quality initiative sustaining our learning organization lou adams sigrid adams cathy cronick jean...
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Quality InitiativeSustaining Our Learning Organization
Lou AdamsSigrid AdamsCathy CronickJean Williams
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Our mission:
MRS partners with individuals and
employers to achieve quality employment outcomes and independence for persons
with disabilities
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RTACGrant
“Because service organizations
produce nonstandard outputs,
quality control is necessarily process control
as no two customers who complete a
service plan (output) are ever likely to be
exactly alike.”
Lawrence L. Martin
In 2012 RTAC awarded MRS
a grant to develop and implement a
Quality Management System.
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Year #1
“Create constancy of purpose for continual
improvement of products and services to society, allocating resources to provide for long range
needs rather than only short term profitability, with a
plan to become competitive, to stay in
business, and to provide jobs.”
~Deming
The aim of this project is to have
an effective set of processes, measurements,
and toolsto improve
customer outcomes.
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Implementation of GrantImplementation of Grant Quality Implementation Quality Implementation
Core Team:
MRS Acting Director and, Executive Director of the Michigan
Council for Rehabilitation Services District Manager Staff Development Manager Several MRS Consultants Executive Secretary Assistant Professor, Oakland
University
Core team member have primary responsibility for the grant/project
Quality Work Implementation Team:
A cross-functional work team responsible for providing suggestions, feedback, field perspective, etc.
Work Teams5
What do we need?
Escaping the quick
fix!
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Moving from Concept to Change
Improve Quality
Engaged in discussions with external Consultant to coach team
members
Initially we improved our knowledge of quality systems
Increased our skill development by enrolling in Quality Academy (“First transform yourself” - Deming)
Application of skills continued the learning (trail and error)
Continue to improve through PDSA cycles to test systems changes
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Top DownBottom Up
ConceptTop Down: Executive Leadership
Quality SummitQuality Academy and, Quality Coaching
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Bottom UpTop Down
Concept
Bottom Up: Counselors, Consultants and Managers
First Round of Quality Learners consisted of 8 employees
Second Round of Quality Learners were selected geographically with our districts
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Concepts of Quality Training
Changed the way we thought by: Replacing “Tampering” with finding root causes Understanding the Voice-of-the-Customer (VOC) Having operational definitions to minimize ambiguity Understanding variation (common cause vs. special
cause) Using testing-and-learning through PDSA cycles
Results: We found even tests that are not successful could add to
our learning if carefully reviewed
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Theories,
Hunches,
Best practices
AIM
Implement Change
Develop a Change
Evidence & Data
Learning & Improvement
Test a Change
Test New Condition
PDSASequential building of knowledge Includes a wide range of conditions in the sequence of tests
P
DSA
P
DSA
P
DSA
P
DSA
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End of Year 1
What was learned….
View issues from a continuous systems improvement perspective
Ask three questions: What are we trying to achieve? How will we know a change is an improvement? What changes can we make that will result in an
improvement?
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Year #2
“Clearly define top management's permanent
commitment to ever improving quality and productivity, and their
obligation to implement all of these principles. Indeed,
it is not enough that top management commit themselves for life to
quality and productivity. They must know what it is that they are committed to—that is, what they must
do.
Support is not enough: action is required!”
~ Deming
“Put everyone to work on
the transformation of the organization.”
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MRS Strategic Plan
The MRS Strategic Plan will reflect and incorporate systems thinking and quality fundamentals, resulting in clear strategies, goals, objectives and performance outcomes and measurements that will support achievement of the agency mission and vision.
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MRS Quality
Academy
“Institute a vigorous program of education, and encourage self-
improvement for everyone. What an
organization needs is not just good people; it needs people that are
improving with education. Advances in competitive position will
have their roots in knowledge.”
~Deming
The MRS Staff Development Unit has designed a quality training curriculum for all managers and consultants.
It will serve as the foundation on the four principles of quality improvement: Appreciation of a System, Profound Knowledge, Knowledge of Variation and, Knowledge of Psychology
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What we learned …
MRS is a System
Quality Improvement is a work in progress Start by failing and gain
knowledge through learning
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“All improvement requires change but not every change results in an
improvement.”
