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Change Management, Continuous Improvement, and Configuration Management in Healthcare Projects and Operations By Craig A. Stevens During the 5/16-17/2014

Tampa Florida craigastevens@westbrookstevens.com

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craigastevens@westbrookstevens.com

Change Management, Continuous Improvement, and Configuration Management in Healthcare Projects and Operations During this workshop, we will meet and interact with fellow PMI members who have an interest in change management, continuous improvement, configuration management, and the related subjects of Lean, six sigma and change control. We will introduce and investigate how project managers might approach the related subjects both during projects and in operations: • Change Management – (Before, during, and after a change) • Continuous Improvement – (CPI, Lean, and Six Sigma) • Configuration Management – (Configuration identification, control, status accounting, and verification).

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craigastevens@westbrookstevens.com

Craig A. Stevens, PMP, MBB Speaker, Author, Engineer

www.e-WBS.com

(http://www.linkedin.com/in/craigastevens) Craig has studied and been a professional practitioner of change management as a Management, Industrial/Systems Engineer for over 30 years. He was the first program manager to develop configuration management systems for the Department of Energy in the mid 80’s and first presented international papers on the subject in the late 80’s. He is the VP of the Communities of Practice (CoP) for the Nashville Chapter of PMI. Mr. Stevens is currently the Manager for the Process Improvement Program for HCA Physician Services, where the CIPp Team is developing the CPI/Lean/Six Sigma program for about 700 practices. He is also the president of Westbrook Stevens, LLC; an Author; and a Visual Artist. For a free eBook, this presentation, and a sample of his work go to www.issuu.com/craigastevens. Before HCA, Craig worked as a consultant for over 100 different organizations in 25 states including (US DOD, US DOE, NASA, Lockheed Martin, Westinghouse, DuPont, etc.). Craig has worked in every layer of an organization and in several industries (Healthcare, Government, Manufacturing, Agriculture, Hospitality, Scientific Research, Energy, Waste Management and Environmental Restoration, Not-For-Profits, and Construction). He was the Chief Engineer and Quality Manager for PRAGMATICS, INC. (8a), Program Manager for Science Applications International Corporation (SAIC), and was the Mechanical Engineer SME in solar and electric power, explosives, and general engineering for U.S. DOE, Office of Scientific, and Technical Information (OSTI). Craig is the Author of the Geronimo Stone series and is writing a book on Strategic Project Management. He teaches Project Management at Belmont University. “Professor” Stevens has written many papers on change management subjects and served as adjunct faculty for Vanderbilt University, Belmont University, Trevecca Nazarene University, University of Phoenix, Nashville State Tech, and UT Knoxville as a TA. He was also a trainer/facilitator of Project Management for the American Management Association International (AMAI) and Padgett Thompson as well as his own company.

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http://issuu.com/craigastevens

Agenda Creating a Team Focused Improvement Program

✓

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Goals/Objectives

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What is Change and Continuous Improvement?

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How is does Project Management relate Change? This an example text. Go ahead andto replace it

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What is Lean and Six Sigma?

5

Simplifying Leah Six Sigma & Continuous Improvement

6

Applying Lean Six Sigma in Healthcare

7

Summary

craigastevens@westbrookstevens.com

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craigastevens@westbrookstevens.com

Event Objectives Some of this…

• To have a conversation about Change Management • Learn about continuous improvement (and Lean Six Sigma) as applied to both projects and operations – Look at the program we developed

• Introduce configuration management 5


What brought you here‌.what would you like to talk about? 1.Change Management 2.Lean 3.Six Sigma 4.Healthcare and Continuous Improvement 5.Configuration Management Hold up the appropriate number of fingers. 6


http://issuu.com/craigastevens

Agenda Creating a Team Focused Improvement Program

✓

1

Goals/Objectives

✓

2

What is Change and Continuous Improvement?

3

How is does Project Management relate Change? This an example text. Go ahead andto replace it

4

What is Lean and Six Sigma?

5

Simplifying Leah Six Sigma & Continuous Improvement

6

Applying Lean Six Sigma in Healthcare

7

Summary

craigastevens@westbrookstevens.com

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How Change Happens

• • • • •

You Make Change Happen Change Happens To You Hopefully Positive • Positive or Negative Changes based on Strategy • Chaotic Changes Step Changes Due To • Planned Changes Innovation – Customers Continuous Improvement – Employers Step Changes Due To – Others Impulse 8


Exercise/Question for your group

What drives your Projects most often?

