STREAMing Quiet Time
Wockhardt Hospitals

Winner - Quality Fables Competition 2016

"A place where we came for quiet is the place where we found it the least"

This statement by one of our patients during our patient rounds set us thinking about noise levels in our hospital.

We had a religious practice of daily patient rounds by the administration team which comprised of nursing, medical & general administration. The mere purpose of these rounds was to ensure comfort of our patients during their stay in the hospital.

Noise was something that we had least expected as a problem since our occupancies weren't that high. But recently couple of our patients started talking about it in words like "I think there was an emergency in the ward I could hear a lot of commotion in the afternoon"; "No its not their mistake. They all come in the room with some purpose"; "I woke up with a start. They couldn't find the housekeeping guy & had to call out his name loudly in the corridor".

Same problem with different packages! Were we that noisy? Our customers perceived our environment as noisy. We couldn't believe it. As healthcare providers we had a responsibility to provide a 'quiet' healing environment to our patients.

We decided to measure our noise levels. As per WHO the average noise level in hospitals should be around 45 dB. And our readings revealed a noise level of 70 dB. So there! It was proved we were indeed noisy! Moreover the review of literature revealed that every 6 dB increase in noise above the normal increases heart rate by 10-12beats/min.

This problem of lack of rest for patients was brining about restlessness in the senior leadership. After perusing through the data that was collected & a rigorous brainstorming, the team decided to observe a period of rest for the patient between 2-4pm & labeled it as 'Quiet Time'. An innovative acronym of 'STREAM' was designed to streamline the activities during these 2hrs the project was titled as 'STREAMing Quiet Time'.

“Even predictions can fill treasuries”
SBI Life Insurance Co. Ltd.

King Krishnadevaraya had the largest kingdom in the region-Vijayanagar. Under his rule, Vijayanagar expanded its boundaries and brought newer areas under its jurisdiction, thanks to brave soldiers in the battlefield and strategic decisions taken by the King and his ministers. Neighbouring kingdoms were not far behind. Though their boundaries were not expanding at the same rate, the high inflow of funds to their treasuries started becoming the topic of discussion at every meeting held by King Krishnadevaraya and his ministers. The gap was widening and becoming an area for concern for the kingdom of Vijayanagar and its position vis-à-vis competitors.

The pressure was building up for the Ministers to find a method to reduce the gap in treasury figures as it had a direct impact on the prosperity of Vijayanagar Kingdom and its people. King Krishnadevaraya summoned for Tenali Rama, one of the Ashtadiggajahs and the King’s favourite Minister, to find the reason and long term solution for the problem. Tenali held intensive discussions with stakeholders and suggested that a specialized project be launched to address the issue.

A cross functional team was formed that held brainstorming sessions followed by detailed study of the treasury management process. Though lack of efficiency and poor performance were found to be the main concerns that could be addressed by re-engineering the treasury management process and employing a tool for performance analysis and monitoring, what was most important was the need for a breakthrough process to improve the inflow of funds.

Informers were put to task by Tenali to research on what prospering kingdoms were doing that lead to their overflowing treasuries. Their research revealed that the kingdoms were employing soothsayers to predict which source of business in the kingdom is most likely to pay the taxes on time and which is not!!

Tenali thought they too have soothsayers in Vijayanagar, so why not employ them for the same purpose. The next day Tenali presented the findings in front of King Krishnadevaraya and his courtiers which lead to a very intensive discussion.

King Krishnadevaraya and the courtiers decided that they would need the help of soothsayers and mathematicians with greater expertise and experience from outside the kingdom for predictive analytics. Work was initiated. The King and his ministers provided their inputs regarding classification of existing businesses into easily identifiable categories based on their propensity for payment to the treasury. Inputs from treasury department helped to refine and improve the effectiveness of results.

Once the categories were clearly identified, the communication strategy was developed and the new process was presented before the King and the council of ministers. Once approved, the new process was initiated by announcing in the common assembly and throughout the vast kingdom of Vijayanagar.

Funds started to flow in as communication became more focussed and through proper process management and monitoring of flow of funds. King Krishnadevaraya personally kept a tab on the treasury inflows after all he had to ensure that his kingdom prospered!!