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Top DownBottom Up
ConceptTop Down:
FY 14 – MRS Operational Plans: MRS executive team proposes using the
systems improvement model to promote and support this culture within MRS and enhance skills in employing continuous quality-improvement activities toward more effective service delivery
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Bottom UpTop Down
ConceptBottom Up:
Initial Pilot: Waterford Aim: Reduction in the number of
individuals dropping out between referral and orientation/intake
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AIM:
Double the
number of applicants reaching Eligibility
status from CMH
Partner
What are we trying to accomplish?
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Initial AIM for Project
AIM:
Double the
number of applicants reaching Eligibility
status from CMH
Partner
#1: Referrals
#2:Orientation and Application
#3: Intakes
#4: Assessment
#5: Eligibility
What are we trying to accomplish?
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Looking at Root Cause
Review of Data
454035302520151050
Total
Referrals(100%)
Attended Orientatio
n(41%)
Attended Intakes(11%)
OpenedCases in system(8%)
Number of referrals
Number of Referrals per Process Steps10/11/12 - 3/31/13
37
15 4 3
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AIM:
Double the
number of applicants reaching Eligibility
status from CMH
Partner
1: Referrals
2:Orientation and application
3: Intakes
4: Assessment
5: Eligibility
Decrease percent of referrals dropping out
before Orientation
What are we trying to accomplish?
Only 41% of those referred
attended Orientation
(37 referred and 15 attended Orientation)
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Looking Up Stream and Changing the Aim
New Aim Statement
AIM:
Decrease the
percent of referrals dropping
out before Orientatio
n
1: Referrals
2:Orientation and application
3: Intakes
4: Assessment
5: Eligibility
What are we trying to accomplish?
Only 41% of those referred
attended Orientation
(37 referred and 15 attended Orientation)
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Looking Up Stream and Changing the Aim
How will we know a change is an
improvement?
9% Increase in number attending Orientation
Generating Ideas
What changes can we make
that will result in improvement?
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Organizing the Information
What?Need to gather information
Look at System Process
Generate Ideas
Organize Information
Determine which ideas to test
Study baseline data
Tools? Listen to VoC
Systems map Brainstorming of ideas
Diagram
Discussion
Run Chart
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Generate Ideas: Potential-PDSA cycles
Is a separate orientation necessary?
Are we missing any protocols between referral & orientation?
What processes should be combined?
Does referral source understand MRS process?
Add 3rd orientation date
Review links between referral and orientation steps
Combine orientation, intake and application steps
Provide information and increase communication with referral source
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How will we know a change
is an improvement?
1: Referrals
2:Orientation & Application
Formerly 3: Intakes
3:Assessment
4: Eligibility
9% Increase in number attending
Orientation
What changes can we make that will result in
improvement?
Increase # of Orientations by
offering one Orientation off site
per month
Cross training between MRS and referral source on core processes and
purpose of each organization
Combine Orientation, Application and Intake
AIM: Decrease percent of referrals
dropping out before
Orientation
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Discuss the three cycles
Action ItemsShort-Term
or Long Term
Solution
Persons Responsible
ScheduleJan Feb Mar Apr May
#1 Communication:
Provide information on MRS programming, eligibility process and documentation needs to referral source. Increase communication regarding number of drop-outs
Long Term
Sub-Aim #1 process
continues
#2 Increase # of Orientations:
Bi-monthly Counselor provides specialized Orientation to referral source CMH referrals. In addition, will offer 1-2 orientations off site (at various CMH referral sites) per month
Long Term Late May Initiated process
#3 Combine processes:
Combine Orientation, Application and Intake processes by adding additional counselor(s) to conduct on-site intakes following orientation
Short Term Late May initiated process
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Can we infer any trends?
Current data is too small of a sample to infer any trends.
Recommendation: Review data collected between June 2013 and June 2014
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Other MRS Projects:
Study of Variation in Eligibility common & special causes
Assessment Project:Increase counselor application of assessment information within VR process (application – IPE) as evidenced in case work over the next 6 –12 months
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Where are
we going?
“Improve constantly and forever every process for planning, production, and service. Search continually for problems in order to improve every activity in the company, to improve quality and productivity, and thus to constantly decrease costs.”
Continuously improve products, services, and processes by:
Fostering quality improvement through current management structure
Refining our expertise in Quality Improvement
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Questions & Answers
Contact List:
Lou [email protected] [email protected]
Cathy Cronick -- [email protected] Jones– [email protected]
Jean Williams— [email protected]
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