean Six Sigma (Lean Six
Sigma Run) 5-15
10.9 55.57 %
1.87 12
Cycle Time 7.88 68.71%
0.28
Cycle Time
5-1 12
5-2
5-1 Cycle Time 4
1 48
Avg.Cycle Time
()

Cycle
Time (%)

SD

Current Run

24.57

0.68

Lean Run
Six Sigma Run

12.8
21.8

-47.9
-11.14

2.52
0.93

Lean Six Sigma Run

10.9

-55.57

1.87

97
5-2 Cycle Time 4
12 37 48
SD

()

Cycle
Time (%)

25.25
10.15
21.4
7.88

-59.8
-15.2
-68.71

0.34
0.53
0.05
0.28

Avg.Cycle Time
Current Run
Lean Run
Six Sigma Run
Lean Six Sigma Run

Cycle Time 5.1

1.1 (Flow Rate Ratio)
Flow Rate Ratio 4
5-8
Flow Rate Ratio
2

1
2

4
3

2 4 2
34 2 34 2 34 23 4 23
3

2 4
3

4
3

12

Flow Rate Ratio : Current Run

Flow Rate Ratio : Lean Run 2
Flow Rate Ratio : Six Sigma Run
Flow Rate Ratio : Lean Six Sigma Run

18
1

24
Month
1

1
3

30

36
1

1
3

42

1
3

48

Dmnl
Dmnl
Dmnl
Dmnl

5-8 Flow Rate Ratio

Flow Rate Ratio
4 5-8
1 (Current Run)
(Slope) 0.0076
(Outflow Rate)

98
25.6 (Inflow Rate) 120

2 (Lean Run)
4 1 1 6
0.13 2 6 18
0.023 Cycle Time
1 4 18 36
1 2 Cycle Time 4
115.54
3 Six Sigma (Six
Sigma Run) 24
0.04 1
99.4
4 Lean Six Sigma (Lean Six Sigma
Run) 2 1 12
0.085 2
12 1
0 Flow Rate Ratio 1.2
117

5-3
5-3

Avg.Outflow Rate()
Current Run
Lean Run
Six Sigma Run
Lean Six Sigma Run

25.6
115.54
99.4
117

(Influence) Flow Rate Ratio

5-9

99

Inflow Rate

Incoming Patients

Adjustment Flow Rate

Flow Rate Ratio

Outflow Rate

Avg.PIP to tasks

Completion rate

5-9 Flow Rate Ratio

Flow Rate Ratio
5-9 Flow Rate Ratio (Outflow Rate)
(Inflow Rate)

(Adjustment Flow Rate), (Completion Rate)
(Avg.PIP to Tasks) Cycle Time Outflow Rate
5-10
Adjustment time for improving Flow rate
Avg.Tasks/patient

Adjustment Flow Rate

Productivity Workforce
Patients in Process
Avg.PIP to tasks

Outflow Rate

(Tasks)
Tasks
Cycle Time

Completion rate

No.of Service Chanels

5-10 Outflow Rate

Outflow Rate 5-8
Cycle Time Flow Rate Ratio Outflow Rate
Outflow Rate Completion Rate Cycle
Time Cycle Time Completion Rate Outflow Rate

100
Flow Rate Ratio
(Productivity Workforce), (No.of Service Channels)
2.
2.1 (Productivity)
Productivity 4 511
Productivity
1
1

12

12

12

3
1

4
2

2
1

0.5

0
0

Productivity : Current Run

Productivity : Lean Run
2
Productivity : Six Sigma Run
3
Productivity : Lean Six Sigma Run

18
1

24
Month
1

1
3

30

1
3

36

1
3

42
1
3

48

Dmnl
Dmnl
Dmnl
Dmnl

5-11 Productivity
Productivity
4
1 (Current Run)
1 48 0.68
2 (Lean Run)

1 24 24 48
0.79
3 Six Sigma (Six
Sigma Run)
1 36 0.86

101
4 Lean Six Sigma (Lean Six Sigma
Run)
1 48 0.96
Productivity
Productivity 5-12
Total productive staffs
Productivity Workforce
Total Staffs

Productivity

f effecf of Total Productive staff toProducivity

5-12 Productivity
Productivity
5-12 (Productivity
Workforce) Effect of Total Productive staff to Productivity Productivity
Workforce
Productivity Workforce 5-13
Experienced Staff
Total productive staffs
Inexpereince Staff
Productivity Workforce
Experiented Staffs (Training)
Total Staffs
(Total productive staffs)

5-13 Productivity Workforce

102
Productivity Workforce
5-13 Total Productive staffs
(Experienced Staffs)
(Inexperienced Staffs) (Total Staffs) Total Productive
Staffs (Experienced Staffs (Training)) Productivity
Productivity Workforce
(Training)

