shawnee county health agency leading the way to a healthier shawnee county basic qi tools &...

Shawnee County Health AgencyLeading the way to a healthier Shawnee County

Basic QI Tools & Techniques


Why QI? By continually working to improve all

processes, we increase our learning and knowledge.

QI is not about pass/fail or right/wrong. Rather it’s about testing a theory. You have a learning opportunity.


Basic Tools of QI Data collection

Check Sheet Survey Tool / Interviews Nat’l, State, Local stat’s

Data Analysis Pie Charts Bar Graph Pareto Chart Line Graph

Process Analysis Flow Charts – Process Mapping 5 Why’s

Idea Creation Affinity Diagram Brainstorming Fishbone Diagram

Effect/Cause Analysis 5 Why’s Fishbone Pareto Chart Brainstorming Interrelationship Diagraph

Evaluation & Decision-Making SWOT Analysis Evidence-based Literature Stakeholder Analysis Force Field Analysis Nominal Group Technique PMI Logic Model

Planning & Implementation PDCA/PDSA Bone Diagram Action Plans


Stage 1Step #1 - Getting StartedDescribe the Situation Writing about the Situation

What’s the issue? Why is this a issue? For whom does the issue exist? Who has a stake in the issue? What do we know about the issue/people involved? What do existing research and experience tell us about

the issue?


Example #1


Stage 1Step #1 - Getting StartedDescribe the Situation An invading enemy sought to overthrow the

kingdom. During the fierce battle the kingdom’s well trained warriors mounted their warhorses to fight the enemy. All in the kingdom were confident they would be victorious as the enemy forces were outnumbered. Ultimately, not all warriors got “deployed” and in the end -

THE KINGDOM WAS LOST.


Stage 1Step #2 - Assemble the Team

No one person understands the entire system.

One cannot change one part of a process without influencing other parts in some ways.


Stage 1Focus on defining the problem(s) / improvement needed Define the issues(s) before attempting to fix

something What’s important? What’s broken / Needs improvement? Where is the “Mother Lode?” (high volume,

high profile, problem-prone)


Stage 1Define the Issue

“The kingdom was lost.”

“Reduce the likelihood the kingdom can be taken again”

What’s important?

What’s broken? Needs improvement?Not enough warriors were

“deployed”




“Reduce the likelihood the kingdom can be taken again”

What’s important?

What’s broken? Needs improvement?Not enough warriors were

“deployed”Where’s the “Mother Lode?” (high volume, high profile,

problem prone)


Stage 1Step #3 - Examine Current Process/Approach

May need to interview staff, external partners

Make a process flow chart Check for efficiency, duplicative steps,

missed steps, steps needed


Stage 1Step #3 - Examine Current Process/Approach

“For want of a nail the shoe was lost

For want of a shoe the horse was lost

For want of a horse the warrior was lost

For want of a warrior the battle was lost

For want of a battle the kingdom was lost

All for the want of a nail.”


Leverage the 5-Whys Basically, the five-why analysis is a

fundamental approach of thinking, based on the logical linkage of elements into a root cause analysis. It is a tool that works with ideas/concepts

With each specific answer, repeat the question up to five times and you will typically end up with a rather solid root cause.

For each answer, look at WHO is involved


Leveraging the 5-WhysLost the kingdom

Lost the battle Not

enough warriors Not

enough horses

Horses were not

shodNot

enough nails

Root Cause

Why?

Why?

Why?

Why?

Why?


Leveraging the 5-Whys The therefore test has proven to be a very

reliable method to check the logic of the five-why analysis.

To do the therefore test, you read the key findings of the analysis in reverse and insert the word therefore between each step.


Leveraging the 5-Whys

Lost the kingdom

Lost the battle Not

enough warriors Not

enough horses Horses

were not shod

Not enough

nails

Root Cause

Why?

Therefore

Start

Result

Why?

Why?

Why?

Why?

Therefore

Therefore

Therefore

Therefore




“Reduce the likelihood the kingdom can be taken again.”

What’s important?

What’s broken? Needs improvement?Not enough warriors

mounted on warhorses Where’s the “Mother Lode?”

Not enough nails to shod all the warhorses


Problem Statement Not enough nails to shod all the

warhorses.

Analyze the ProblemRoot cause -

Brainstorming 6-3-5

Affinity Diagram

Fishbone Diagram – all possible causes


Fishbone Diagram

Not enough nails to shod all the warhorses

Main Cause 2

Main Cause 1

Main Cause 1

Main Cause 1

Main Cause 1

Minor Cause

Minor Cause

Minor Cause

Minor Cause

Minor Cause

Minor Cause

Minor Cause

Minor Cause

Minor Cause

Minor Cause

Minor Cause

Minor Cause

Minor Cause

influence

influence

influence

influence

influence

influence


Stage 1Step #4 - Potential Solutions Avoid making your first QI effort a large-

scale project. Solving issues is usually easiest when you

focus on decreasing/reducing the “negative” driving forces rather than increasing the “positive” driving forces.