The project not only increased the inflow to the treasury but also helped to optimize resource utilization by prioritizing efforts and without compromising on quality. Further, the communication strategy additionally helped to identify alternate modes of obtaining funds from businesses.

“Spark neglected burns the house” - Quick Response to a complicated problem
Tata Cummins Ltd.

Sandeep Sinha the chief Operating officer of Cummins Group in India exited from the steering committee meeting between Cummins and Tata Motors Ltd., and started to walk towards his car, expressions of deep thought and concerned were visible on his face. He knew blocks were a bottle neck in achieving the numbers being asked by TML. TML was constantly asking for reasons for the sudden drop of supply and wanted the supply to be up. Emission changeover was around the corner and TML wanted to maximize sales in this pre-buy period. Sandeep entered his room and Ashwath Ram, Vice President manufacturing followed Sandeep. “What happened Sandeep?” asked Ashwath, “It has been one long meeting with TML on production numbers. TML is losing market share and we can’t let that happen for long” Sandeep said. “Well you know about the issues with block line, even if we buy a new machine we are down to 50% for next 8 months, its quality versus quantity, a catch 22 scenario” said Ashwath. “I know that, and I won’t ask you to compromise on quality but do something“Said Sandeep, “let me see to it” with these words Ashwath left and called an urgent meeting with key stakeholders Ashish Bhatnagar, plant Manager of TCPL Jamshedpur plant Master Black belt Sushma Mani and Block BU Head Ashwani Kumar, and asked them to start a Six Sigma project with an immediate effect to be completed less than 6 month.A cross functional team was formed with Anjan Mahanty as project lead. In the conference call with Sandeep, Sandeep promised all the resources however, “Anjan, I want a methodical coverage of this problem, I would be calling you for regular updates and support you but I need a date to commit to TATA Motors and you won’t get a day more”. “Right Sandeep I am on work” Said Anjan. Anjan was worried as he was the person who had the hands-on experience on this machine, and was trying to solve the problem without any results since last few months. Ashwini approached to Anjanand patted his back and said, “You look worried”, Anjan Said, “You know the effort gone into this machine, I am not sure how we are going to get this fixed in this short time, Sushma who was overhearing this conversation pitched in “We will do it Six Sigma Way”.

TCPL Block Machining lines were operating in full capacity to meet customer demands which were all time high and customer was gaining market share piggybacking on acceptance of Cummins engines. However, it was observed that honing parameters on Cylinder block were going out of specification. Soon High Engine Oil Consumption started reporting from the field in our engines and on investigation it was realized that surface finish is the root cause of these failures.

Based on Cummins philosophy of “Customer’s First” production stopped from this machine resulting in drop of production to 50%.

The project started at break neck speed with a deep dive Fault Tree Analysis done and constant leadership reviews followed. This was being done with a commitment to TML to start with the machine within 6 months of time. This project was closed in 172 days with a savings of around $32000.00.

“SYNERGY” - Mantra of LEAN Success
Tata Cummins Ltd.

“Shivraj, How are you placed tomorrow? I want to discuss something very urgent in tomorrow’s meeting so be on time” said Ramesh. “Sure” I replied but could sense the urgency in Ramesh’s voice. Next day I rushed to office, Ramesh and other Senior Leaders were present in Room. “1stJan is the deadline” said Shubhankar, Director - EBU, “We need to dismantle PMUC (Phaltan Midrange Upfit Center) and merge the business into TCL. Evacuate PMUC and hand over the facility to Cummins Fuel system(CFS) plant which is required for BS-IV launch. Tata Motors is banking on us and committing that they will give 3-5% higher Fuel economy over competitors with CFS fuel system. I know this seems to be impossible but we will have to make this possible”, he continued. “Shivraj I want you to lead this and ensure that we are ready by 1st Jan, stated Shubhankar.  “PMUC & TCL extreme ends of one ship, TCL considered to be most LEAN plant where as PMUC the most complex working in batch production methodology, How are we going to bridge these gap” thoughts started floating in my mind.

You look baffled, said Ramesh. “Ramesh, TCL has only 16 types of variants where as PMUC has 400+ variants; 3000 new parts proliferations, throughput of variants varies from 25 to 75 mins, increase capacity from 20 to 50 / shift embed with different cultural approach to engines assembly, Are we going to achieve this in such a short span”

“LEAN” is the Answer Shivraj, Stated Ramesh.

