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.