“Expand-Focus Sequence”Expand

Focus

Expand

Focus

Expand

Focus

POSSIBLE PROBLEMS

PROBLEM DEFINED

POSSIBLE CAUSES

ROOT CAUSE IDENTIFIED

POSSIBLE SOLUTIONS

SOLUTION CHOSEN TO TEST


Imposing a Change Before imposing a change, begin by asking

three key questions: What are you trying to accomplish? How will you know that a change is an

improvement? What changes can you make that will result in an

improvement? Define changes you believe will achieve your goal

Countermeasures


Stage 1Step #5 - Develop an Improvement Theory Make a prediction – How will you know that a

change is improvement? (Measurement is essential!)

Plan What Where Who How When – timeline


Stage 2Step #6 - Test the Theory

Just Do It!!!! Carry out the plan

During the process collect, chart, and display data to determine efficiency.

Document problems, unexpected observations


Stage 3Step #7 - Study the Results Based on measurements

What worked? What didn’t work?


Stage 4Step #8 - ACT Sustain if improvement

Monitor Develop new theory

If successful, plan another cycle to test it on a larger scale or under different conditions

If unsuccessful, test a different theory


Stage 4Step #9 - Establish Future Plans Recognize, review, refocus your efforts

What went right? Where can we apply what we’ve learned? What’s next?


9 Steps of Improvement

Focus Improve Sustain Honor

Plan – Do – Study – Act


Describe Situation

Assemble Team

Develop aim statementDefine problem(s) / improvement needed

Examine Current Process

Decide on potential solutions

Collect supportive data-Surveys / Interviews-Nat’l, State, Local stat’s

-What’s important?-What’s broken/needs improvement?-Where’s the Mother Lode?

-Logic Model -Flow charts -Survey’s -Pareto chart -Line graph

-Include qualitative information -Check sheets-Standardization -Flow charts-Documentation -Training

Analyze the problem

PDSA Cycles

-Develop theory

-Test improvement theory

-Study Results

-ACT

-CELEBRATE!

-Flow Charts-5 Why’s

-Fishbone -Brainstorming-5 Why’s -Affinity Diagram-Pareto chart-SWOT Analysis -CIC Analysis-Stakeholder Analysis-Force Field Analysis -Bone Diagram

CQ

I

STAGE 4

STAGE 3

STAGE 2

STAGE 1


Example #2

“QI Feud”


Stage 1Step #1 - Getting StartedDescribe the Situation

During the last 5 months of the year there has been a increase in errors in paychecks


78

195

1%

71%

0

34

68

102

136

170

204

238

272

Printed Non-printed

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

10/9/2008


Stage 1Step #2 – Assemble the Team


Define the Problem / Improvement Needed

“Errors in paychecks.”

“Reduce errors”What’s important?

Where’s the “Mother Lode?”

Printed checksWhat’s Broken? Needs Improvement?


Stage 1Stage 1Step #3 – Examine Current Step #3 – Examine Current Process/ApproachProcess/Approach Printed Checks


Where’s the “Mother Lode”?

27

723

46

92

100%

86%83%

71%

47%

0

20

40

60

80

100

120

140

160

180

Time Codes Benefits Withholdings Printing Other

Nu

mb

er

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

10/9/2008


Defining the Problem

“Errors in paychecks.”

“Reduce errors”What’s broken?

What’s important?

Where’s the “Mother Lode?”

Printed checks

Time codes


Problem StatementDuring the first five months of the year, time code errors accounted for 47% of all incorrect printed paychecks, which was 2X higher than the next highest contributor (non-printed).


Time code errors accounted for 47%

of all incorrect paychecks

MATERIALSPEOPLE

PROCESS / METHODS

MACHINERY / EQUIPMENT

Out of date documents

Confusing Timesheets

Wrong codes entered

Software Incorrect

Entered incorrectly

Old codes used


Invalid codes

Duplicate Entries Required

Paycheck reduction errors project

Table Updates

All Possible Causes


Next Steps Step #4 - Potential Solutions

Time code errors accounted for 47%

of all incorrect paychecks

MATERIALSPEOPLE

PROCESS / METHODS

MACHINERY / EQUIPMENT


Confusing Timesheets

Wrong codes entered

Software Incorrect

Entered incorrectly

Old codes used


Invalid codes

Duplicate Entries Required

Paycheck reduction errors project

Table Updates


“Expand-Focus Sequence”Expand

Focus

Expand

Focus

Expand

Focus

POSSIBLE PROBLEMS

PROBLEM DEFINED

POSSIBLE CAUSES

ROOT CAUSE IDENTIFIED

POSSIBLE SOLUTIONS

SOLUTION CHOSEN TO TEST


Next Steps – Impose a Change Step #5 - Develop Improvement Theory

Target – 50% reduction in time code errors by 6/1/09

Step #6 – Do Test the Theory

Step #7 – Study The Results

Step #8 – Act Step #9 – Honor

CELEBRATE!!!