In a discussion with Biswadeep(Regional leader for Operations excellence)suggested to use Value Stream Transformation through Six Sigma Way(D-144 days)

That’s It, this would be one of its kind approach ever taken in Cummins– To work on VST through Six Sigma.

Diverse Team was formed including members from Operations Excellence, Quality, SCM and PMUC Production team. We did 3 day workshop on VST to have focus. (D-130 Days)

Mr. TIM WOOD famously known as 7 wastes in VST pitched in and pinpointed the Non-Value Added process in system, collaborated with operators to understand the current pain area. Ms. Ease Effect filtered all easy to do and high impact action and handed it to Mr. Pareto who in turn funneled the actions and converted them to critical “X”. Mrs. RACI ensured that team was made accountable and responsible to accomplish the task.  (D–100 Days)

Shubhankar invited Steve Cooper (Global Director, OE) to review this project, and give his insight. After reviewing Steve said, Guys your work till now is really commendable, I am looking forward to see the results, it will be a big breakthrough if you guys can crack it, All the best.” (D-75 days)

“Focus on the right approach and success will be yours” and 7 day ahead of schedule we could complete the project with PBIT Avoidance saving of $ 78,996. We all were jubilant to accomplish the results. This project was accoladed at various platform: Best Six sigma project in TCL, awarded in Integrated-SCM meets for significant contribution in improving delivery, runner up Award in LSSEA, Symbiosis Institute Pune.

A Twist in the Tale of Hexane Production
Bharat Petroleum Corporation Ltd.

Disruptive Thinking:

The Revolution is in Full Swing    

“We do not merely want to be the best of the best.

We want to be the only ones who do what we do.”

—Jerry Garcia,


A brilliant innovation by BPCL Mumbai Refinery, resulted in making India,the first in the history of refining, to produce stringent quality hexane as a byproduct along with isomerate – a motor spirit blend component - from its Isomerization unit.This was done by delving into unchartered territory. This Isomerization unit has the world’s first top divided wall column.

What turned out to be an innovation did not set out to be one….,

It was almost seven years ago that the idea to co-produce hexane from isomerization unit had germinated when the existing semi regeneration reformer, at BPCL Mumbai Refinery, was being converted into an isomerization unit. Like most out-of-the-box ideas, bounced off in a group, this idea had a few contenders, two to be very specific, in favor of it.It was sheer foresight of the person at the helm of things, to be able to judge the merits of the idea, over the rising banterand incorporate it in the project.

Somewhere down the road, while the offers were being evaluated, came up an option of using a divided wall column to co-produce hexane from the isomerization unit. This option had the benefit of huge energy savings and low foot-print-area. This idea was vetoed outright. Thus began a tussle, to let go of the idea or pursue. To go or not to go where no refiner has gone before, use a divided wall column in an isomerization unit and that also to co-produce very stringent quality hexane. It was decision time, once more. The idea was rebooted. This time round, the scale tilted in its favor.

Now we were running with not one, but two newbies – unchartered territories

Challenges galore, different people have different ways of handling them. Some of us go with the gut feeling while people with more experience,work on guesstimates – calculated risks. This innovation was a mix of both. The person involved at the working level had a strong belief that ‘It can be done’ and ‘Not to let go’ while the person in the decision making position had the ability ‘To try something new’.

Other turning points, like is it feasible?, backing out by designers as the design was too complicated to try, columntaller than any other in the refinery, were much easier to cross as the conviction was strong. The thought process that, the design was too complicated to try, unearthed the possibility that we had stumbled upon something that was not only new but also shiny. 

The outcome of this drive and people’s ability to take bold decisionswas an out and out success. Besides the production of hexane of world class specification, which has modified the refinery product slate to include ‘pharmaceutical’ and ‘polymer’ grade hexane along with food grade hexane and that also at around 27% lesser energy consumption, it is the sense of having done something out of the ordinary, something which makes people sit-up and pay attention, something which has reduced our carbon foot print, something that has not been done elsewhere, that gives a sense of pride. It strengthens the belief that, “Perseverance Pays”. 

