maintaining the gain

TRANSFORMING HEALTH CARE FOR THOSE WE SERVE

Maintaining the GainProcess Ownership & Accountability

Teresa Pinter, RN, Managing Master Black BeltPerformance Improvement DivisionOSF Saint Francis Medical Center, Peoria, Illinois


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ESSENTIAL ELEMENTS OFPROCESS MANAGEMENT•An effective measurement system

•Performance analysis• Performance to target (gap analysis)• Variation (special cause or routine)• Mean performance and range of performance

•Enrolling staff and key stakeholders in performance improvement efforts and goals

•Education, training, communication

•Developing, implementing, and monitoring action plans for improvement


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KEY COMPONENTS…..PROCESS MANAGEMENT PLAN

• Process Steps• Key performance

indicators• Measurement

Plan• Targets• Corrective

actions to be taken when performance fails to meet expectations

•A measurement plan to assist the Process Owner to implement change and to manage performance of key processes

•Provides process owners with all the information needed to evaluate how well the process is meeting the requirements of Those We Serve


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WHY IS PROCESS MANAGEMENT IMPORTANT?•It is how we know that improvement solutions have been implemented and are effective.

•It is how we know that implementations have achieved projected benefits.

•It is how we sustain the gains over time.

•It is how we identify when ourenvironment is changing and additional improvement is needed.


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PROCESS MANAGEMENT IS NOT JUST ABOUT PERFORMANCE IMPROVEMENT PROJECTS• Process Management is a critical

competency that managers need to develop in order to achieve the organization’s strategic goals

• Process Management requires measurement

• To identify performance gaps• To focus our improvement efforts• To communicate performance objectives• To demonstrate ongoing performance

improvement outcomes


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WHY USE A CONTROL CHART WITH PROCESS MANAGEMENT?• Control charts are tools used to monitor performance over

time

• The control chart will allow us to view variation in the process • Variation means that a process does not produce exactly

the same result every time the product or service is delivered.

• Variation exists in all processes.

• Has the ability to determine the presence of routine causes vs. special causes that upset our processes

• Help us to detect, diagnose, and correct problems in a timely fashion

• Provide an easy to understand visual indicator of process performance

• Trending vs. Dashboard (red/yellow/green)


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SUSTAINING THE GAINS…OBSERVING PERFORMANCE OVER TIME

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THE GOAL OF PROCESS MANAGEMENTHardwire process management into our daily work

• Review measures• Focus on closing your largest performance

gaps• First, reduce routine variation by finding

and eliminating root causes• Next, work on improving the mean

Process Management may start with:• The control phase of a performance

improvement project• Key indicators that you need to improve for

your area


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CONTROL CHARTS

• Provides the “Voice of the Process”

• Method to detect process “signal” vs. “noise”

• Method to focus process improvement efforts

• Simple method for displaying and interpreting process performance over time and in context


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CONTROL CHARTS FUNDAMENTALSTime series dataCentral line for detecting shifts and trendsControl Limits computed from the dataDistance of the limits from the center line = 3σ

Statistically there is <1% probability of data point falling outside of Limits

Filters out the process noise so that real signals can be detected

Control Limits help us understand what needs to change by demonstrating the type of variation• Special Cause variation

makes the process unpredictable and must be eliminated (dots outside of the control limits)

• Common Cause variation can not be eliminated without making fundamental process change (dots within the control limits)

Helps us understand when to react…and when not to


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WHY USE CONTROL CHARTS?Allows us to focus on the important questions:

• Is the process stable and predictable?

• Is the amount of common process variation acceptable?

• If not, what is the root cause of variation?

• Is the average process performance acceptable?

• If not, work on eliminating variation. That will usually be sufficient to move the mean.


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PROCESS VARIATION

• All work occurs in a system of interconnected processes

• Variation exists in all processes

• Understanding and reducing variation are keys to process and performance improvement


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• There are always inherent chance causes responsible for natural variation in all processes due to “normal” variation in materials, environments, methods, people etc. (common cause)

• Variation within a stable process is inevitable

• Do not react to this type of variation (process tweaking)

COMMON CAUSE VARIATION


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SPECIAL CAUSE VARIATION

• Once we have an indication of a shift outside what seems to be normal in a previously stable process, we must discover the reason for the shift (special cause)

• We want to remove the influence of a special cause if it is adversely affecting the process

• If the special cause influence is improving the process, we want to permanently capture its effect


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IDENTIFYING SPECIAL CAUSESCommon Cause Special Cause

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MAINTAINING THE GAINS

• Now that we have reviewed tools monitor our processes…

• Lets discuss maintaining our gains.


