Beginning an Improvement Journey II

Improvement Models

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Initiatives / Solutions / Tools

• TQM• Zero Defects• SPC• PDSA• Six Sigma• DMAIC• Ritz Carlton

• Toyota Production System

• Lean • Kaizen• RPI• MDI• TPM• Kanban

What improvement model should I use?

• It depends on– What improvement you’re trying to achieve– Your organization’s improvement maturity

level– The degree of resource commitment

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Many ways, many models• What are you trying to achieve?

– Improve flow (reduce bottlenecks)?• Theory of Constraints (Goldratt, 1986)

– Reduce waste?• Lean/Toyota Production System (1950’s)

– Reduce variation?• Six Sigma (Motorola, 1980’s)

– All of the above?

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Lean and Six Sigma• We use Lean to eliminate the things that

are not value-added.• We use Six Sigma to improve the things

that are value-added by reducing variation in the process.– We do not want to spend our time improving

something that, ultimately isn’t worth doing!• Lean and six sigma share many tools

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Evolution in approaches to improving health system quality

Organizational Improvement Maturity

Qu

alit

y an

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alu

e

Crisis response and quick fixes

Improvement Projects/Kaizens

Continuous Improvement Programs

Managing for DailyImprovement

Improvement Resources“Quality is free.”

Phillip Crosby, 1926-2001

• But…– It usually requires “activation energy”.

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Improvement activation energy

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Time

Ene

rgy

Net gain(Improvement)

Improvement resource concepts• Start small

– “draining the ocean” problems• Coach

– “My job is to coach process improvement, not do process improvement”

• Bootstrapping– saving resources and flying under the radar

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Improvement resource concepts• Leadership

– Champion’s role: Recognize, support, and encourage

• Recognition– Celebrate the team’s accomplishments

• Culture change– Improvement is a team sport– nurture and grow all players

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PDSA Model for Improvement

Model for Improvement* is a method to guide improvement efforts through three questions and Plan-Do-Study-Act cycles. The model's three guiding questions are:

1.Setting Aims: What are we trying to accomplish?

2.Establishing Measures: How will we know if the change is an improvement?

3.Selecting Changes: What changes can we make that will result in improvement?

*Institute for Healthcare Improvement(2011). “Science of Improvement: How to Improve” (Deming)

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A Comparison of ModelsFADE PDSA DMAIC DMADV Focus Plan  Define Define

Analyze   Measure MeasureDevelop Analyze Analyze

Design  Execute Do Improve VerifyEvaluate Study Control  

Act

Each model reflects a common thread of analysis, implementation, and review. As in the graphic for the FADE model, each also has deeper meaning (further levels of analysis) for the headings. Using a methodology ensures that you are not missing any of the critical steps. No one method is best for everyone or all situations.

Plan

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- What are the objectives?

- What are the predictions (hypotheses)?

- How will the plan be carried out (Who, What, Where, When)

- What are the metrics?

- How will the data be collected?

Do

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- Execute the plan

- Record data

- Document observations

Study

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- Analyze the data

- Compare the results to the predictions

- Summarize what was learned

Act

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- What are the changes to be made?

- Implement standard work

- Determine next cycle

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Do-It• Simple scope/Single task• Very short duration (1-2 hours)• 1-3 people• Immediate impact• No decisions or management intervention

required

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Burst Event

• Minimal scope/Single issue• Short duration (2-8 hours)• 4-6 people• Quick impact• Intended for relatively simple tasks

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Kaizen Events

• Kai = Change

• Zen = Good (For the Better)

• Kaizen events are used to make a fundamental process shift

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Kaizen Event

• Scope significant - often cross-functional• 1-5 days• 6-12 people or more• Quick impact

– 80% of improvements implemented during event– 20% of improvements implemented within 30 days

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Typical Kaizen Schedule• Pre-event – Charter, data collection, analysis• Day 1 – Training, analyze Current Process• Day 2 – Define new process• Day 3 – Test & finalize new process• Day 4 – Test & finalize new process, report out &

celebrate• Post-event – Follow-up, modify, standardize

Some of these “days” may be reduced to “hours,” depending

on the scope of the effort

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Project

• Long duration (3-12 months)• Complex scope• Multiple departments/functions• Long-term impact

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MDI• MDI = Managing for Daily

Improvements• A philosophy of incremental

improvements– Everyday improvement– Everybody improvement– Everywhere improvement

How kaizen events & MDI work together

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Current Process

Kaizen event

Kaizen event

Pro

cess

P

late

au

MDI

MDI

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Problem Solving Model – A3

• Developed by Toyota• Often used in conjunction with a VSM• The A3 is a way to look with “new eyes” at a

specific problem• Done on the front side only of an 11x17” (thus

the name, A3) sheet of paper• Offers a structure that begins by always defining

the Issue through the eyes of the customer

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Problem Solving Model – A3

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The A3 format

Problem Statement:What is the problem to be solved?

Background:brief narrative

Current State:Pictorial description

Followup:Are the gains sustained?

Problem Analysis:Why does the current condition exist?

Future State:Pictorial description of the desired state

Containment Action:How do we get to the target condition?

Action Register:Who does what?

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A3, PDSA, DMAIC

• Problem Statement

• Background• Current State• Problem

Analysis• Future State• Containment

Action• Action Register• Followup

• Define• Define• Measure• Analyze• Improve• Improve

• Control• Control

• Plan• Plan• Do• Do, Study• Do, Study• Do, Study

• Control• Control

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A3 Example

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Advantages of using the A3

• Simple format• Focuses on one issue

– Bite off only what you can chew• Has a flexible time frame

– Do it in half a day or over several weeks• Allows for flexible team structure

– Stakeholders and experts can be brought in as needed

• Creates a record as you go

Pilots

• Pilot is another term for controlled experiment

• Benefits of pilots– Reduces risk– Allows for “tweaking”– Eases pain of change– Allows for stakeholder buy-in

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Pilot Options• Limited time

– Try solution for a few process cycles• Open minds may result with short pilots• Offers downtime for refinements• Comparative measures may be more revealing

• Selected items or Customers– Alternative path where certain type or

select number is sent through new process– This works well with “parallel”

implementation • Where more and more work is moved over to new

process

Pitfalls of pilots

• Same team pilots everything– Pioneers, early adopters (Rodgers)

• Microsystem to microsystem variation– one size does not fit all!

• Local buy-in– ownership and stewardship

• x

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How do we know which event type to use?

• Type of activity• Scope of process/task• Resources required

Don’t worry about fitting the event type into a specific category

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Key to Successful Improvement: Teams

• Have the right people in the room• Agree on measures and how they will be

collected – Make sure the team understands the

objectives and deliverables• Empower the team to make immediate changes

to the process– Each member should be able to speak with

authority about the project• Attack process, not people• Review action plan frequently for progress

Questions?