the journey of a begins - hcca official site · 3/18/2016 1 the journey of a thousand miles begins...

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TheJourneyofaThousandMilesBeginswithaSingleStep

KristineKoontz,PhD,SSGBAmyDianeShort,MHSA,CSSBB

KristineKoontz,Ph.D.• ClinicalPsychology—SciencePractitioner• SixSigmaGreenBelt• DirectorofQualityandPerformanceManagement• QPMOversightofBehavioralHealthOrganization

• ResidentialandCommunitySettings• IntellectualDisabilities,MentalHealth,AutismSpectrumDisorders

• LifespanServices• USA:PA,DE&CT• International:Moldova,India

AmyShort,MHSA• BSPsychology• MHSA(Master’sHealthServicesAdministration)• CertifiedSixSigmaBlackBelt• OperationalOversightofHospitalFunctions• QILeadershipofImplementationResearchatAcademicHealthCenter

• PatientAdvisoryCouncilMentor• UniversityofCincinnatiIRBMember• AdministrativeDirectorofCenterofImprovementScience,CincinnatiCCTST

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PresentationOverview

• ANewApproach• GettingtoKnowYou• SixSigmaandDMAIC• Data,Data,Data• StrongProjectStarts• MakingImprovements• MaintainingtheGains

Active Learning

ChangesfromYOURFeedback

• LessBroad,aDeeperDive• ExamplesfromaSuccessfulProject• MoreTimetoDoActivities

• WorksheetSentAheadofTimetoRegisteredParticipants

WhoAreYou?• AnswerPrivatelyinSocrative.com,• TypeinRoomNumber:

AMYSHORT• LoginasStudent• EnteratLeastOneLetterasaName

Click Here for Menu

Click Here to Login

Or Use the App

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HowExperiencedAreYouinQI?• AnswerPrivatelyinSocrative.com,• TypeinRoomNumber:

AMYSHORT• LoginasStudent• EnteratLeastOneLetterasaName

Click Here for Menu

Click Here to Login

KeepingItReal• WhatComplianceIssueKeepsYouUpatNight?

Worksheet

DMAICDefineMeasureAnalyzeImproveControl

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WheretheJourneyBegins:Data

WhyData?• YouCannotManagewhatYouCannotMeasure

• DataInformation KnowledgeWisdom

WhatisData?Datais….

• Pluralof“Datum”Latin for“SomethingGiven”

• SetofValuesofQualitativeorQuantitativeVariables

• InformationinaRaworUnorganizedFormthatReferto,orRepresent,Condition,IdeasorObjects

• FactsthatCanBeAnalyzedorUsedinanEfforttoGainKnowledgeorMakeDecisions

• InformationthathasBeenTranslatedintoaFormthatIsMoreConvenienttoMoveorProcess

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WhatDoWeMeasure?

Characteristicsof:

• IndividualsWeSupport• Outcomes• Demographics/Characteristics

• Workforce• Outcomes• Demographics

• Programs/Services• Outcomes• Processes• Environment

“Everyday”Data

OUTCOME

• Lab/AssessmentResults

• SatisfactionRatings• UtilizationRate• ProgressNoteContent

PROCESS• TimelinessofExpectedDeliverable(E.g.,24HrsforaProgressNote)

• PointsofContactwithCaregivers

• CriticalProcessMilestones

Quality Services

Quality Assurance

Ongoing measurementof “Vital Signs”

Data

Quality Improvement

Targeted and SystematicChange and

measurement of impact

QualityAssuranceorImprovement?

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DataAreOurFriends

https://dailysliceofpi.wordpress.com/2013/08/05/perfect-friendly-and-amicable-numbers/

DataTypes/Levels• Nominal Name• Ordinal Order• Interval EqualUnits• Ratio EqualUnits&“True0”

• Derived LinearCombination

NominalData• ToNameanObjectandThustoAssignIttoaClass(a.k.a.Categorical)

• StatisticsCanBeAppliedtoTheseDataOnlyAfterTheyHaveBeenConvertedtoPercentagesorProportions,forExample:

• 45%Femaleand55%Male• Gender• Program• LevelofDelay

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OrdinalData• ObjectsAreMeasuredasBeingEitherGreaterThanorLessThan,HigherorLowerThanaComparativeObject

• IntervalsBetweenAreMeaningless(Non‐Standard)

• BirthOrder/Win,Place,Show• LikertScale(Never,Sometimes,Always)

IntervalData• Interval:ABasicStandardIntervalbutNotNecessarilyaTrueZero/StartingPoint

• DifferenceBetweenScoreof1and2isSameasDifferenceBetween2and3Etc.