3.
3.1 (Quality of Services)
Quality of Service 4
5-14
Quality of services
2

1
2

3
12

4
1 2

1 2

4
3

0
0

12

Quality of services : Current Run

1
Quality of services : Lean Run
Quality of services : Six Sigma Run
Quality of services : Lean Six Sigma Run

18

24
Month
1

1
3

30

36
1

1
3

42

1
3

48

Quality
Quality
Quality
Quality

5-14 Quality of Service

Quality of Service
4
1 (Current Run)
3 1 5 Quality of Service 0.7969
0.16 2 5 30 Quality of
Service 0.5833 0.009 3

103
30 48 Quality of Service 0.3178
0.015
2 (Lean Run)
4 1 4 Quality of
Service 0.8418 0.21 2
4 13 Quality of Service 0.77
0.008 3 13 36 Quality of Service 1.028
0.011 4 36 48
Quality of Service 1.061 0.003
3 Six Sigma (Six
Sigma Run) 3 Quality of Service
1 3 Quality of Service 0.9299
0.309 2 3 24 Quality of Service
1.18 0.012 3 24
48 Quality of Service 1.218 0.0016
4 Lean Six Sigma (Lean Six Sigma
Run) 3 Quality of Service
1 3 Quality of Service 0.9889
0.329 2 3 24 Quality of Service
1.354 0.017 3 24
48 Quality of Service 1.478 0.005
Quality of Service
Productivity 5-15

104

Workload Ratio
Effect of Workload on Quality
f Effect of workload on Quality
Total productive staffs

Quality of services
Productivity Workforce

Total Staffs
Quality Services Normal

5-15 Quality of Service

Quality of Service
5-15 Quality of Service


Workload Ratio Workload Ratio Quality
of Service Workload Ratio
Productivity Workforce


3.2 (Perception of Quality)
Perception of Quality 4
5-16

105
Perception of Quality
2

4
4

0
0

12 3

23
1

12

18

Perception of Quality : Current Run

1
Perception of Quality : Lean Run
2
Perception of Quality : Six Sigma Run
Perception of Quality : Lean Six Sigma Run

24
Month
1

1
3

1
3

36
1

30

42

1
3

48

Quality
Quality
Quality
Quality

5-16 Perception of Quality

Perception of Quality
4
1 (Current Run)
0.1 31 0.003
32 48 0.075
0.001
2 (Lean Run)
3 1 6 0.4215
(Slope) 0.07 2 7 33
0.8213 0.015 3
34 48 0.8649 0.001
3 Six Sigma (Six
Sigma Run) 2 1 30 0.99
0.33 2 31 48
1.03 0.002
4 Lean Six Sigma (Lean Six Sigma
Run) 2 1 24 1.343

106
0.056 2 25 48
1.402 0.002
Perception of Quality
5-17
Adjustment Time For Perception of Quality
Inflow Rate
Flow Rate Ratio
Outflow Rate
(Productivity Workforce)
Productivity

Perception of Quality

f effecf of Total Productive staff toProducivity

Effect of Workload on Quality
Productivity Workforce

Quality of services

Quality Services Normal

5-17 Perception of Quality

Perception of Quality
5-15



3 1. Flow
Rate Ratio 2. Productivity 3.
Quality of Service

(Net Income)
5-18

107
Net income
4M
4 2
2

4 2

2 4
3

12

23 4 2 34 2 34

23 4
1

42

48

234

-4 M
0

Net income : Current Run 1

Net income : Lean Run
2
Net income : Six Sigma Run
3
Net income : Lean Six Sigma Run

18
1

24
Month
1

1
3

30
1
3

36

1
3

1
3

1 Baht
3

Baht
Baht
Baht

5-18 (Net income)

,
,
Net income 5-19
Other Cost
Baht/Patient
Total Revenue
Outflow Rate
Avg.Salary per staff per month

Net income
Total Staff Cost

Total Staffs
Trainer Cost per level
Training Cost
Trainer training Productivity

5-19 Net income

108

(System Dynamics
Model)

1) 2)
3) Six Sigma
4) Lean Six Sigma
3 1) 2
(Cycle Time) (Flow Rate Ratio) 2)
(Productivity) 3)
(Quality of Service) (Perception of Quality)

6.1

4 48
6-1
6-1

Flow Rate
Quality

Perception
Avg.Cycle
Time

Ratio(OutflowRate
(patients/Hr))

Productivity

of
Service

of Quality

Current Run

25.6

0.213 (25.6)

0.69

0.58

0.07

Lean Run

12.8

0.963 (115.54)

0.72

0.89

0.6

21.8

0.828 (99.4)

0.82

1.13

0.75

10.9

0.975 (117)

0.90

1.28

1.14

Six Sigma
Run
Lean Six
Sigma Run

110


Six Sigma Lean Six Sigma

6.2




(Robust Model)
(Endogenous Variables) (Exogenous Variables)

30

. Six Sigma. . 226 (..46)

175-182
. Dynamic Lean Scorecard.

