Presentation overview of Lean Six Sigma and how it applies to Child and Youth Mental Health Organizations

1. Lean Six Sigma for
Child and Youth Mental Health
Organizations
CMHO Webinar Series
October 26, 2016

2. LBCG CMHO Webinar Series
Introductions
Michael Schiel is a Director at Lough Barnes with 17 years of experience
in community, healthcare and broader public sector focusing on process
improvement, transformation and change management. He is certified
in Lean Six Sigma, Change Management, Project Management, and IT
Services. Michael has completed Lean Six Sigma and Quality
Improvement projects for CMHO organizations, Ministries, Community
Health Centers, and other Community Services organizations.
Mark L. Fraser is the Director of System Management and Quality at the
Child and Family Center. Mark is a registered psychotherapist with the
College of Psychotherapists of Ontario with over 16 years of clinical and
research experience working with complex children, youth and families
within the children’s mental health and child welfare sectors, he holds a
Master’s in Applied Psychology, and Bachelor Degrees in
Psychology (H.B.A.) and Biochemical Sciences. Mark is the lead at CFC
for the Lean Intake Redesign Project.
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3. LBCG CMHO Webinar Series
Today’s Objectives
What You Will Learn Today:
 How Lean Six Sigma fits into the
quality picture
 What is Lean Six Sigma
 5 Key parts of Lean
 What Lean Six Sigma means for
CMHO organizations
 Case Study: Child and Family Center
and Intake Redesign
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4. Refresher: Why Quality?

5.  Some major trends are acting as drivers for changes in community and
broader public sector:
• Continued drive to push service deliver closer to the community
• Desire to see demonstrated value for money
• Increasing expectations for access and equity of services
• Increasing expectations of service efficiency and effectiveness
 Quality models help you to define quality for your organization, assess quality
challenges, and to improve quality outcomes
Quality Drivers
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6. Quality Improvement Models
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 No one model is better than others
 Most models have:
• A statement of the quality vision you are trying
to achieve
• A defined process for how QI will be conducted
• Approach to determining quality
issues/challenges
• A list of improvement goals or priorities that
are specific, measurable, achievable, relevant,
and time bound.
• Who is responsible and accountable (team,
individual, etc.)
• A plan to collect and report the performance
• A plan for how the results (and the goals) will
be evaluated
• A process for determining next steps

7. Where Does Lean Six Sigma Fit?
 There are literally hundreds of approaches, tools
and applications you can use related to quality
improvement
• The American Society of Quality has a list of over
one hundred (http://asq.org/service/body-of-
knowledge/tools)
• The IHI also has a page on tools
(http://www.ihi.org/resources/Pages/Tools/defaul
t.aspx)
 We are recommending tools by where you are in
the process journey:
• Planning
• Quality assessment
• Implement change
• Continuous process improvement
Plan Assess Implement CPI
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Lean Six Sigma can help with
assessing quality challenges, and
figuring out how to improve

8. What is Lean Six Sigma, and Why Should
You Care About it?

9. What is Lean?
Some definitions of Lean:
 The core idea is to maximize client
value while minimizing waste
 Use of continuous process
improvement techniques to increase
productivity, reduce wasted time and
activities, find efficiencies, improve
service reliability and…
 Improve staff morale and customer
service
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10. What is Lean?
Lean is NOT:
 An acronym
 Only for manufacturing
 About staff or service reduction
 A silver bullet or a “fix all your problems” fad
 A temporary fix
 Fast and easy
 The same as Six Sigma
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11. Why Should You Care About Lean?
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12. Benefits of Implementing Lean
 Improved client experience and satisfaction
 Faster response to client needs
 Improved, standardized and repeatable processes
 Improved service quality
 Reduced service delivery costs
 Ability to focus resources on more value-added activities
 Improved asset utilization: people, equipment & technology
And….
 Increased job satisfaction/reduced stress for staff
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13. Lean Vs. Six Sigma
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 Both seek to create the most
efficient system possible
 Biggest difference is in the
“how”:
• Lean practitioners seek to
eliminate “waste” that comes
from unnecessary steps in the
production process that do not
add value to the finished
product
• Six Sigma focuses on reducing
variation within the process
(that causes waste in its own
way)

14. 5 Main Lean Principles

15. 5 principles of Lean
 Value - specify what creates value from the
client’s perspective.
 Value stream – identify all the steps along the
process chain.
 Flow - make the value process flow.
 Pull - make only what is needed by the customer
(short term response to the customer’s rate of
demand).
 Perfection - strive for perfection by continually
attempting to produce exactly what the
customer wants.
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16. Value and Waste
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 Steps in any process can be…
A step is value-added if:
• The client/end user recognizes the value
• It transforms the product or the service
• It is done right the first time
• Steps that are required due to legal, fiduciary,
fiscal, compliance, etc. reasons
• Contributes to running the organization
• Steps do not contribute directly to fulfilling
customer needs
Value added (for the
client)
Necessary but not
Value added (for the
organization)
Waste
Our goal is to…
• Eliminate waste
• Minimize the time
required to do
organization value-
added steps
LBCG CMHO Webinar Series