• ZeroDoesNotHaveaTrueMeaningIndicatingtheCompleteAbsenceofWhateverWeAreMeasuring

• E.g.Temperature(FahrenheitandCelsius)• 60DegreesIsNotTwiceasHotas30Degrees• 0DegreesIsNotAbsenceofKineticEnergy

• E.g.StandardScores(IQ,AdaptiveBehavior)

Ratio• ThereIsaBasicStandardIntervalasinInterval

• AlsoHasaMeaningfulZeroValue

• E.g.Height,Weight,DurationofTime

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DescriptiveStatisticsTermGiventotheAnalysisofDatathatHelpsDescribe,ShoworSummarizeDatainaMeaningfulWay

• MeasuresofCentralTendency

• MeasuresofDispersionandVariability

Hellloooooo! Let Me Tell You a Bit About Me and the Gang!

CentralTendencyNAME DESCRIPTION BEST FOR…

Mode Most Frequently Occurring Value (Can Have More Than One)

Nominal Data

Median “Middle Point” of the Distribution; Point Below which 50% of Values Fall

Ordinal Data or for Use with a Skewed Distribution

Arithmetic Mean

Sum of All Data Values in the Distribution Divided by the Number of Values

Most Commonly UsedStatistic; Not for Use with Skewed or Bi‐Modal Data

Distributions:“Eyeballyourdata”

• TheImportanceofVisualInspection

• FirstStepinAnalyzingandUnderstandingYourData

• DiscreteVariables• FrequencyDistributionTable

• BarCharts

• ContinuousVariables• Histogram

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Behold……andBeware

MeasuresofDispersion/Variability

VariabilityofDistribution• 155555559• 122356789

• BothDistributionsHaveaMeanof5

• InwhichDistributionIsYourScoreof9More“Impressive”?• InwhichDistributionaretheScoresMoreSpreadOut?

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KnowYourData

SecuretheFoundationandTrajectoryofYourProject

WheninDoubt,ConsultanExpert….

WhenConfidentAboutYourData,StillConsultanExpert….

(R)DMAIC

RecognizeDefineMeasureAnalyzeImproveControl

Recognize

• TheSecretStepBEFOREDMAIC

• First,LookatData:• QualityControl• Audits• CustomerServiceSurveys• FinancialPerformanceIndicators

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Recognize

• Second,MakeanEvaluation:• NixifThereIsaKnownSolution

• Implement!• NotSuitableifProblemIsaManagementIssue• MakeSuretheProblemIsProcessRelated

Recognize

• Third,Prioritize:• HowImportantIsIttoYourOrganization?• IsItWorthyofResourcesthatCouldBeOtherwiseDeployed?

• AreThereOtherProjectsthatNeedtoHappenFirst?

Recognize

• Fourth,DefinetheProblem• DevelopaHigh‐LevelUnderstandingoftheProblem• BegintoThinkAboutScope

• HelpfulTools:• ProjectDefinitionWorksheet• MacroMap

Worksheet

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Recognize

MacroMap

DMAICDefineMeasureAnalyzeImproveControl

Define

• IdentifyTeamMembers• LocalExperts• PeoplefromUpandDownStream

• HelpfulTools:• TeamAttributeChart• TeamRoster

• BuildTeamCulture• HelpfulTool:

• GroundRules

Worksheet

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DefineTeamAttributeWorksheet

ProjectRoster

Define

Meetings start and end on time.

Stick to the agenda.

No looping back.

Be honest/speak your mind.

Members will meet deliverables’ 

deadlines.

Treat each other with respect.

Challenge ideas, not people.

Be actively engaged.

All voices will be heard.

Silence equals agreement.

Limit side conversations.

Seek consensus.

Define how decisions will be made.

Cell phone used only for emergencies.