, 2546.
.
() .

, 2548.
. :
.

, 2548.
. .. 2525, 5,
, , 2538.
.
.

, 2545.
. Lean Six Sigma. Industrial Technology Review. 20 (..
47):159-162
. .

, 2545.

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116

System Dynamics Equations

118

119
1. Adjustment Flow Rate = DELAY1I(Productivity Workforce/"Avg.Tasks/patient",
Adjustment time for improving Flow rate, 0)
Units: Dmnl
2. Adjustment time for improving Flow rate = 1
Units: Month
3. Adjustment time for moving staff = 2
Units: Month
4. Adjustment Time For Perception of Quality = 1
Units: Month
5. Adjustment time for Quarterly Profits = 6
Units: Month
6. Adjustment Flow Rate = DELAY1I(Productivity Workforce/"Avg.Tasks/patient",
Adjustment time for improving Flow rate, 0)
Units: Dmnl
7. "Avg. Quarterly Profit" = INTEG (+Net Change in Quarterly Porfits, Estimated
Quarterly Profits)
Units: Baht
8. Training per employee" = Level Staff of Training/Total Staffs
Units: level/staff
9. "Avg.PIP to tasks" = XIDZ(Patients in Process, Tasks, 0)
Units: patients/task
10. "Avg.Salary per staff per month" =
8500
Units: Baht
11. "Avg.task/pateint normal" = 4
Units: tasks/patients
12. Avg.Tasks/patient" = XIDZ("Avg.task/pateint normal", Number of Tasks per
cell, "Avg.task/pateint normal")
Units: tasks/patients
13. "Avg.time to get experience/staff" = 3
Units: Month

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14. "Baht/Patient" = 200
Units: Baht/patient
15. Cycle Time = Initial cycle time-(Takt Time*Effect of Workload on Cycle time)
Units: Min
16. desired Training Level = 0
Units: level/staff
17. Effect of Workload on Cycle time = Normal Workload-Workload Ratio
Units: Dmnl
18. Effect of Workload on Quality = f Effect of workload on Quality(Workload
Ratio)
Units: Dmnl
19. Estimated Quarterly Profits = Months Per Quarter*Net income
Units: Baht
20. Experienced Staff = INTEG (Gaining Experience-Quitting-Staff moving to
training function,12)
Units: staffs
21. "Experienced Staffs (Training)" = INTEG (Staff moving to training function,
Initial Staffs training)
Units: staffs
22. f effect of Total Productive staff to Productivity(
[(0,0)-(2,1)],(0,0),(0.25,0.5),(0.5,0.6),(0.75,0.625),(1,0.6625),(1.25,0.75
),(1.5,0.82),(1.75,0.9),(2,1))
Units: Dmnl
23. Effect of workload on Quality(
[(0,0)-(100,1)],(0,1),(10,1),(20,0.97),(30,0.9),(40,0.87),(50,0.83),(60,0.8
),(70,0.712),(80,0.489),(90,0.3),(100,0.15))
Units: Dmnl
24. FINAL TIME = 48
Units: Month
25. Flow Rate Ratio = Outflow Rate/Inflow Rate

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Units: Dmnl
26. fraction of experienced staff in Training = "Experienced Staffs (Training)"/Total
experienced staffs
Units: Dmnl
27. fraction of experienced staffs desired in training = 0
Units: Dmnl
28. Gaining Experience = Inexperience Staff/"Avg.time to get experience/staff"
Units: staffs/Month
29. Incoming Patients = 600
Units: patients/day
30. Incoming Task = Inflow Rate*"Avg.Tasks/patient"
Units: tasks/day/Month
31. Increase staff Providing Training = Staff moved to Training*pressure to increase
training staff*Perception of Quality
Units: staffs/Month
32. Inexperience Staff= INTEG (+New hiring-Gaining Experience, Initial Staffs
training)
Units: staffs
33. Inflow Rate = Incoming Patients
Units: patients/day/Month
34. Initial cycle time = 30
Units: Min
35. Initial Staffs training = 0
Units: staffs
36. INITIAL TIME = 0
Units: Month
37. Length of Employment = 50
Units: Month
38. Level Staff of Training = INTEG (Increase in Training benefits-Training Benefit
lost when staff leaves,0)