Time will tell if this innovation will get erased, like footsteps in sand, or leave an indelible mark.

Beyond the Benchmarks
The Tata Power Co. Ltd.

Rajan is always eager to hear from MD, during MD’s communication meets, about new developments & challenges faced at Company level. That day MD stressed upon bringing down the Cost of Generation to ensure sustenance of Trombay operations. MD’s words kept echoing in Rajan’s mind & he reached home in a thoughtful state.

Rajan’s son Prashant greeted him at the door & asked him to play with him. Rajan told him “Beta my mind is occupied with some serious problem of our company, you play with your friends”.

Prashant insisted on knowing the problem. Rajan tried to explain, saying “We at Tata Power Trombay Station generate power mainly from Coal. In recent times, the power business has turned in to a fiercely competitive one. Cost of Generation is the most important component for survival of the business. However, we must fire costlier environment friendly imported coal, received via sea route, to comply with the stringent environment norms. This results in our power being costlier, as compared to the competitors.”

After listening attentively, Prashant said “Daddy, it seems that you people are in a big trouble. I remember, our teacher saying that Teamwork Divides the Task & Multiplies the Success. So, why don’t you talk to Rakesh uncle & Mahesh Uncle in the office?”.

Next day in the office Rajan called an urgent meeting with his colleagues Rakesh, Yogesh, Sachin, Mahesh and Lalit to discuss ways to reduce Cost of Generation. Even after three hours of discussion & 15 cups of coffee, the team reflected that there is not much of scope as the processes are already at a matured level. However, after serious brainstorming the team could see some light at the end of the tunnel & realized that there is a scope for reduction in Auxiliary Power Consumption at Coal Plant, which was recently showing an increasing trend. They further decided to adopt the six-sigma methodology as it is a disciplined, data-driven approach for eliminating defects in any process. Next day, a dedicated team lead by Rajan was formed & started working under the guidance of Senior Leadership for optimizing APC by 'Improving Coal Conveying System Efficiency'. Senior Management regularly reviewed the progress during management reviews.

In the beginning, the team eyed a target saving of Rs. 40 Lakh/Annum, which appeared very stretched, as processes and equipment were believed to be operating at their best. The team devised optimum coal conveying stream utilization strategy and developed a software program in-house, formulating barge unloading strategies under all the possible scenarios.

By adopting a holistic problem-solving approach, Rajan & team could ultimately achieve a saving of Rs. 1.03 Crore/Annum.

While reaching & surpassing the target, the team could also achieve:

  • Improved turnaround time of barges
  • Better stockpile management with optimized resource utilization
  • Significant reduction in diesel consumption
  • Improved maintenance practices

After successful completion, Rajan & team received a glittering trophy. Rajan very proudly presented the same to Prashant saying “Beta, our team wants to thank you” Prashant was puzzled & asked “What for?”. Rajan replied “You said that day ‘Teamwork Divides the Task & Multiplies the Success’ & we followed the same.”

Amrita Institute of Medical Sciences & Research Centre

He could not shake off the troubling thoughts from his mind. Yet another recovering patient had succumbed to an infection to which no antibiotic had control over. 'He was almost cured and his family had been so relieved!' his thoughts screamed back at him. Being the administrator of a reputed multispeciality hospital, he felt he had to do whatever it takes to tackle the emerging resistance of infection-causing microbes in the hospital to even the last resort antibiotics. Antimicrobial resistance was slowly but surely becoming a deadly reality worldwide.Well, I won’t let this go on in my hospital!' he resolved. He understood that fighting antimicrobial resistance was not easy and required an interdisciplinary team from varied health professionals to use their expertise to combat the issue from every angle. Bacteria’s are getting smarter; the solution needs to be smartest for combat.And so the antimicrobial stewardship programme (ASP) was formulated with the passionate team of the intensivist, physicians, pediatricians, microbiologist, and clinical pharmacists. Post prescriptive audit of all prescriptions with reserved antimicrobials was conducted during daily ASP meetings to ensure patients received the right antibiotic for the right indication at the right dose,frequency and duration.The ASP team gradually increased in size with an intention to reduce the size of hospital bacterias.

