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PUBLIC ADMINISTRATION REFORM IN SERBIA – SIGMA Monitoring Report 2019

In context of the public administration reform implementation program, SIGMA – OSCE presented key finding of its Serbia 2019 Monitoring Report. The event brought together high-level SIGMA experts, representatives and officials from various government bodies and civil society organizations, as well as representatives from the European Commission and the EU Delegation, to discuss the current challenges and priorities in the areas of public service and human resource management and public service delivery . The opening speeches were given by Dr. Gregor Virant (Head of SIGMA), Sem Fabrizi (Ambassador and Head of Delegation of the European Union to the Republic of Serbia), Prof. Mihailo Jovanović (Director at Office for Information Technologies and e-Government), Branko Ružić (Minister of Public Administration and Local Self-Government) and Ana Brnabić (Prime Minister of Serbia).The detailed key-note presentation of the Key Findings and Recommendations of the SIGMA 2019 Monitoring Report for Serbia in the Areas of areas of Public Service and Human Resource Management and Public Service Delivery was delivered by Annika Uudelepp from the SIGMA team, followed by lively interactive discussion sessions moderated by Milena Lazarević from the Center for European Policy. Focus areas for the 2019 Monitoring Report were selected jointly by the Organization for Economic Co-operation and Development and the European Commission, as the selected areas of public service and human resource management and public service delivery are considered relevant to Serbia’s European Union integration process and are important aspects of the policy dialogue relating to the ongoing accession negotiations. The 2019 Monitoring Report follows up on the 2017 analysis and recommendations and provides an overview of the “state of play” and main developments with a detailed analysis based on related SIGMA Principles of Public Administration measured against the indicators of the Methodological Framework for the Principles of Public Administration.

Simulated Six Sigma: A multi response optimization

Six Sigma is widely used in many industries for the purpose of improving process performance. Typical improvements sought in Six Sigma projects include decreased operational cost, increased customer satisfaction, decreased cycle time, and enhanced profits, but regardless of the nature of the improvement, all projects follow the “Define-Measure-Analyze-Improve-Control” (DMAIC) methodology.This paper proposes the use of simulation and multi response optimization in addition to other typical Six Sigma tools in order to arrive at optimum performance at the end of each project through an established optimization framework. The framework is used in a real case study performed at a global logistics company.The case study is concerned with an e-commerce logistics station located at John F. Kennedy airport (JFK) in New York; a station that suffers from low on-time delivery performance and high operational cost. As result, a Six Sigma project was implemented and the process was simulated to reveal various scenarios suggested by the Six Sigma team in order to optimize the process.The project resulted in 65 percent reduction in labor, 41 percent reduction in work in process (WIP) and 55 percent reduction in average time packages spend at the station. These improvements highly support the effectiveness of implementing Six Sigma projects in the format suggested.

Intentional Clinical Process Design to Improve Outcomes for Patients Who Require Emergency Surgery.

Ruptured abdominal aortic aneurysms (AAAs) are associated with a 90% overall mortality and $150 000 cost of care per patient. Despite improvements in intensive care and surgical technology, morbidity and mortality remain unchanged over the past 20 years. The most significant predictor of survival is time from the door of the hospital to the operating room. To streamline operational efficiency, a team utilized Lean Six Sigma methodologies, team training, and intentional clinical process design to institute changes in our clinical processes, enhance care coordination, and improve communication. Changes led to a $1.8 million profit on operations, 10-day reduction in length of stay, and 89% survival rate among patients with ruptured AAA.

IR Lean Sigma Team Improves Patient Experience and Throughput

IR Lean Sigma Team Improves Patient Experience and Throughput

The Role of Six Sigma Approach by Applying (DMAIC) Model and Forming Work Team in Improving Banks Performance: A Survey Study in Syrian Banks in Damascus

Banking systems face many changes and challenges that require the application of new performance management and improvement concepts and an attempt to achieve excellence. Six Sigma is one of the best methodologies that can help in this regard because it can be used to improve the performance of banks and reduce defects in their operations. This study aimed to highlight the role of the Six Sigma approach to improve the performance of Syrian Islamic banks according to the implementation of the six elements of the Sigma model (DMAIC) and the selection of Six Sigma teams (Team Improvement). The results of the study indicate the importance of implementing Six Sigma methodology in all local sections including industrial and service organizations and there is a trend in Syrian banks to take advantage of the Six Sigma approach. The results also show that there is a statistically significant effect application of six sigma model elements (DMAIC), Selecting six sigma team (Improvement Team) and the performance improvement of Syrian banks. Based on that, several recommendations were presented. Among these recommendations were the urgency and the need of benefiting from the best practices in the field of Six Sigma. Invest in training and provide the employees with some experience in this field.