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HOW CAN I INTEGRATE PROCESS MANAGEMENT INTO MY WORK?

The goal is to hardwire process management into our daily work

• Review measures• Focus on closing your largest performance gaps

• First, reduce routine variation by finding and eliminating root causes

• Next, work on improving the mean

Process Management may start with:• The control phase of a Performance

Improvement project• Key indicators that you need to improve for your

areaSustain the gains, pursue perfection

• Show me the data• Action plans• Specific Recommendations for action

based on analysis


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PROCESS VARIATION QUESTIONS FOR LEADERSHIP

Leadership Questions to ask… Reviewing process performance…Q: Is the new process being followed?

Q: Have the key leading and lagging indicators for your process been identified?

Q: Is the process stable?

(free of special cause variation)

Q: Is the process capable?

(able to meet requirements)

Q: Is your process stability and capability being monitored on an ongoing, regular basis?

Q: Is there a mechanism to monitor feedback from Those We Serve for changes in expectations?

Q: What progress has the team made in implementation of solutions and achieving performance targets?

Q: What are the lessons learned?

Q: What milestones have been reached? Not reached?

Q: What obstacles have been identified? Are anticipated?

Q: What is the action plan to overcome the obstacles and place the team back on schedule or to improve the process?

Q: What support or resources do you need?

Q: What actions needs to be taken and by when?


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QUOTES:

“Confusion between common causes and special causes leads to frustration of everyone, and leads to greater variability and to higher costs, exactly contrary to what is needed.”

“I should estimate that in my experience, most troubles and most possibilities for improvement add up to proportions something like this: 94% belong to the system (responsibility of management), 6% special.”

– W. Edwards Deming


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SUSTAINING GAINS THROUGH COMMUNICATION Communicating the performance and action plans

locally

Unit/Department/Division/Regional meetings– Standing agenda item• “Takeaway” information

Performance Improvement Display Boards:• Include: What was the baseline data, current

performance and the target?

Utilize existing structures:• Professional Committees or Councils• Local communication pathways• Portals


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COMMUNICATION TACTICS

• Leverage all current processes, vehicles, and resources• Management structure & processes• Employee newsletters• Internal communication boards etc

• Provide consistent key messages that are easy to remember

• Use a variety of methods & media• Tailor messages to meet the needs of the specific

audience• Uses appropriate language and detail• Addresses audience specific concerns (What’s in it for

them or WIFM)


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TAKEAWAYS• All key elements of process management must be in place to sustain gains

• Control charts show performance trends over time and focus analysis efforts

• Leadership engagement and involvement is essential to success.

• Effective communication is a critical function for successful implementation and sustaining change

Remember - a mature process is:owned and managed, documented, known,

standardized, produces consistent quality outputs,

is measured and evaluated’

and is improved in a disciplined way

Process management is the first step in process maturity


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PMCS: PROCESS MANAGEMENT CONTROL SYSTEM


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WHO IS PART OF THE PROCESS MANAGEMENT TEAM?

• Business Leaders• Directors/Project Sponsors• Managers/Supervisors• Process Owners• PI Coach/MBB• PI Facilitator/BB


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PROCESS MANAGEMENT CONTROL SYSTEM

A measurement plan to assist the Process Owner to implement change and to manage performance of key processes• Illustrates the relationship between process

performance and outcomes• Focuses on the key process variables that have

significant impact on the quality of the process outputs

Defines process prioritiesEstablishes performance targets and accountabilities

necessary to drive change and continuously improving performance

Provides process owners with all the information needed to evaluate how well the process is meeting its customer’s requirements


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PMCS EXAMPLE


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Process Description:• Reflects a key process, job, or group of work tasks• Uses simple and general terms• Must be understandable for owners, customers, and users

Process Description:• Reflects a key process, job, or group of work tasks• Uses simple and general terms• Must be understandable for owners, customers, and users

PMCS Process Description


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CCRs of “Those we serve”:• Identified measurable expectations in regard to service product or experience• Includes the “Voice of the Business”

CCRs of “Those we serve”:• Identified measurable expectations in regard to service product or experience• Includes the “Voice of the Business”

PMCS CCRs of Those We Serve


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Outcome Indicator (Y): • Measures how well the requirements of “Those we serve” are being met”

Outcome Indicator (Y): • Measures how well the requirements of “Those we serve” are being met”

