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General Approach On How To Use The Basic Tools Of Quality Improvement
Issue ToConsider
Flow ChartExisting Process
Brainstorm& ConsolidateData
Cause & EffectDiagram – Greatest Concern
Use 5 Whys ToDrill Down ToRoot Causes
Gather DataOn Pain Points
Translate DataInto Information
• Pie Charts• Pareto Charts• Histograms• Scatter Plots, etc.
Flow ChartNew Process
Monitor New Process & Hold
The Gains
• Run Charts• Control Charts
Data ManagementStrategy – Ch. 14
“As Is” State to “Should Be” State
“As Is” StateBrainstormingForce and Effect
Analyze Information andDevelop Solutions
Solution andEffect Diagram
Source: The Public Health Quality Improvement Handbook, R. Bialek, G. Duffy, J. Moran, Editors,Quality Press, © 2009, p.160
“AIM”
Plan
1. Identify and Prioritize Opportunities
2. Develop AIMStatement
3. Describe the CurrentProcess
4. Collect Data on Current Process
5. Identify All PossibleCauses
6. Identify PotentialImprovements
7. Develop Improvement Theory
8. Develop Action Plan
1. Implement theImprovement
Do
2. Collect and DocumentThe data
3. Document Problems,Observations, and Lessons
Learned
Check/Study
1. Reflect on the Analysis
Act
2. Document Problems,Observation, and Lessons learned
Adopt
Adapt
Abandon
Standardize
Do
Plan
The ABC’s of PDCA, G. Gorenflo and J. Moran
Some Tools To Help Create AIM Statements
1. Current and Future State Model
2. AIM Work Sheet
3. Force Field Diagram
4. Force and Effect Diagram
Current State
• What is the current state?
• Why is this important?
• What is it costing us time/dollars/staff/etc?
• What is the impact on our customer/clients?
• What is the impact on our division/agency?
Future State:
• What are the important aspects of the future state?
• What is driving us to this future state?
• What might be the consequences of not moving to the future state?
• What might change?
• What is the proposed timeline?
Pathway
Consequences
Driving Forces:
Benefits
AIM or Opportunity StatementAn opportunity exists to improve the
________________________________________________________________________(name process, or area to work on)
beginning with ___________________________________________________________(beginning boundary, starting point)
and ending with __________________________________________________________.(ending boundary, finish point)
This effort should improve_______________________________________________________________________
_______________________________________________________________________
(key characteristics of area the team is working on)
for the _______________________________________________________________________________
_________________________________________________________.(customers, staff or those affected by the process under improvement)
This process is important to work on now because_______________________________________________________________________
_______________________________________________________________________
(what will it improve and for whom?)
Positive Forces Negative Forces
CurrentState
Force Field Diagram - Basic
Des
ired
Sta
te
Process/Activities:
Begins With:
Ends With:
Inputs:
Suppliers:
Outputs:
Customers:
Constraints:
High Level S I P O C+CM Collection Form
Measures
High Level S I P O C Collection Form
Process/Activities:
Begins With: Ends With:
Inputs:
Supplier(s):
Outputs:
Customers:
Constraints:
Identifying required service standards of performance
Trained and effective employees committed to using the standards in all areas.
Limited funds for benchmarking other public health organizations. Human Resources is short two staff and overworked already.
LPH System values and vision. Current job descriptions and job performance expectations. Benchmarking from other PHDs and service organizations. Training on interviewing and employee selection criteria. General idea of client, inspector, nurse, and other staff expectations
Approved standards of service performance excellence for PHD Training modules developed for all levels of management and employees Announcement campaign to provide awareness and support of standards Rollout of training to all staff Training to supervisors on how to use the standards in performance planning.
PHD senior management, Human Resources, Benchmarking organizations, consultant on hiring and interviewing, clients, health officer, nurses, supervisors, and employees.
Employees, Human Resources, supervisors, PHD clients, senior management, partners, nurses, community.
Benchmark other PHDs for standards of service performance. Gather and review all current job descriptions for existing standards and expectations. Research current journals for trends on behaviorally-based characteristics. Work with H/R and Senior management to establish LPH standards. Update all job descriptions and performance planning models to new standards. Develop training materials to roll out new standards for current employees and new hiring. Announce rollout, timelines and measurements. Work with supervisors and employees to put standards into each performance plan. Gather feedback, adjust, report and maintain.