Analysis of Lean Six Sigma tools from a multidimensional perspective

The aim of this research is to analyse 68 Lean Six Sigma (LSS) tools from a three-dimensional perspective, i.e. in terms of their rate of implementation, necessity and sufficiency. Using comprehensive survey data gathered from 106 respondents who are Six Sigma team leaders and practitioners, this research conducted Ward’s hierarchical clustering and linear discriminant analysis (LDA) to determine and conclude on the implementation, necessity and sufficiency levels of the LSS tools. LDA helped to achieve a complex evaluation of the tools based on their positions on the three-dimensional space. The location of the tools is evaluated to provide a complete discussion on the LSS tools. The results revealed the fact that the most frequently used LSS tools are Pareto histograms, brainstorming, process flow maps, supplier–input–process–output–customer (SIPOC), control charts, plan-do-check-act and Ishikawa diagram, whereas, Pugh matrix, artificial neural networks, structural equation modelling, principal component analysis and Taguchi’s loss function are among the least frequently used tools during LSS projects. Process flow diagram is used more than required, whereas design of experiments, lean tools, simulation techniques and process sigma reassessment are found as not being used as required. SIPOC, voice of customer and critical to quality are considered as not sufficient in addressing their particular goal.

Impacts of change management on Six Sigma team leadership style

This study analysed the impact of change management on leadership in Six Sigma teams. The research concentrated on identifying the effects that change management has on shared leadership throughout each phase of the Six Sigma Define, Measure, Analyse, Improve, and Control (DMAIC) process. The study used a longitudinal approach to study how change management impacted eight Six Sigma teams during the DMAIC structure. At each phase, change management and team performance data were collected and analysed to identify relationships. Non-parametric statistical tests were used at each phase to understand how change management and team performance changed over time. The degree of change management impacts the type of leadership that a team can select. As a result, as the degree of complexity for change management increases, a quality improvement team relies more on shared leadership. The obtained results led to two implications. The first revolved around the need for internal members and external coaches to be able to identify and understand the relationship between change management and leadership. The second was that a Six Sigma training program needs to include training and educational modules about change management and leadership. This study contributes to current knowledge since practitioners can use it to evolve Six Sigma models and maximize future quality improvement teams' ability to achieve optimal performance and effectiveness.

Factors to Consider in Selecting an Organisational Improvement Initiative: Survey Results

Organisations should select the appropriate improvement initiative that will fit with the context of organisation and provide value to the organisation. This paper presents 18 factors to be considered when selecting an organisational improvement initiative. Organisational improvement initiatives are approaches, management systems, tools and/or techniques that can be used for managing and improving organisations, such as Lean, ISO9001, Six Sigma and Improvement Team. A survey was conducted to identify the level of importance of these 18 factors as criteria for selecting an improvement initiative. Purposive sampling was used for this survey involving practitioners, managers, engineers, executives, consultants and/or academicians, who have been involved in the selection and/or implementation of organisational improvement initiatives in Malaysia. Two factors were rated as ‘very high importance’, which involve: (1) The ability to gain top management commitment and support to introduce and implement the initiative successfully, and (2) The initiative is aligned to the vision, mission and/or purpose of the organisation. All these factors can be adopted by the organisations as decision criteria to assist in the selection of the most appropriate improvement initiative based on rational decision making.

Impacts of change management on Six Sigma team leadership style

This study analysed the impact of change management on leadership in Six Sigma teams. The research concentrated on identifying the effects that change management has on shared leadership throughout each phase of the Six Sigma Define, Measure, Analyse, Improve, and Control (DMAIC) process. The study used a longitudinal approach to study how change management impacted eight Six Sigma teams during the DMAIC structure. At each phase, change management and team performance data were collected and analysed to identify relationships. Non-parametric statistical tests were used at each phase to understand how change management and team performance changed over time. The degree of change management impacts the type of leadership that a team can select. As a result, as the degree of complexity for change management increases, a quality improvement team relies more on shared leadership. The obtained results led to two implications. The first revolved around the need for internal members and external coaches to be able to identify and understand the relationship between change management and leadership. The second was that a Six Sigma training program needs to include training and educational modules about change management and leadership. This study contributes to current knowledge since practitioners can use it to evolve Six Sigma models and maximize future quality improvement teams' ability to achieve optimal performance and effectiveness.