PMCS Outcome Indicators


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Process Map or Process Steps:• The set of sequential and parallel activities that must be completed to ensure the Customer requirement is met• Shows individual as well as cross-functional accountability

Process Map or Process Steps:• The set of sequential and parallel activities that must be completed to ensure the Customer requirement is met• Shows individual as well as cross-functional accountability

PMCS: Key Process Steps


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Outcome Indicators (Ys):• A set of indicators identified during the project which measure key elements of performance•Based on critical relationship between process variables and outcomes Y = f(x)•Tied to the specific process activities•Approved by Business Leader Team

Outcome Indicators (Ys):• A set of indicators identified during the project which measure key elements of performance•Based on critical relationship between process variables and outcomes Y = f(x)•Tied to the specific process activities•Approved by Business Leader Team

PMCS Outcome Indictors


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Upstream Indicators (Xs):• The description of the data type and operational definitions to be monitored based on CCRs

Upstream Indicators (Xs):• The description of the data type and operational definitions to be monitored based on CCRs

PMCS Upstream Indicators


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Capturing Data:• Defines the measurement plan the Process Owner will implement• Defines the frequency at which they should be checked• Defines the individual accountable for checking

Capturing Data:• Defines the measurement plan the Process Owner will implement• Defines the frequency at which they should be checked• Defines the individual accountable for checking

PMCS Capturing Data


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Recovery Action:• Defines the actions the Process Owner will take in response to certain identified events

Recovery Action:• Defines the actions the Process Owner will take in response to certain identified events

PMCS Recovery Action


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Next Steps

Develop the turnover agreement

Compile the turnover documents Sign the turnover documents


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TURNOVER DOCUMENTS

Standard documentation for project turnover includes all of the following:

• Charter• MGPP• CCRs/CBRs• Root Cause

Validation Matrix• Communication

Plan

•FMEA•Implementation Plan•PMCS•Turnover Agreement•Education & Materials


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TURNOVER AGREEMENTPurpose: to formally transfer the project

implementation responsibility and management to the process owner.

• Elements of a turnover agreement• Define Roles and Responsibilities• Agreed upon project success metrics• Agreed upon time frame for Leadership

Reviews• Signatures of those taking ownership


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TURNOVER AGREEMENT DOCUMENTWe are presenting to you on August 24, 2012 a detailed Solution Implementation Plan for the Respiratory Protection Program for Employees Project that was approved on July 5, 2012. This document contains process design, process control management, communication/ education plan, and implementation plan. Upon review of this plan, it is agreed this project team’s work is complete and the process owner will complete the detail as written in the implementation work plan. Roles & Responsibilities Black Belt: Patty McMahillProvide detailed implementation plan to process owner.Coordinate quarterly leadership review. Global Process Owners:Director of Business and Community Health, Jo GarrisonOccupational Health Manager, Peggy GraceServe as Chair of the Environment of Care Safety Sub-Committee

See EOC Safety Committee Charter in Turnover documentsTrack completion of employee medical evaluations.


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TURNOVER AGREEMENT METRICS

Measure

Current

Success Target

Respiratory Protection Program Compliance 90%

Hazard Assessment Completion Rate 100%

Respiratory Protection Education Module Completion 90%

PAPR Education Module Completion 90%

Success Metrics & Review The solutions for this project were implemented on July 5, 2012. The following metrics and success criteria will be used to evaluate the success of this project starting July 1, 2012. Operational definitions and collection plans are documented in the Process Management Control plan provided at this meeting. Leadership review of performance will be scheduled as listed below.


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TURNOVER AGREEMENT TEMPLATE

Review Dates Coordinated by

January, 2013 Patty McMahill

April, 2013 Patty McMahill

July, 2013 Patty McMahill

October, 2013 Patty McMahill

Leadership ReviewsLeadership Reviews

Leadership Sign Off We, agree with the above, assume the process owner(s) responsibilities and will complete the activities assigned to ensure successful implementation and process control. ____________________________________ __________________Director of Business and Community Health, Jo G DateProcess Owner Signature ____________________________________ __________________Occupational Health Manager, Peggy G DateProcess Owner Signature


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TAKEAWAYS• All key elements of process management must

be in place to sustain.• Key elements include clear responsibilities,

measurement plan with targets, communication plan

• Clear recovery action if not meeting target.• Clear line of sight of accountability.

• Provides process owners with all the information needed to evaluate how well the process is meeting its customer’s requirements


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QUESTIONS?

Thank you!

maintaining the gain

Documents