The Science of Improvement

The presenters have nothing to disclose

Generating Ideas for Change

FacultyRebecca Steinfield, M.A. and Jane Taylor, Ph.D.

November 2011

Question #3: What Changes Can We Make that will Result in Improvement?

Nobody really looks forward to change, except a wet baby!

OK, I’m ready for a change now…any time would be fine with me!

3

“Change is possible if we have the desire and commitment to make it happen.”

Mohandas Gandhi

But, why do we do things the way we do?

• US standard rail gauge is 4’8.5”-why?

• Because English standard rail gauge is 4’8.5”-why?

• Because pre-rail trams used that gauge-why?

• Because the same tools were used for building wagons-why?

• Because the wheel spacing was designed to fit the width of ruts in old English roads-why?

Maybe it’s time to think differently about why we do what we do?

Because the width of the ruts was carved into the dirt by

Roman war chariots!

On the Nature of Change

The Model for Improvement (MFI) provides an approach to help increase the odds that the

changes we make will result in lasting improvement.

“All improvement will require change, but not all change will result in

improvement!”G. Langley, et al The Improvement Guide. Jossey-Bass Publishers,

San Francisco, 1996: xxi.

How Do You Generate Ideas for Improvement?

• Skills• Knowledge• Work experience• Relationships• Fitness for use• Others…??

What Changes Can We Make that will Result in Improvement?

• Understand the system.─ Front-line knowledge about drivers generates insights for useful changes

• Use a change concepts & brainstorming to generate additional change ideas.─ Change ideas can spark creative thinking

• Copy from successful colleagues. Use a change package if available.─ Who does this best? Who has successfully improved? How did they do it?

How do you generate new ideas and come up with

change concepts?

“Logical and precise, left-brain thinking gave us the Information Age. Now comes the Conceptual Age - ruled by artistry, empathy, and emotion.”

When I was a kid - growing up in a middle-class family, in the middle of America, in the middle of the 1970s - parents dished out a familiar plate of advice to their children: Get good grades, go to college, and pursue a profession that offers a decent standard of living and perhaps a dollop of prestige. If you were good at math and science, become a doctor. If you were better at English and history, become a lawyer. If blood grossed you out and your verbal skills needed work, become an accountant. Later, as computers appeared on desktops and CEOs on magazine covers, the youngsters who were really good at math and science chose high tech, while others flocked to business school, thinking that success was spelled MBA.

Tax attorneys. Radiologists. Financial analysts. Software engineers. Management guru Peter Drucker gave this cadre of professionals an enduring, if somewhat wonky, name: knowledge workers. These are, he wrote, 'people who get paid for putting to work what one learns in school rather than for their physical strength or manual skill.' What distinguished members of this group and enabled them to reap society's greatest rewards, was their 'ability to acquire and to apply theoretical and analytic knowledge.' And any of us could join their ranks. All we had to do was study hard and play by the rules of the meritocratic regime. That was the path to professional success and personal fulfillment.

But a funny thing happened while we were pressing our noses to the grindstone: The world changed. The future no longer belongs to people who can reason with computer-like logic, speed, and precision. It belongs to a different kind of person with a different kind of mind. Today - amid the uncertainties of an economy that has gone from boom to bust to blah - there's a metaphor that explains what's going on. And it's right inside our heads.

Revenge of the Right Brain by Daniel H. PinkWired Magazine February 2005 issue 13.02

Creative Thinking

• Creativity implies having thoughts that are outside the normal pattern.

• What can you do to have “new” thoughts?

• How do we “provoke” new thinking?

Lateral Thinking of Edward de Bono

Provocation occurs

New thought

Logical in hindsight(after that fact everyone is a genius)

IH: 16-2

Normal thought

“Provocation has everything to do with experiments

in the mind.”Edward de Bono

Using Change Concepts

Change Concept: a general notion or approach to change that has been found to be useful in developing specific ideas for changes that lead to improvement.