Soon we realized that ego is a bad word but clinical ego is worse. Who can tell the prescribing doctor to be appropriate? But the team got some teeth and did that. Appropriate use was applauded with positive feedback and engagement was initiated with inappropriate use. Sweetly worded recommendation was filed in the patient’s file and were discussed with the providers too. However,the team realized that working with bacterias is better. Many “God’s gift to mankind” would ask ‘On what basis can you recommend changes in our treatment?”. The team, worked hard with passion and grace and persevered to become change agents. Intent was not to do harm with over and under prescription. Strategies changed and many mid-course corrections were brought in viz new and simple forms, stand up huddle meetings, team meetings, post it recommendations and bed side rounding with treating clinicians. Reviewof practices and consistency in follow up helped. Outcome sharing brought a concept of data driven decision making for best outcomes. Compliance of seniors improved and they became role models. They soon started monitoring the junior colleagues thus bringing ripple effect. Impact of “Hit hard and Hit fast” for targeted therapy brought in huge dividends. Adherence to good prescription practices improved, patients stay was reduced, mortality became better, harm because of inappropriate antibiotics reduced. Attributable mortality on Antimicrobial Resistance improved, with morbidity and patient experience improved. High bills are huge “No No” and this judicious practice lead to cost benefit of 1.2 CR (INR).

Success was shared and very soon other healthcare institutions started following this quality improvement initiative. The State government's also adopted the state action plan for fighting AMR which would definitely lead to improved practices and good outcomes.

'The bugs are in for a tough battle' he chuckled while he sat down for yet another fruitful meeting with his purpose driven ASP team.

The success of the ASP program did not come overnight. It was through constant and untiring efforts from the team.

Changing the beauty of colours with innovation
Kansai Nerolac Paints Ltd.

In KNPL, we always try to replace the word “impossible” with “I am possible”. This becomes visible when we consider all failures as an opportunity for developing better ideas to reach the goal.

Our QA head being experienced in Manufacturing Excellence always analyse  issues before solving it.

During his initial days in QA head role, he analysed and found that, solving residue complaint will resolve the major issues faced at our OEM customer end. Residue is some ungrounded particles which will chock the paint guns while application at customer end.

He was confused on how to resolve the  issue and approached the Production Engineering Head who is an expert in finding solutions and hence nicknamed as doctor in our factory. Through a detailed analysis of process, he concluded that residue issue is mainly arising at the time of cartridge chock while filling. Further, they tried to find out why residue is entering the containers along with the final paint, even though filter is present. They dismantled the filtration unit and found that there is a gap between filter cartridge and its fixture and the residue particles are escaping through these gaps to the paint containers.

Now here comes the role of a Mechanical engineer who is capable of redesigning the cartridge fixture that suits the existing unit. Our Mechanical team under the leadership of Mr. Senthil started the brainstorming session and came up with multiple solutions. Initial 3 designs failed to suit the existing unit.

This disappointed the team and they even thought of handing over the case to filtration unit manufacturer.

Our Works manager and Production head, who are very keen on utilizing existing resources before any third party involvement, directed the team to take trials and took responsibility of batches getting spoiled during trials.

This gave motivation for the team to gear up their thoughts further and finally arrived at a fixture design which suits the existing unit and solves the residue issue.

It was surprising that zero batches were spoiled while conducting the trials. After all, satisfying customer is more important than satisfying internal stakeholders. Therefore, we invited our customer to visit our site and judge the improved design as per their requirement. Our customer team was very glad to see our involvement in developing such a design.

Believing in the confidence which we have given back to them in sustaining quality, they suggested us to do one more project to avoid any case of wrong label on containers or containers without label. Since labels pasted on containers are the only source to identify the product details, it is critical to paste the correct label on containers.

Being a Japanese company, we believe in their practices, and therefore we planned to develop “Pokayoke” which means mistake proofing. We are having a system in water based paint filling line where the container position is corrected with the help of a sensor at the time of printing. Keeping the same logic in mind, the same engineering members developed a sensor, which sense the abnormality in label and stop the filling line till the abnormality is cleared. The details of the label can be pre fed into the sensor unit using a USB. To our surprise, this pokayoke was well appreciated by customer and they even gave an opportunity to display this in their premises to their other suppliers.

The journey of Kaizen in KNPL still continues.