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http://www.e-wbs.com/linked-managementmodels/strategy-and-the-storm-of-chaos/

Strategy Driven Changes Out of Scope for today to read more go to link

• Strategy may and should drive changes.

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Change Management Curve

"Things will get worse before they get better" Ehrman's Commentary on Ginberg's Theorem (from the infamous Murphy's Laws)

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craigastevens@westbrookstevens.com http://www.westbrookstevens.com/Phase_5.htm

Two Types of Change - 2nd Order Change (or A Major Step Change) Before the Change

1/7/2013

During the Change

After the Change

Metamorphosis = 2nd Order 12 Change Copyright Š 2007, www.WestbrookStevens.Com

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Risk and the “J” Curve Positive ROI

Good Change Management Average Change Management

Breakeven Point

Negative ROI

Poor Change Management

Copyright © 2007, www.WestbrookStevens.Com 13


Best Case for A Bad Change

II. THE FIFTH DISCIPLINE: THE CORNERSTONE OF THE LEARNING ORGANISATION Peter M. Senge, The Fifth Discipline, The Art & Practice of The Learning Organization, Currency Doubleday, 1994

4. The laws of the fifth discipline

1. Today’s problems come from

yesterday’s solutions – usually because they shift the problem from one part of the system to another, so to the person who applied the solution, it appears to have gone away. 2. The harder you push, the harder the system pushes back – compensating feedback, eg a scheme to provide low cost housing and job training in one place is flooded by low-income migrants so problems get worse.

3. Things get better before they get worse

– eg, new wells are dug and villages are saved; but this lowers the water table faster

so in the long term droughts are worse than before. 4. The easy way out usually leads back in. 5. The cure can be worse than the

disease – the most insidious effect of non-systematic solutions is the need for more and more of the solution. Ill-conceived interventions, whether by the government or by an individual trying to solve their stress problems by social drinking, not only fails to solve the problem but leads to addiction. It’s a problem of ‘shifting the burden to the intervener’. 6. Faster is slower – in a complex system, fastest growth is not the best. In organisms, they lead to cancer; in organizations, they lead to crisis. 7. Cause and effect are not closely related in time and space. 8. Small changes can produce big results, but the areas of highest leverage are often the least obvious – it takes a huge force to turn a moving oil tanker to the left by pushing the bow to the left, but it can be done easily by turning a small rudder to the left, which by changing the water pressure, sucks the stern to the right. To realize this you have to understand the complexities of hydrodynamics. Learning to see underlying ‘structures’ rather than ‘events’, and to think in terms of ‘processes’ rather than ‘snapshots’, helps you spot the points of leverage. 9. You can have your cake and eat it too, but not at once – manufacturers used to think that you had to choose between high quality and low cost, but then discovered that raising quality meant improved methods, lower warranty costs, fewer complaints, higher sales, and so eventually lower costs as well. 10. Dividing an elephant in half does not make two smaller elephants – if you set up strong divisions between different parts of the organization, you don’t get each one working independently, you just get a mess. The heads of marketing, manufacturing and research are often like the blind men trying to describe an elephant. 11. There is no blame – the cure for problems is in relationships and systems.

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Copyright © 2007, www.WestbrookStevens.Com


Example of 2nd Order Changes with a Negative Result (from bad decisions)

Start

Dissolution Copyright Š 2007, www.WestbrookStevens.Com 15


craigastevens@westbrookstevens.com

1st Order Changes or Continuous Improvement

Adaptation = Positive 1st Order Change

Adapt Adapt

Adapt

Start

1/7/2013

Copyright Š 2007, www.WestbrookStevens.Com 16 16


1st Order Changes or Continuous Improvement – With a Negative Result

Deterioration © CraigAStevens@WestbrookStevens.com – www.e-WBS.com


Exercise/Question for your group

Are possibly negative results related to a change ever discussed at your office?

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Time

Decline

Maturity

Growth

Introduction

Development

Cash

Business - Product Lifecycle

www.westbrookstevens.com

Revenue Profit

Copyright Š 2007, www.WestbrookStevens.Com 19


Lifecycles and “S” and “J” Curves and Continuous Improvement

Copyright © 2007, www.WestbrookStevens.Com 20


http://issuu.com/craigastevens

Agenda Creating a Team Focused Improvement Program

1

Goals/Objectives

2

What is Change and Continuous Improvement?

3

How does Project Management relate to Change?