17. Client Point of View
Who Is Your Client or End User?
 Value and service delivery should be based on your users’ needs
What Do They Really Want?
 Who are your clients or customers?
• Think both internal to your organization and external
• Do you have more than one type?
 What are their service requirements? What do they value?
 How do you know?
Are You Structured To Meet Their Needs?
 Are your processes, approaches, systems set up with the customer’s point of
view?
Its important to document who your users are, and what they value – then share
this with everyone on the staff for feedback
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18. Value Stream Map
o A value stream map (VSM) is a pictorial representation of how things flow through the
system from beginning to end (e.g., intake, assessment, referral, etc.)
o It is used to:
 Confirm how the process actually works
 highlight any inefficiencies in the current system (i.e., waste,
flow issues, examples of variability)
o A VSM provides a great framework for opportunity identification and solution development
Allows the team to
“See the flow” of the value
stream and wastes in the
flow
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19. Steps for creating a value stream map
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1. Define customer requirements
2. Identify key steps in the process
3. Gather process data
4. Identify additional information including material/information flows
5. Identify value add and non-value add times
6. Determine initial areas of opportunity
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20. Sample Value Stream Map
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21. Sample Future State Map
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Immediate data entry, rather than
manual transportation, reduces
errors
AP Staff can review files electronically
as they are submitted
Reduced cycle time
and lead time
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22. Pull
 Push versus Pull
 “Push”: service is provided at a set schedule that’s created in advance
• Ford assembly line
• Fast food chains using heat lamps
• Always providing all your services at full service levels every hour every day
regardless of client trends
 “Pull” services are delivered in response to a client’s request
• Having just enough parts, to create a product “just-in-time”
 In some ways, Child and Youth mental health services are “pull” naturally”:
you don’t provide the service until the child/youth requires it
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23. Perfection
 Lean is not a one-off activity
 The journey of continuous
improvement ties the process
together and make it ever-lasting
 Continuous improvement is a
mind-set or a culture as much as it
is a set of activities or tools
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24. Perfection
Continuous Process Improvement (CPI)
 A CPI model is one that allows an organization to plan, implement, measure
and sustain its approach to making organizational improvements
Define
MeasureAssess
Control
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25. Remember the 8 Types of Waste
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Defects
Overproduction
Waiting (queuing)
Non utilized brainpower
Transport
Inventory
Motion
Extra or complex processing
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26. Examples of Waste
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Waste Example
Defects / Poor service
/ Documentation errors
Overproduction / Multiple assessments
/ Filling out the same information on different forms
Waiting / Waiting to be registered as a client
/ Waiting for a clinician/staff/service
Non-utilized Brainpower / Idle staff
/ Not using staff/resources as input for service
delivery, process improvement, etc.
/ Staff working on activities they are over-qualified for
Transport / Moving clients from room to room
/ Poor workplace layouts, convoluted client flow
Inventory / Too much inventory
/ Idle equipment
Motion / Needless movement of workers
/ Needing to get up and go get forms from different
offices
Extra or Complex Processing / Asking the patient the same questions multiple times
/ Redundant forms or work-steps
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27. How Do You Know if You Have Waste?
 Your staff or clients can tell you!
 Typical symptoms of waste:
• Excessive cycle, lead or flow time
• Excessive costs
• Poor quality
• Dependency on work-arounds
• Reactive fire-fighting
• Daily management by exception
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28. Lean Six Sigma and CMHO Organizations

29. CYMH Organizational Challenges
Some challenges of applying Lean to CMHO organizations:
 Value may be different for each client
 Service variety and complexity make process standardization difficult
 Sometimes services are delivered in partnership with other organizations
 Need to consider social value and the equitable provision of services
 Balancing high quality service levels with reducing costs, and wait lists
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30. Case Study: Child and Family Centre
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 Child and Family Centre (CFC) is using Lean to review, redesign and centralize
the intake process
 CFC is using the Lean methods and tools to:
• Map current state intake pathways and processes
• Centralize intake processes
• Identify barriers
• Find efficiencies and improve overall quality of the intake process
• Engage community stakeholders
 Some lessons learned so far:
• Take the time to stress quality as a main principle for the work
• Leverage existing relationships and work completed to date
• Use the process to effectively engage the community
• Need some time to figure out timing of engagement

31. Thank You!
What You Learned Today:
 What Lean is and isn’t;
 What Lean means for community organizations like you;
 Some lessons learned from other organizations similar to yours;
 Ways you may consider using Lean in your organization
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32. Q&A Session
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Join us for a live discussion on quality!
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 Pin: 124 436 9753

33. LOUGH BARNES CONSULTING GROUP
439 University Ave., Suite 1920
Toronto, ON
M5G 1Y8
T/ 416.977.3811
www.loughbarnes.ca
We are a public sector management consultancy serving the human services sector.
Our vision is to build stronger communities through positive social change, a
collaborative approach and our Social Investment Fund.
Our mission is to contribute to improving human services through high quality
consulting and our Social Investment Fund.