An Investigation in How Six Sigma Project Teams Should Make Rational Decisions in Shared Leadership Environments

It is proposed that shared leadership environments have an effect on six sigma team decision-making as well as the methods used to make decisions. It is also proposed that the consensus decision-making method is the technique that is the most effective and related to the fundamental conditions of a shared leadership environment. Furthermore, it is believed that a model of shared leadership decision-making can be developed from the results of these hypotheses. Research has found that a strong relationship exists between shared leadership and team decision-making principles and approaches. As a six sigma team becomes more involved in the shared leadership model, the methods utilized to make decisions change in such a way that the power is more distributed among members; the team moves from a single individual decision method, towards a shared decision method. Review of the relationship between shared leadership and team decision-making techniques has shown that the consensus approach is the most effective in satisfying the fundamental conditions and requirements of the shared leadership model. A model of decision-making in shared leadership environments is proposed for use by teams to determine the type of decision-making method that should be employed as a team's level of shared leadership increases.

The knowledge transfer process in Six Sigma subsidiary firms

Although the operative benefits of the Six Sigma methodology in the business world are well accepted, the long-term benefits of the initiative are currently under discussion. This paper aims to analyse how Six Sigma methodology is related to the knowledge transfer process, a source of competitive advantage. For this purpose, we observe how team management in Six Sigma firms differs statistically from the team management proposed by other quality management initiatives, and how Six Sigma team management is related to the knowledge integration and knowledge transfer processes. An ANOVA analysis and Partial Least Squares approach were used to analyse data from 53 European Six Sigma firms, confirming the hypotheses developed. The results confirm that Six Sigma methodology offers new possibilities to companies and that implementation of Six Sigma has a positive effect on the variables that influence long-term organisational performance, such as knowledge management. Relevant academic contributions and implications for practitioners are included.

Reduction in Repair rate of Welding Processes by Determination & Controlling of Critical KPIVs

Six Sigma is being Implemented all over the World as a successful Quality Improvement Methodology. Many Companies are now days are using Six Sigma as an Approach towards zero defects. This article provides a practical case study regarding the implementation of Six Sigma Project in a Welding Facility and discusses the Statistical Analysis performed for bringing the welding processes in the desired sigma Limits. DMAIC was chosen as potential Six Sigma methodology with the help of findings of this Methodology, Six Sigma Team First Identified the critical Factors affecting the Process Yield and then certain Improvement Measures were taken to improve the Capability of Individual welding Processes and also of Overall Welding Facility. Cost of Quality was also measured to Validate the Improvement results achieved after Conducting the Six Sigma Project.

Achieving a Culture of Quality in Pharmaceutical Biostatistics: One Approach to Achieving Quality Deliverables.

Biostatistics units within the pharmaceutical industry are faced with the challenge of increasing productivity, reducing costs, and accelerating timelines while at the same time maintaining high quality. This paper describes how the global biostatistics unit in one company is addressing this challenge by nurturing a "culture of quality" to engage frontline staff responsible for daily deliverables. The approach ties together the measurement, improvement, and maintenance of quality, thus inviting staff to understand their role in achieving quality deliverables. Appointment within the operations unit of a quality lead, who is responsible for quality oversight, further increases visibility and contributes to the culture. Measurement is addressed through the use of a quarterly quality report card in which quality-related metrics are consolidated and tracked over time. Trends and outliers are explored. Through established process improvement practices, a Lean Sigma team tackles select high-value processes. Quality is maintained through continuous feedback loops driven by formal quality assurance audits and logs of lessons learned. This paper first considers how to define quality in this context; then addresses the sometimes disjointed areas of measurement, improvement, and maintenance; and ultimately ties them together to drive a culture of quality.