4

What is Lean and Six Sigma?

5

Simplifying Leah Six Sigma & Continuous Improvement

6

Applying Lean Six Sigma in Healthcare

7

Summary

craigastevens@westbrookstevens.com

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Copyright Š 2007, www.WestbrookStevens.Com

Project Management is the Change Implementation Tool Before the Change

During the Change

After the Change

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craigastevens@westbrookstevens.com

1st Order Changes or Continuous Improvement Adapt Adapt

Adapt

Start

1/7/2013

Copyright Š 2007, www.WestbrookStevens.Com 23 23


Strategic Planning

Industrial/Systems Engineering

Process Improvement

Lean

Productivity Improvement

Project Selection Portfolio Management

Project Management Program Management


Exercise/Question for your group

As a Project Manager, are you aware of the drivers of the changes that you are implementing?

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http://issuu.com/craigastevens

Agenda Creating a Team Focused Improvement Program

1

Goals/Objectives

2

What is Change and Continuous Improvement?

3

How does Project Management relate to Change?

4

What is Lean and Six Sigma?

5

Simplifying Leah Six Sigma & Continuous Improvement

6

Applying Lean Six Sigma in Healthcare

7

Summary

craigastevens@westbrookstevens.com

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History of Lean Improvement Focused Teams

Lean Developed by Toyota in the 1950s Originally called TPS – Toyota Production System Focuses on reducing waste and improving cycle time through continuous quality improvement Impact – Improves process flow and efficiency Example From the HCA PI Teams


Lean = Elimination of Waste • • • • • • • •

Defects Over-Production Waiting Not Clear (confusion) Transporting Inventory Motion Excess-Processing

The 8 Types of Waste MUDA for Muddy Water 28


History of Six Sigma Improvement Focused Teams

Six Sigma Developed by Motorola in the 1980’s Focuses on reducing errors through rigorous data analysis and statistical controls  Impact – Improves quality and reduces process variation Example From the HCA PI Teams


Š CraigAStevens@WestbrookStevens.com – www.e-WBS.com

Comparing - Six Sigma DMAIC Lifecycles to Change

Before the Change Define Measure Analyze

During the Change

Implement = Project Management

After the Change Control

Operations and Maintenance Phases

Copyright 2009 Westbrook Stevens


Exercise/Question for your group

Have you been exposed to the Lean Six Sigma training and was it complicated?

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http://issuu.com/craigastevens

Agenda Creating a Team Focused Improvement Program

1

Goals/Objectives

2

What is Change and Continuous Improvement?

3

How does Project Management relate to Change?

4

What is Lean and Six Sigma?

5

Simplifying Leah Six Sigma & Continuous Improvement

6

Applying Lean Six Sigma in Healthcare

7

Summary

craigastevens@westbrookstevens.com

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Westbrook Stevens, Seven Attributes of Excellent Management Model, 1990 Š

http://issuu.com/craigastevens

People and Team Building

From Book Geronimo Stone http://www.llumina.com/store/geronimostone2.htm

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Exercise/Question for your group

What part of the Mobile is left out most often where you work?

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craigastevens@westbrookstevens.com

Optimizing The Three Phases of Change Before the Change

During the Change

After the Change

Copyright Š 2007, www.WestbrookStevens.Com 35


Three Easy to Understand and Use Improvement Phases A= Assessments

P = Problem Solving

I = Implementation Using Project Management Tools/Support

craigastevens@westbrookstevens.com

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Assessment Phase

A= Assessments

P = Problem Solving

I = Implementation Using Project Management Tools/Support

craigastevens@westbrookstevens.com

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Select the Problems to Solve - Build the Problem Solving Portfolio A= Assessments

P = Problem Solving

I = Implementation Using Project Management Tools/Support

craigastevens@westbrookstevens.com

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Solve Problems and Build/Apply GFR Benchmarking A= Assessments

GFR GFR

GFR P = Problem Solving

I = Implementation Using Project Management Tools/Support

craigastevens@westbrookstevens.com

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Select the Solutions and Build a Project Portfolio A= Assessments

GFR GFR

GFR P = Problem Solving

I = Implementation Using Project Management Tools/Support

craigastevens@westbrookstevens.com

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Exercise/Question for your group

Does the three phases sound easier than Lean Six Sigma systems you use?

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http://issuu.com/craigastevens

Agenda Creating a Team Focused Improvement Program

1

Goals/Objectives

2

What is Change and Continuous Improvement?

