CHAD Quality Improvement Feb 26, 2018
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Sarah Pavelka, MHA, OTR/L, CPHQ, FNAHQFaculty, Iowa Healthcare Collaborative
Pavelka’s Point Consulting, LLC
Background and Context: The Leadership & Quality Processes
Change in the PDSA Process
Breaking down the PDSA for Performance Improvement ◦ Tools of Continuous Improvement
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Leadership and Quality Process
PDSA
Lean
Six Sigma
Others…
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Improve Quality…
Increases Productivity
Decreases Cost
Increases Profit Margins
Decrease Price/ Increases Value
Increases Market Share
Opportunity to Stay in Business
Jobs and More Jobs
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Deming repeatedly reminded us that we must continue to improve quality
as the first step towards creating organizational performance.
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Easy to use
Cycle of improvement - continuous
Part of everyday life problem solving
Provides a framework for improvement
Can use multiple tools
Reduces the “Ready- Fire – Aim” or “trial and error”
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1. Define the System & the Problem2. Study the Current State3. Analysis of the Root Causes4. Theory of Improvement5. Implement Theory6. Study the Results7. Standardize the Improvements8. Continuous Improvements9. Celebrate Improvements
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*Source:
Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement
Guide: A Practical Approach to Enhancing Organizational Performance (2nd
edition). San Francisco: Jossey-Bass Publishers; 2009. 2/26/2018 10
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Steps Sub-Steps, Questions to Ask, & Tools Steps Sub-Steps, Questions to Ask, & Tools P
lan
1) Define the problem in a general
statement a. What process do we need to
improve? b. What do we expect or hope to gain? c. What employees can work on the
team? d. Communicate the purpose and goals
of the team/problem solving!
Tools: A3 (part 1)
2) Understand the current problem and situation
a. What is the CURRENT process (how work is being done)? Currently happening?
b. What is the current situation?
Tools: Value Stream Mapping, Checklist, Brainstorming
3) Study the Root Cause
a. What is the underlying reason for the problem?
b. Why does the problem exist?
Tools: Fishbone, 5 Why, Waste Identification
Do
4) Create an action plan for improvement: a. What is going to happen (steps for
improvement)? b. What do you hope to gain or improve
(results)? Tools: A3 (part 2), Brainstorm, Action Plan (where, what, when, who, how, why)
5) Do / Complete the action plan: 1. Trial with timelines and communication
Tools: 5S (space needs), Hot Dot, Waste Identification
Steps Sub-Steps, Questions to Ask, & Tools
Stu
dy 6) Study results of the action plan
a. Are we meeting the expected measures or results that were expected?
b. What did we gain? Tools: A3 (part 3), Observations, Run Chart, Control Charts
Steps Sub-Steps, Questions to Ask, & Tools
Act
7) Put new process in place
a. What do we need to communicate to the staff about improvements?
Tools: Checklists, Check sheets, Dashboards
8) Define the next steps of the cycle of improvement a. What are the next improvements?
Tools: A3 (part 4), Huddle boards, Dashboards
9) Celebrate the improvements Tools: Newsletters, Dept/Leaders meetings
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Review the System – Think big picture
Form a team – Those that do the work
Define the Problem – Everyone on the same page
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Gains team support
Clearly defines the situation/problem for team and organization
States a BEGINNING and an END◦ Scope of work
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Who is your customer?
What does the customer want? (“it”)
Where do they want it?
When do the want it?
How do they want it to perform?
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Value Added ◦ Any activity that increases the market for
or function of the service (the products the customer is willing to pay for)
Non-Value Added◦ Any activity that does not add form,
function, or is not necessary
Necessary Non-Value Added◦ “Keeping the doors open”
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Understandable to everyone
Can move forward with data driven decisions
Create goals and metrics for “improvements”
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Discover the underlying reason problem exists
Create solutions so the problem does not return
Focuses on the current state moving to future state
Should not point blame Remember: the process is broken –not the people
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Step 4 – Plan for Improvements
Action Planning
Step 5 –Implementation
Project Management
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Creates opportunity to see if process is “broken”
Assists in training and cross-training
Creates platform to everyone to understand process
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Definition: The best arrangement of people, materials, work stations, and methods within a work area to eliminate waste ◦ Creating a consistent method for work
flow to improve quality, speed, and cost in addition to reducing variation
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Never an end
Lower the water level (iceberg)
Next phase or cycle
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Audits◦ Surveys
◦ Focus Groups
◦ Sampling
Parking Lot issues
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Past FuturePresent
Sarah Pavelka, PhD, MHA, OTR/L, CPHQ, FNAHQ
Pavelka’s Point Consulting, LLC641-780-0810
[email protected]@ihconline.org