SampleGroundRules

Define

• ReviewProjectDefinitionWorksheet• VerifyMacroMap• RefinetheProjectStatement• VerifyBaselineCorrect• IdentifyAdditionalDatathatAreNeeded• DefineProjectMetrics

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TypesofProjectMetrics1: Six Sigma Project Metrics

Project Metric DefinitionCorrelation to Primary Metric

Use in Improvement Project

Primary Metric

Defines the project goal: “improve (primary metric) from (baseline) to (target) by (date)”

N/AMeasure baseline and improvement level when the project ends

Secondary MetricCaptures, validates and tracks welcome side effects of the project

Strong (high relative predictive power, or R2). By default, there is a cause‐and‐effect relationship between the primary and secondary metrics.

Measure baseline and impacts of project after improvement. Monitor during and after project if linked to financial metric.

Consequential MetricCaptures, validates and tracks non‐welcome side effects of the project

Strong (high R2). In the current design of the process, there is a cause‐and‐effect relationship between the primary and consequential metrics.

Collect data before, during and after the project to prove no collateral damage was caused by the project.

Financial Metric

Links progress in the primary and secondary metrics to financial advantage. Most often this metric is tailor‐made for the specific project

Expected strong (high R2).

Evaluate at project milestones (i.e., Define, Measure, Analyze and Control phases) and typically one year after the project ends.

Business MetricMeasures how an organization achieves one of its major goals.

Typically weak (low R2).Monitoring is optional and mainly needed for communication purposes.

From: Be Consistent in Six Sigma Project Metric Selection; M. Ohler; isixsigma.com

Define Worksheet

Define

• CreateProjectTimeline,MeetingPlan,andCommunicationPlan

• HelpfulTool:• ProjectCharter

Pro‐Tip:IssuesList

Worksheet

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Define

DMAICDefineMeasureAnalyzeImproveControl

MeasureThe Process Map

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WhyProcessMap?

• YouCan’tFixaProblemUntilYouUnderstandthePresentState• …HowItREALLYWorks• ….EveryoneSharestheSameUnderstanding

• ProcessMapsRevealWhereImprovementIsNeededMost

• ProcessMappingHelpsKeepaProjectinScope

HowtoProcessMap

• GatherYourTeam• DefinetheEndPoints• BrainstormtheProcessSteps• PutProcessStepsinProperOrder

Pro‐Tip:UseStickyNotes

Activity

ProcessMapErrors

• OnlyWorkingwithThoseDistaltotheProcess• MappingtheImprovedProcessFirst• MappingtheWayaProcessis“SupposedtoWork”• IncorrectLevelofAbstraction• NotVerifyingAccuracy

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DMAICDefineMeasureAnalyzeImproveControl

Analyze• WalktheProcessMapandRefineIt

• SpendTimewiththePeopleWhoDotheWork• Re‐scopeifNeeded• CaptureCycleTimes• BrainstormIdeasforImprovement

• FishboneDiagrams• AffinityDiagrams

DMAICDefineMeasureAnalyzeImproveControl

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START HERE

Plan

• Objective• Predictions• Plan to carry out the cycle (who, what, where, when)

• Plan for data collection (who, what, where, when)Do

• Carry out the plan

• Document observations

• Record data

Study

• Analyze data

• Compare results to predictions

• Summarize what was learned

Act

•What changes need to be made?

• Next cycle?

Improve

DMAICDefineMeasureAnalyzeImproveControl

NowWhat?

CONTROL

• “Surface” Key Process and Outcome Measures

• Timely Data Entry =“Knowable” Individual and Group Performance

• Embed Use of Data into Management Repertoire

C

B

A

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CONTROL• ThisistheMostDifficultPhaseinDMAIC

• MaintainingtheGains

• Safeguards:WhatWillBeDonetoKeepThisonTrack?

• ResponsibilityRestsontheProcessOwner(RoleofKPI)

• WhatHappensinthisPhase?

• PicktheRightControlMethod(Checklists,Monitoring,Reporting)

• WhatisAcceptableVariance?

• DocumenttheResponsePlan

Focus andStreamline

Typical Desired

Data Collection/Measure

Data Analysis

Data Utilization/Improve

Plan/Define

Follow-up/Control

Changing the Approach is Key to Success

Scorecard

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ActiveManagementvs.AuditingFactor Active Management Auditing

Time Close to “Real Time” 6 Months, Yearly

Sample Size Population Served Sample

Focus Current Time and Prospective

Retrospective

Action Point‐in‐Time and Proactive

Reactive

Ownership Operations & QPM Compliance & Operations

WhoeverOwnstheProcessAssumestheResponsibility

PuttingItAllTogether

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Questions?