Radioactive Iodine and Krypton Control for Nuclear Fuel Reprocessing Facilities

The removal of volatile radionuclides generated during used nuclear fuel reprocessing in the US is almost certain to be necessary for the licensing of a reprocessing facility in the US. Various control technologies have been developed, tested, or used over the past 50 years for control of volatile radionuclide emissions from used fuel reprocessing plants. The US DOE has sponsored, since 2009, an Off-gas Sigma Team to perform research and development focused on the most pressing volatile radionuclide control and immobilization problems. In this paper, we focus on the control requirements and methodologies for85Kr and129I. Numerous candidate technologies have been studied and developed at laboratory and pilot-plant scales in an effort to meet the need for high iodine control efficiency and to advance alternatives to cryogenic separations for krypton control. Several of these show promising results. Iodine decontamination factors as high as 105, iodine loading capacities, and other adsorption parameters including adsorption rates have been demonstrated under some conditions for both silver zeolite (AgZ) and Ag-functionalized aerogel. Sorbents, including an engineered form of AgZ and selected metal organic framework materials (MOFs), have been successfully demonstrated to capture Kr and Xe without the need for separations at cryogenic temperatures.

Linking learning and knowledge creation to project success in Six Sigma projects: An empirical investigation

This study investigates the impact of two organizational antecedents, (1) Six Sigma resources (technical) and (2) team psychological safety (social), on learning behaviour and knowledge creation and, in turn, on the success of Six Sigma process improvement projects. The paper proposes an integrated model to explain process improvement implementation success through two learning activities undertaken by Six Sigma project teams: Knowing-what and Knowing-how. The conceptualization of these knowledge types in this research is different from usual conceptualization as it represents the knowledge brought into projects through various phases of Six Sigma projects. The three hypotheses proposed in the model were tested using the data collected from 52 Six Sigma project teams from a single organization. Regression analysis showed psychological safety affects project performance through knowing-how. Regression and bootstrapping analyses showed resources influence project performance through the combined mediation of knowing-what and knowing-how. The paper provides an interdisciplinary treatment of knowledge management in process improvement teams, and offers a research model demonstrating how Six Sigma project teams promote deliberate organizational learning. By doing so, this study empirically establishes the notion that technical and social supports jointly impact the success of operations management initiative such as Six Sigma through learning. The limitations of the study along with the future research directions are highlighted.

Applying Six Sigma to Quality Improvement in Construction

Taiwan is in a seismically active zone because it is located in the earthquake-prone Pacific ring of fire. The cracks in lightweight partition walls caused by frequent earthquakes decrease customer satisfaction and increase repair costs in the case company. This research demonstrates how a Six Sigma team can determine and improve the key input variables affecting the cracks in lightweight partition walls. A case study methodology is used in this research to illustrate the tools of Six Sigma by using the project charter to define problems, by using tools of process mapping to display all the input and output variables affecting cracks in lightweight partition walls, by using the C&E (cause-and-effect) Matrix to select highly correlated input variables, and by using failure modes and effects analysis (FMEA) to identify causes of the cracks. Unlike conventional Six Sigma, finite-element analysis (FEA) simulation software ABAQUS was used instead of statistical tools to verify variables and to identify initial causes of cracks because data collecting was time consuming. The results showed that a 1-cm preset spacing between the board and the main structure substantially reduces cracks caused by earthquakes. A new earthquake-proof construction method has been developed based on the finding of this research and was recently granted a new patent (M 431196) by the Intelligent Property Office in Taiwan.

TH-F-217A-01: Informatics Driven Quality Initiatives - Using the Tools of Six Sigma

An informatics technique that can be used for improving image quality, dose prescription and delivery and other imaging services is Six Sigma. Six Sigma is a quality improvement process that strives for near perfection (99.99966%) in the organizations ‘product’. This may be the appropriate dose prescription for every patient or the absence of repeated scans or artifact free examinations or the number of finalized reports completed by the end of the business day. In Six Sigma a DMAIC (Define, Measure, Analyze, Improve, Control) process is applied to systematically inspect and review quantified data (chosen by the Six Sigma team) to improve the delivered services. Patients may ‘feel’ unacceptable variations (a repeated exam due to noise, motion, etc) and quantified data can be used to identify instances of high dose prescriptions permitting an opportunity for improvements. Informatics enables collection of requisite data using modality, RIS (HL7) and PACS (DICOM) data to add knowledge that is actionable for improving the outcome of the delivered service. These systems provide information that are strongly interconnected in the users understanding of what is the ideal dose prescription. Understanding critical quality components and reducing variation in these actions are keys for improvements. For example, small patient size can easily result a patient not being accurately centered in a CT scanner which is (interconnected) to the dose modulation prescription. A Six Sigma approach uses statistical thinking and statistical tools. It: Defines and identifies the improvement opportunity (e.g., lower dose, improve Imaging Quality (IQ), shorten exam time, patient positioning etc.)Measures critical information that relates to performance goal (dose index or metric, added or extra scans, reduced IQ, etc). We suggest an Informatics environment for this. Analyze data to identify variation and its causes. Formulate solutions and validate root cause hypothesis prior to introducing change. Improve performance by introducing change. Verify improvements as measured by the metric — iterate improvements and gain group approval for current final solution. (technique charts, education modules, purchase technology that adds robustness to the prescription of radiation or another imaging service etc)Control and monitor variability in the chosen metric. As it relates to the skills and ability of physicists, accept the challenge of having a mistake proof process. This lecture will provide an introductory overview of Six Sigma concepts and review some practical examples from mammography, CT, and interventional fluoroscopy. Learning Objectives: 1. Understand the origin and evolution of Six Sigma and DMAIC processes. 2. Provide examples of measurement data from Informatic sources and tools Present issues and opportunities related to improving patient care using Six Sigma.