LPH standards of performance completed % of standards signed by employees % of job descriptions updated Training materials for standards complete on time % employees completing training…
Measures
SIPOC+CM
Flow Chart Symbols
Activity:Operation/Inspection
Decision
Start/EndBookends
Document
Wait/Delay
Storage
Data Base
Transport
Input
Output
Flow Lines
A Connector
Forms
CommentCollector
Input/OutputData
ManualOperation
Preparation
ManualInput
Display
Unfamiliar/Research
Flow Chart Summary MatrixPHF E-News, March 2, 2010, http://www.phf.org/pmqi/Flow-Chart-Summary-Matrix.pdf
∑Flow Chart Step Number
Type of Step
Type of Step: P – process, D – decision, T – transport, W – wait, S – storage
Delta = Proposed – Actual – the more negative the subtraction the better – more savings
1. Touch Point (√)
2. Cost
3. FTEs/Person Hrs.
4. Supplies Required
5. Equipment Required
6. Space Required
7. Time
8. Cost of Quality
8. Partnerships Needed
9. Etc.
10. Value added
ActualDelta
+/-∑Proposed
P D P T W P D S
1 2 3 4 5 6 7 8
LSS
5S is a visual method of setting the workplace in order. It is a system for workplace organization and standardization.
The five steps that go into this technique: Seiri – sort – essential items
Seiton – set in order – promote work flow
Seison – shine – clean workplace
Seiketsu – standardize - consistency
shitsuke)- sustain – hold the gains
Definition of 8 Types of Waste:
Waste Description Public Health Example
Overproduction Items being produced in excess quantity and products being made before the customer needs them
Insurance filing or immunization record opened before all required information is received
Waiting Periods of inactivity in a downstream process that occurs because an upstream activity does not produce or deliver on time.
Paperwork waiting for management signature or review
Unnecessary Motion
Extra steps taken by employees and equipment to accommodate inefficient process layouts.
Immunology testing equipment stored in cabinets far from specialist work area.
TransportationHandling
Unnecessary movement of materials or double handling
Department vehicles stored in central facility, requiring constant movement of vehicles to and from other high traffic locations
Over-processing Spending more time than necessary to produce the product or service
Combining client survey instruments into one form rather than develop specific instruments for each program
Unnecessary Inventory
Any excess inventory that is not directly required for the current client’s order
Over estimating vaccination support materials requiring additional locked storage cages, inventory counting and reconciliation
Defects Errors produced during a service transaction or while developing a product.
Ineffective scripts for initial intake applications. Unclear directions for filling out required forms
Duplication Having to re-enter data or repeat details on forms. Poorly designed client intake computer screens or services checklists
Cause and Effect Diagrams - Construction
Generate ideas as to what are the main causes of the effect
Label these as the main branch headers
Organizes group knowledge about causes of a problem and display the information graphically
Effect
HeaderHeader
HeaderHeader
Root Cause Analysis Rating Form
PotentialRootCause
ImprovedQuality
ReducedCosts
ImprovedCustomerSatisfaction
Others Total Score
Ranking
Impact Scoring Scale: Low = 1, Medium = 3, High = 5
Impact on the Problem
Cause and Effect Diagram
Solution and Effect Diagrams - Construction
Generate ideas as to what are the main Solutions of the effect
Label these as the main branch headers
Effect
SolutionSolution
SolutionSolution
Root Cause Analysis Solution Impact Analysis
Potential Solutions
CorrectiveAction Type
VerificationMethod
CostToFix
BenefitOf Fix
CostBenefitRatio
Selected?Y/N
Corrective Action Type: Immediate but Interim – II, Short-term Temporary - ST,Permanent – Short Term – PST, and Permanent – Long Term - PLT
Solution and Effect Diagram
1. 2. 3. 4. 5. 6. 7. 8.
Intervention Number
Date What Was The
Change?
How Did It Impact The
AIM?
How Did Your
Thinking Change?
How Did It Impact Your Procedures?
How Did It Impact Your Customer?
How Do You Know?
Measures
Intervention and Impact FormAIM Statement Description:
The following columns can be added to the Intervention and Impact Form when needed to track the impact of unintended consequences.
9 10 11 12 13 14 15
Unintended Consequence Letter
UnintendedConsequenceDescription
Date It Happened
Impact To Aim Statement
Need a Sub AIM Statement?
Impact to Customer
ModificationsMade
Intervention and Impact Form when needed to track the impact of unintended consequences.