3

How does Project Management relate to Change?

4

What is Lean and Six Sigma?

5

Simplifying Leah Six Sigma & Continuous Improvement

6

Applying Lean Six Sigma in Healthcare

7

Summary

craigastevens@westbrookstevens.com

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craigastevens@westbrookstevens.com

The Most Efficient Doctor Visit Improvement Focused Teams

Doctor Lucy Treatments

5 C


Three Easy to Understand and Use Improvement Phases A= Assessments

P = Problem Solving

I = Implementation Using Project Management Tools/Support

craigastevens@westbrookstevens.com

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craigastevens@westbrookstevens.com

Training by Levels of Expertise Improvement Focused Teams

3 Hrs For Leaders

Create an Understanding with a focus on Leadership and Empowerment (White Belt)

For Supervisors 10 Hours – Culture, Teams, Motivation

Be Able to Manage and Contribute to Improvements (Yellow Belt)

For Practitioners 2 Weeks Worth of Training, Projects and Tools For CPIp Mentors and Facilitators 3 Months Worth of Implementation – Mentoring and Implementation Study

Be Able to Perform Improvement Projects Independently (Green Belt) Be able to Teach and Facilitate Improvement Projects for Others (Black Belt) 45


craigastevens@westbrookstevens.com

White Belt – 180 Minutes of Building Leaders Improvement Focused Teams - White Belt Training

Element 1 -Leadership 2 - Culture 3 - Customer Focus 4 - People and Teams 5 - Skills and Tools 6 - Processes and Systems 7 - Performance Measures

% of Introduction ~180 Minutes Time Presentation 50 90 15 30 15 30 5 5

12 12

Goal: To Create an Understanding

1 -Leadership 2 - Culture 3 - Customer Focus 4 - People and Teams 5 - Skills and Tools

5

12

6 - Processes and Systems 7 - Performance Measures

5

12

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craigastevens@westbrookstevens.com

Training by Levels of Expertise Improvement Focused Teams

3 - Hrs For Leaders

Create an Understanding with a focus on Leadership and Empowerment (White Belt)

For Supervisors 10 Hrs – Culture, Teams, Motivation

Be Able to Manage and Contribute to Improvements (Yellow Belt)

For Practitioners 2 Weeks Worth of Training, Projects and Tools For CPIp Mentors and Facilitators 3 Months Worth of Implementation – Mentoring and Implementation Study

Be Able to Perform Improvement Projects Independently (Green Belt) Be able to Teach and Facilitate Improvement Projects for Others (Black Belt) 47


craigastevens@westbrookstevens.com

Yellow Belt – 10 Hrs – Building Direct Supervisors Improvement Focused Teams – Yellow Belt Training

Element 1 -Leadership 2 - Culture 3 - Customer Focus 4 - People and Teams

% of Leaders’ Time 2 2

Goal: To Be Able to Manage and Contribute to Improvements

4 4

1 -Leadership 2 - Culture 3 - Customer Focus

5 - Skills and Tools 6 - Processes and Systems 7 - Performance Measures

63

4 - People and Teams 5 - Skills and Tools

13

6 - Processes and Systems 7 - Performance Measures

13

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craigastevens@westbrookstevens.com

Yellow Belt – Problem Solving (Skills and Core Competiveness) (63%of time)

• Highest Impact Tools and Solutions – Staffing – Doctor Schedule Templates – Patient Throughput – Phones – Room Utilization – Front Line Patient/Customer Service

• Green Flag Reports 49


craigastevens@westbrookstevens.com

Yellow Belt – Problem Solving (Skills and Core Competiveness) (63%of time)

• Introduce Lean Tools – – – – – – –

In addition to the Big Rocks & GFRs Observations Value Stream Mapping Flow Charting A3 Processing and Reporting Spaghetti Diagram 5 S Events

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craigastevens@westbrookstevens.com

Training by Levels of Expertise Improvement Focused Teams

3 Hrs For Leaders

Create an Understanding with a focus on Leadership and Empowerment (White Belt)

For Supervisors 10 Hrs – Culture, Teams, Motivation

Be Able to Manage and Contribute to Improvements (Yellow Belt)

For Practitioners 2 Weeks Worth of Training, Projects and Tools For CPIp Mentors and Facilitators 3 Months Worth of Implementation – Mentoring and Implementation Study