Improvement


Example #3


Stage 1 Step #1 - Getting StartedThe Situation

“It appears (staff observations)” WIC clients are not keeping scheduled

appointments


Collect supportive data Kansas WIC Program -Show Rates

72%

74%

74%

75%

77%

78%

84%

86%

86%

65% 70% 75% 80% 85% 90%

FU

RD

NE+

TOS

MC

RC

CP

NC

NEI

App

oint

men

t Typ

e

Series1


Stage 1Step #2 – Assemble the Team

Nurses Dietitians Clerks


Stage 1Defining the Problem

“WIC no-show rates.”

“Reduce no-show rates.”What’s broken / Needs improvement?

What’s important?

FU Appts”

Where’s the Mother Lode?


Stage 1Stage 1Step #3 – Examine Current Step #3 – Examine Current Process/ApproachProcess/Approach Scheduling FU Appointments


Collect supportive data Kansas WIC Program -Show Rates

72%

74%

74%

75%

77%

78%

84%

86%

86%

65% 70% 75% 80% 85% 90%

FU

RD

NE+

TOS

MC

RC

CP

NC

NEI

App

oint

men

t Typ

e

Series1


What’s Broken / Needs Improvement?

Pareto Chart for WIC 33 percent fail for RC Appt Type

653

521

225 225

109 93 77 683 2

33.0%

59.4%

70.8%

82.2%

87.7%92.4%

96.3%99.7% 99.9%

0

200

400

600

800

1000

1200

1400

1600

1800

RC NE+ CP FU NEI MC NC RD TOS Other

Appointment Categories

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%


Defining the Problem“WIC no show rates.”

“Reduce no-show rates.”

What’s broken / Needs improvement?

What’s important?

“Re-cert appts”





What’s broken?

What’s important?

“Re-certs”


“?? – ”


Stage 1Stage 1Step #3 – Examine Current Step #3 – Examine Current Process/ApproachProcess/Approach Scheduling Re-cert Appointments


Problem Statement

During May 2008-July 2008. WIC Recertification (RC) appointments accounted for 33% of WIC “No-show” rates.


Analyze All Possible Causes

Personal Barriers (for clients)

During May -July 2008, Recertification appointments

Accounted for 33% of WIC No Show rates.

Time

People/Staff Technology SPACE

Lack of space For clients

Transportation

Space being used for staff & storage

Reminder callsNot made

Too manyStaff scheduling

Lack of Auto-dialer

Lack of delegation Of who can schedule

Staff overwhelmed

Staff not Properly trained

Lack ofTraining/flexibilty

InefficientDistribution

Of tasks

Short-staffed

Client’s don’tTrust staff

Staff some-Times rude

Lackof

Clients notorganized

Appointmentavailability

Client’s workschedule

Client’s whoWork late need

Late clinichours

Appt. Duration times

Some toolong

IneffectiveUse of

Staff timeLack of training

= Identified Root Cause




What’s broken?

What’s important?

“Re-certs”


“1) – Staff training ”


Client Satisfaction SurveyPlease circle how well you think we are doing in

the following areas:

GREAT

5 (avg.67%)GOOD

4OK

3FAIR

2POOR

1

Ease of getting services:

Ability to get in to be seen 85 (64%) 37(28%) 11(8%) 0 0

Hours office is open 82 (62%) 41(31%) 8 (6%) 1 (1%) 0

Convenience of office location 83 (64%) 36 (28%) 9 (7%) 2 (2%) 0

Prompt return on calls 60 (46%) 43 (33%) 17(13%) 6 (5%) 4 (3%)

Time in waiting room 56 (43%) 47 (35%) 19 (14%) 8 (6%) 1(1%)

Staff: (Nurse/Dietitian)

Friendly and Helpful to you 96 (72%) 27 (20%) 8 (6%) 2 (2%) 0

Takes enough time with you 89 (67%) 32 (24%) 8 (6%) 3 (2%) 0

Explains what you want to know 91 (69%) 29 (22%) 9 (7%) 2 (2%) 0




What’s broken?

What’s important?

“Re-certs”


1) – “Staff training ”

2) – “Prompt return of phone calls”


Next Steps Step #4 – Potential Solutions Cross train staff Prompt return on phone calls

Need to conduct a phone call tally


Next Steps – Impose a Change Step #5 – Develop Improvement Theory

Target –

Step #6 – Do Test Theory

Step #7 – Study The results

Step #8 – Act Step #9 – Honor

CELEBRATE!!!

shawnee county health agency leading the way to a healthier shawnee county basic qi tools &...

Documents

shawnee county health

healthier shawnee county

deployed slide

problemprone slide

problem prone slide

situation whats

whats important

needs improvement