Critical and creative thinking can lead to change concepts.

ConceptThoughtProcess

ConceptAn opportunity to create a new connection

Specific Idea A

Specific Idea B

• Eliminate waste• Improve workflow• Optimize inventory• Change the work environment• Producer/customer interface• Focus on time• Focus on variation• Mistake proofing• Focus on product or service

Source: The Improvement Guide, Appendix A

Change Concept

Nine general groupings of

change concepts with 72 specific

ideas for change.

“A general notion or approach to change that has been found to be useful in developing specific ideas for changes that lead to improvement.”

A. Eliminate Waste

1. Eliminate things that are not used

2. Eliminate multiple entry

3. Reduce or eliminate overkill

4. Reduce controls on the system

5. Recycle or reuse

6. Use substitution

7. Reduce classifications

8. Remove intermediaries

9. Match the amount to the need

10. Use sampling

11. Change targets or set-points

B. Improve Work Flow

12. Synchronization

13. Schedule into multiple processes

14. Minimize handoffs

15. Move steps in the process close together

16. Find and remove bottlenecks

17. Use automation

18. Smooth work flow

19. Do tasks in parallel

20. Consider people as in the same system

21. Use multiple processing units

22. Adjust to peak demand

Change Concepts Related to Eliminating Waste and Improving Work Flow

Source: The Improvement Guide, Appendix A

H. Design Systems to Avoid Mistakes

59. Use reminders

60. Use differentiation

61. Use constraints

62. Use affordances

Change Concepts Related to Eliminating Waste and Improving Work Flow

Source: The Improvement Guide, Appendix A

This is all about increasing RELIABILITY!

Methods for Generating New Ideas

• Edward de Bono’s work

• Six Thinking Hats

• Lateral Thinking Methods

• Provocation

• Movement

• Random Entry

• Concept Triangle

• Lens of profound knowledge

• Developing a change(Improvement Guide Ch. 5)

• 70 Change concepts (Improvement Guide, Appendix)

• IHI Idealized Design

• A “Whack on the Side of the Head” (Roger Von Oech)

• IDEO’s “deep dive”

The Concept Triangle

A creativity method to help generate new ideas that relate back to a particular purpose:

─ Separate our current ideas from the concepts to which they are attached

─ Then come up with new ideas for the concept

Purpose/objective

The Concept Triangle: An Example

Improve communicationamong caregivers

Revise the policy onchain of command

communication flow

First idea

Current up-to-datepolicies that are

clear and identifyresponsibilities

will improvecommunication

Concept

#1: What is the overall

concept behind the

idea?

Purpose/objective

The Concept Triangle: An Example

Improve communicationamong caregivers

Revise the policy onchain of command

communication flow

#2: Are there any other ways (ideas) to carry

out the concept?SBAR

Red Rules

New ideas#3: Are there any other ideas that can be offered?

First idea

Activity ≠ Change

Is a change:

• Include ASC culture in admission pack

• Create a standing order

• Provide staff with protocol compliance feedback

• Test placement of alcohol rub dispensers

Is NOT a change:(but may be a necessary preliminary task)

• Planning

• Having a meeting

• Educating staff

• Creating a protocol

• Assigning responsibility

For each change idea, you should have an explicit prediction of how it will impact the outcome.

• Identify several Change Concepts from the STAAR change packages for your setting

• For each Change Concept identify specify Ideas that you can actually test.

• Use the Developing Change Concepts Worksheetto record your ideas.

• Be sure to explore your theories and predictions about each change concept.

• Spend about 15 minutes on this exercise then report out as group.

Exercise:Developing Change Concepts

Developing Change Concepts

Discussion Questions:

• What specific change concepts will achieve the Aim?

• What theories and predictions can you make about how these change concepts will cause improvement?

• Use Force Filed Analysis to evaluate the ideas

Project: ____________________________________

Change Concept Idea to Test Theories and Predictions

Source: R. Lloyd

See Worksheet Packet