Be Able to Perform Improvement Projects Independently (Green Belt) Be able to Teach and Facilitate Improvement Projects for Others (Black Belt) 51


craigastevens@westbrookstevens.com

Green Belt – 4 Days & Project – Building Practitioners Improvement Focused Teams – Green Belt Training

Element

% of Practitioners’ Time

1 -Leadership

2

2 - Culture

2

3 - Customer Focus

6

4 - People and Teams

10

5 - Skills and Tools

60

6 - Processes and Systems 7 - Performance Measures

Goal: To Be Able to Perform Improvement Projects Independently 1 -Leadership 2 - Culture 3 - Customer Focus 4 - People and Teams

10 10

Requires Completion of a Complete Improvement Project

5 - Skills and Tools 6 - Processes and Systems 7 - Performance Measures

52


craigastevens@westbrookstevens.com

Green Belt – Select a Green Belt Project that Relates to Your Work Area • Use and Be Able to Mentor the Three Phases – Assess Using the Seven Attributes • Plant Green and Red Flags • Build Red Flag Portfolio

– Perform Problem Solving On One or More of the Red Flags • Facilitate a Team Problem Solving Effort • Build a Solution Portfolio and Select the Best (a Real Project)

– Implement Solutions • Build a Project Portfolio Based on the Solutions • Implement some Quick Fixes and • Select and Use PM tools to Implement a Real (Larger) Project 53


craigastevens@westbrookstevens.com

Green Belt – Training • Teach the Key Six Sigma Tools – Stats and Use the Lean Tools

• Review and Expand on the Other Subjects • Apply to The Selected Project • Teach Project Management Tools

54


craigastevens@westbrookstevens.com

Training by Levels of Expertise Improvement Focused Teams

3 Hrs For Leaders

Create an Understanding with a focus on Leadership and Empowerment (White Belt)

For Supervisors 10 Hrs – Culture, Teams, Motivation

Be Able to Manage and Contribute to Improvements (Yellow Belt)

For Practitioners 2 Weeks Worth of Training, Projects and Tools For CPIp Mentors and Facilitators 3 Months Worth of Implementation – Mentoring and Implementation Study

Be Able to Perform Improvement Projects Independently (Green Belt) Be able to Teach and Facilitate Improvement Projects for Others (Black Belt) 55


craigastevens@westbrookstevens.com

Black Belt – 6 Months Experience, Training, & 4 Projects for PIP Facilitators Improvement Focused Teams - Black Belt

Element

% of Facilitators' Time

1 -Leadership

5

2 - Culture

5

3 - Customer Focus

5

Goal: To Be able to Teach and Facilitate Improvement Projects for Others

1 -Leadership

4 - People and Teams

20

2 - Culture

5 - Skills and Tools

30

3 - Customer Focus

6 - Processes and Systems 7 - Performance Measures

30

4 - People and Teams 5 - Skills and Tools 6 - Processes and Systems 7 - Performance Measures

5

Requires Facilitating the Successful Completion of 4 Complete Improvement Projects for Others

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craigastevens@westbrookstevens.com

Black Belt – Training • Review and Expand on the Attributes and Tools • Add Systems Thinking Archetypes • Apply to The Selected Project • Strategic Focus • Focus on Mentoring Others • Focus on Training-the-Trainer • Configuration Management 57


Exercise/Question for your group

What part of the Mobile is left out most often where you work?

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Configuration Management is a black belt issue

Why control changes? What could possibly go wrong?

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1984, a pesticide plant owned by Union Carbide, had an accident in their facility in Bhopal India. The resulting accident produced a toxic leak that became the world’s worst industrial disaster. In total, 15,000 people died and 150,000600,000 people were injured.


1/7/2013

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What is Configuration Management

A CM program can be subdivided into four practices: 1. configuration identification, 2. configuration control, 3. configuration status accounting, and 4. configuration verification. Read about it at http://issuu.com/craigastevens 63


Exercise/Question for your group

What Project Configuration Management issues have you seen?

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http://issuu.com/craigastevens

Agenda Creating a Team Focused Improvement Program

1

Goals/Objectives

2

What is Change and Continuous Improvement?

3

How does Project Management relate to Change?

4

What is Lean and Six Sigma?

5

Simplifying Leah Six Sigma & Continuous Improvement

6

Applying Lean Six Sigma in Healthcare

7

Summary

craigastevens@westbrookstevens.com

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Process improvement simplified 20140615  

Presentation in Tampa looking at Change, Continuous Improvement (Lean Six Sigma) in Healthcare. June 16 and 17, 2014

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