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More than Wishful Thinking: Strength-based Lean Six Sigma for improving access April 1, 2019 Ann Barber, Julie Breau, Kristina Rohde CMHA-Ontario Conference
More than Wishful Thinking:Strength-based Lean Six Sigma for improving access
April 1, 2019Ann Barber, Julie Breau, Kristina RohdeCMHA-Ontario Conference
About us
Introductions & wishes
Improve access to services
What is quality improvement (QI)?
“Quality improvement in health care is a systematic approach to making changes that lead to better patient [client] outcomes and stronger health system performance. This approach involves the application of Quality Improvement (QI) science, which provides a robust structure, tools and processes to assess and accelerate efforts for the testing, implementation and spread of QI practices.” Health Quality Ontario (HQO)
• The Model for Improvement• Lean• Six Sigma• Lean Six Sigma• Strength-based Lean Six Sigma• Kaizen
QI frameworks • Total Quality Management (TQM)• ISO 9000• Theory of Constraints• Experience Based Co-Design• Baldrige Criteria for Performance
Excellence• IHI Triple Aim• FADE QI Model
From Lean Six Sigma to Strength-based Lean Six Sigma
Lean:
• From the automotive industry; Ford and the Toyota Production System.
• Aims to reduce waste, maximize flow, and minimize non value steps.
Six Sigma:
• From manufacturing – Motorola and General Electric.
• Aims to reduce variation, validate hypotheses, and show quantifiable results in 5 step process.
Lean Six Sigma:
• Views Lean and Six Sigma as complementary processes aimed at driving organizational excellence overall.
• Use combined ‘toolbox’ of tools and techniques from each depending on what is relevant to the situation.
Lean, Six Sigma, and Lean Six Sigma
Lean Six Sigma in healthcare – why?
• Increasing cost of care• Difficult or variable access to services• Long wait times, for service, for results• Client satisfaction & safety of clients
Demand
• Inefficiencies in processes- 60% of operating costs= Non value added (waste)
• Inefficient/ inconsistent processes• Time consuming processes• Duplication
Waste
• Examples from hospitals- across the country BC to Ontario.• Ontario examples - Hôtel-Dieu Grace Healthcare.
Successes
Strength-based Lean Six Sigma
• Roots in appreciative inquiry and other strengths based approaches (David Shaked)
• Moves from deficit-focus to strength-focus
What’s the problem? What are the deficiencies?
What’s the root cause of the problem?
What is right, successful, usefulthat we can build on?
What existing assets and resources can we build on?How can we amplify what
already works?
Strength-based Lean Six Sigma
ClassicLean Six Sigma
Eliminate waste
Remove bottleneck
Reduce defects
Desiredoutcome
Value for customer
Flow (materials, people and
information)
Quality (product and service)
Strength-basedLean Six Sigma
Find and growexisting value
Identify and expand good practices
Find and study greatoutcomes/perfection
Access to mental health and addictions services
Getting to root causes
Identifying opportunities for improvement
Institute for Clinical Evaluative Sciences, THE MENTAL HEALTH OF CHILDREN AND YOUTH IN ONTARIO: 2017 SCORECARD
Identifying opportunities for improvement
Youth Wellness Hubs Ontario, Youhhubs.ca
Getting to root causes
• Problems may be identified by many symptoms.
• A Band-Aid solution to address a symptom will likely result in the problem re-occurring.
• A root cause is the underlying reason for the problem. If the true root causes are addressed the problem will not re-occur.
• Using a strengths based approach, this would be an examination of the facilitators or enablers of a positive outcome.
• A visual tool to logically organize possible causes for a specific problem by graphically displaying them.
• Uses team brainstorming.
• Creating a cause & effect diagram helps you think through the many potential causes of a problem.
• Ex. of categories: People, process, technology, resources, environment
Fishbone diagram
Strength-based tool: Wishbone diagram• Analytical process to
identify contributors / root causes of success
• Can have two purposes:• Used to facilitate
shared learning, growth based on recent successes
• Used to identify needs that need to be worked on in (re)design
Fishbone and wishbone
TechnologySurveys are not being completed Use electronic forms
Technology
Surveys are illegible
Example: Client satisfaction surveys
PeopleClient leaves before completing survey
PeoplePerson available to help fill out survey
From wishbone to data collection
Selecting and testing improvements
Selecting
• Where can we make an improvement?
• Can we learn more from what has worked in the past? (data)
• What can we learn from where wewere successful?
Testing
• Where is there available data?
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Average time to complete paperwork
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Paperwork
Improving access with the wishbone
Wishbone for improving access
Shorten the time at intake
(for service)
Technology
Resources
Environment
Process
People
Wishbone take-up and debrief
• How did you like the wishbone tool for thinking about access to services?
• Do you see some enablers of access that you could take to your organizations and test?
• Was it easy to think about access threw a strength-based lens?• Do you think there is space for a strength-based approach to QI
in your organizations?
• How to make a better cake or improve access challenges? Consider being strength-based
• You need to deal with the root causes to get rid of the dandelions, but seeking innovation may prevent those dandelion puffs from flying about
• Use the Wishbone tool to facilitate shared learning on recent success or to design new opportunities
• Use data to validate the issue and test solutions
• Strength based QI approach combines the rigour of Lean with the innovation and energy of Appreciative Inquiry
• It’s not just wishful thinking!
Key takeaways
Questions?