Reduction in Chemotherapy Mixing Errors Using Six Sigma: Illinois CancerCare Experience.

Chemotherapy mixing errors (CTMRs), although rare, have serious consequences. Illinois CancerCare is a large practice with multiple satellite offices. The goal of this study was to reduce the number of CTMRs using Six Sigma methods. A Six Sigma team consisting of five participants (registered nurses and pharmacy technicians [PTs]) was formed. The team had 10 hours of Six Sigma training in the DMAIC (ie, Define, Measure, Analyze, Improve, Control) process. Measurement of errors started from the time the CT order was verified by the PT to the time of CT administration by the nurse. Data collection included retrospective error tracking software, system audits, and staff surveys. Root causes of CTMRs included inadequate knowledge of CT mixing protocol, inconsistencies in checking methods, and frequent changes in staffing of clinics. Initial CTMRs (n = 33,259) constituted 0.050%, with 77% of these errors affecting patients. The action plan included checklists, education, and competency testing. The postimplementation error rate (n = 33,376, annualized) over a 3-month period was reduced to 0.019%, with only 15% of errors affecting patients. Initial Sigma was calculated at 4.2; this process resulted in the improvement of Sigma to 5.2, representing a 100-fold reduction. Financial analysis demonstrated a reduction in annualized loss of revenue (administration charges and drug wastage) from $11,537.95 (Medicare Average Sales Price) before the start of the project to $1,262.40. The Six Sigma process is a powerful technique in the reduction of CTMRs.

Abstract 2317: A Multidisciplinary Team Approach to Improving Laboratory Results and Thrombolytic Treatment in Acute Code Stroke Patients.

Despite improvement in acute stroke care, stroke remains the third major cause of death and leading cause of disability nationwide. An increase in the number of certified Primary Stroke Centers (PSC) over the past years has been credited for the improvement. Los Angeles County proactively implemented the Approved Stroke Center Network in which Emergency Medical Systems may passes non-certified PCS for acute stroke treatments. Our hospital’s journey towards building a stroke program began in early 2008, and in 2009 a CODE STROKE algorithm was implemented. Over the past two years, the team has strived to continuously improve ‘door to needle’ times. Opportunity to improve door-to-lab results was recognized so we sought to investigate and identify barrier(s)/reason(s) for delays. Methods The LEAN Six Sigma team guided our multidisciplinary committee for identifying contributing delays. A review of the clinical pathway from the patient’s arrival time (door) and activation of Code Stroke are time-stamped at every step. Phase I identified delays with phlebotomist transit times. The laboratory management addressed this issue by reinforcing the need to expedite the specimen collection, transit time and processing. Some improvement was noted in the door-to-lab results time but significant delays remained a problem. Phase II incorporated lab draws being performed prior to the patient going for their CT scan. Phase III involves utilization of an iStat unit within the emergency department for analysis of a CHEM 8 panel. Results Analysis of data initially showed door-to-lab results had a median time of 52 minutes, with 38% having results within 45 minutes. Ten patients received tPA within median times of 66 minutes, with 53% receiving tPA within 60 minutes. In 2010 action plans initiated yielded significant improvements with door-to-lab results median times of 44 minutes, 64% having lab results within 45 minutes. Twenty one patients received tPA within a median time of 55 minutes, and 70% having received tPA within 60 minutes. Conclusion The multidisciplinary stroke team identified barriers and implemented process changes yielding improvements in door-to-lab results that in turn resulted in overall improvements in tPA treatment times. Data collection and process evaluation continue.