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Units: level
39. Adjustment Flow Rate = DELAY1I(Productivity
Workforce/"Avg.Tasks/patient", Adjustment time for
improving Flow rate, 0)
Units: Dmnl
40. Months Per Quarter = 3
Units: Month
41. Net Change in Quarterly Profits = (Estimated Quarterly Profits-"Avg. Quarterly
Profit")/Adjustment time for Quarterly Profits
Units: Baht/Month
42. Net income = Total Revenue-Total Staff Cost-Other Cost-Trainer Cost
Units: Baht
43. New hiring = Quitting*Pressure to reduce Staff
Units: staffs/Month
44. Adjustment Flow Rate = DELAY1I(Productivity
Workforce/"Avg.Tasks/patient", Adjustment time for
improving Flow rate, 0)
Units: Dmnl
45. Normal Workload = Incoming Patients/Total productive staffs
Units: tasks/day/staff
46. Number of Tasks per cell = 0
Units: Dmnl
47. Other Cost = 50000
Units: Baht
49. Outflow Rate = Completion rate*"Avg.PIP to tasks"* Adjustment Flow Rate
Units: patients/(Month*day)
49. Patients in Process = INTEG (Inflow Rate-Outflow Rate,0)
Units: patients/day
50. Perception of Quality = DELAY1(Quality of services*Productivity*Flow Rate
Ratio, Adjustment Time For Perception of Quality)

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Units: Quality
51. pressure to increase training staff = f pressure to increase training staffs("Raito
of Avg. to Desired Level of Training")
Units: Dmnl
52. Pressure to reduce Staff = WITH LOOKUP ("Raito of Avg. Quarterly to Min
Reqd",([(0,0)-(2,2)],(0,0.2),(1,0.75),(2,1) ))
Units: Dmnl
53. Pressure to Reduce Training Staff = WITH LOOKUP ("Raito of Avg. to
Desired Level of Training", ([(0,0)(2,2)],(0,0),(1,0),(2,1) ))
Units: Dmnl
54. Productivity = (f effect of Total Productive staff to Productivity(Productivity
Workforce))
Units: Dmnl
55. Productivity Workforce = DELAY1I(Total Staffs/Total productive staffs, 1, 0)
Units: Dmnl
56. Quality of services = Effect of Workload on Quality*Quality Services
Normal*Productivity Workforce
Units: Quality
57. Quitting = Experienced Staff/(Length of Employment*Pressure to reduce Staff)
Units: staffs/Month
58. "Raito of Avg. Quarterly to Min Reqd" = "Avg. Quarterly Profit"/"Min. Reqd
quarterly profit"
Units: Dmnl
59. "Raito of Avg. to Desired Level of Training" = XIDZ(desired Training Level,
"Avg. Training per employee", 5)
Units: Dmnl
60. Reduction in Staff Training = "Experienced Staffs (Training)"*Pressure to
Reduce Training Staff/Adjustment time for
moving staff

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Units: staffs/Month
61. Staff Learning = "Experienced Staffs (Training)"*Trainer training
Productivity/Time for Learning to sink in
Units:level/month
62. Staff moved to Training = Experienced Staff*(fraction of experienced staffs
desired in training-fraction of experienced staff in
Training)/Adjustment time for moving staff
Units: staffs/Month
63. Staff moving to training function = Increase staff Providing Training-Reduction
in Staff Training
Units: staffs/Month
64. Takt Time = Working hours/Incoming Task
Units: Min
65. Tasks = INTEG (+Incoming Task-Completion rate,0)
Units: tasks/day
66. Time for Learning to sink in = 2
Units: month
67. Total experienced staffs = Experienced Staffs +"Experienced Staffs (Training)"
Units: staffs
68. Total productive staffs = DELAY1I(Experienced Staffs +Inexperienced Staffs,
6, 12)
Units: staffs
69. Total Revenue = "Baht/Patient"*Outflow Rate*20
Units: Baht
70. Total Staff Cost = "Avg.Salary per staff per month"*Total Staffs
Units: Baht
71. Total Staffs = DELAY1I("Experienced Staffs (Training)"+Total productive
staffs, 1, 12)
Units: staffs
72. Trainer Cost = Trainer training Productivity*Trainer Cost per level-

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STEP(Trainer Cost per level*Trainer training Productivity, 1)
73.
74.
75.
76.
77.
78.

Units: baht
Trainer Cost per level = 10000
Units: bath/level/staff
Trainer training Productivity = 0
Units: level/staff
Training Benefit lost when staff leaves = 0
Units: level/month
Working hours = 300
Units: Min
Workload = Tasks/Total productive staffs
Units: tasks/day/staff
Workload Ratio = Workload/Normal Workload
Units: Dmnl

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