untangling quality improvement tools cah/small rural learning community lynne hall
TRANSCRIPT
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Untangling Quality Improvement Tools
CAH/Small Rural Learning CommunityLynne Hall
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s2 Histograms
Check sheets
Brainstorm
in
g
Pareto ChartsNominal Group Technique
Root Cause
Analysis
Flow Charts
Scatter
DiagramsCause and
Effect Diagrams
Force Field Analysis
Run
Charts
Bar Charts
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ObjectivesDescribe the quality control and
the management and planning tools used in quality improvement
Explain how to use the various performance improvement tools to implement the quality management
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What is Quality?
According to Merriam-Webster Online Dictionary, Quality is:A degree of excellence : gradeA distinguishing attribute :
characteristic <possesses many fine qualities>
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Total Quality Management (TQM)A management approach to
achieve long-term successEveryone in the organization
participates in improving processes, services, patient care, and the culture where they work
TQM takes strong commitment from leaders in your organization
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Quality ToolsKey: Manage what you measure
◦What process needs work?
Gather data
Act on data
Change process
Gather data
Act on data
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Quality ToolsKey: Manage what you measure
◦What process needs work?
◦Present data to leadership!!
Gather data
Act on data
Change process
Gather data
Act on data
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TOOLS AND TECHNIQUES
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How do I decide which improvement area needs to be address first?
You can use:Flow ChartCheck SheetPareto ChartBrainstormingNominal Group TechniqueRoot Cause Analysis
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BrainstormingProcess
◦Define the topic◦Ask each person for 5 ideas on the
subject◦Give them a couple of minutes to
write them down◦Ask for ideas and list them on a
flipchart◦Review / clarify / combine like ideas◦Revisit and revise the list later in the
meeting or at the next meeting
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BrainstormingMethods
◦Have people use sticky notes and stick on a flipchart
◦Take turns around the room until everyone says pass
◦Have each team member write one idea on a sheet of paper and pass it to the next person can add to or build off other statements
◦This is your chance to think outside the box!!
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Nominal Group TechniqueCan enhance one or more
dimensions of effectiveness of decision-making groups
NGT provides:◦more unique ideas, ◦more balanced participation between
group members, ◦increased feelings of
accomplishment, and◦greater satisfaction with idea quality
and group efficiency
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Nominal Group Technique
The nominal group technique is particularly useful:When some group members are
much more vocal than others.When some group members think
better in silence.When there is concern about some
members not participating.When the group does not easily
generate quantities of ideas.
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Nominal Group Technique
The nominal group technique is particularly useful:When all or some group members
are new to the team.When the issue is controversial or
there is heated conflict.When there is a power-imbalance
between facilitator and participants or participants: the structure of the NGT session can balance these out.
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Flow ChartIdentifies problems and
opportunitiesHelps define scope of processDocuments a processAnalyzes process for
improvements
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Flow Chart Get Bread
Toasted?
Not toasted
Toasted
Add Peanut Butter
Add Jelly
Enjoy!
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Check SheetUsed for data collectionMeasure/track:
◦Process◦Problems◦Causes◦Other performance factors
Helps with pareto charts and other display tools (pie charts, run charts)
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Check SheetApplication for Check Sheets:
◦Provides consistent data collection ◦Identifies and defines problems /
opportunities◦Sets priorities◦Identifies root causes◦Used for follow-up and verify results
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Check SheetGetting started:
◦Determine the data to be gathered◦Decide on the frequency◦Design a checksheet◦Train users◦Mark appropriately (checks or
hashmarks)◦Compile results◦Analyze and graph data
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Check Sheet
Making a PB & J SandwichData Analyst ___________
Process Step Date/Time start Date/Time Stop
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Pareto ChartA special type of bar chartHelps focus team on components of
the problem that has the biggest impact
Based on the Pareto Principle◦80% of the effects we see are due to
20% of the causesThe data are easy to gatherThey are easy to constructEasy to interpret
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Pareto Chart
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Root Cause AnalysisInterdisciplinary REVIEW of the process surrounding an event (actual or near)
to develop prevention strategies
When – Unplanned Event (REACTIVE)What – Tool for Review Why - Review Process StepsWho – Organizational Leadership AND Frontline
CaregiversHow – Correct Process to Prevent Future Event
FOCUS on process NOT personAppropriate use Consistent use
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Next:
Describe the problem Check SheetPareto ChartHistogramPie chartStratification
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Next:
Arrive at a statement that describes the problem in terms of what is specifically, where it occurs, when it happens, and its extentCheck SheetPareto ChartHistogramPie chartStratification
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StratificationUtilizes the data to “slice and
dice”◦What are the differences◦What are the similarities
Consider this application anytime you want to collect data
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StratificationFactors Examples
Who • Department• Individual• Customer Type
What • Type of Complaint• Defect Category• Reason
When • Month, quarter• Day of week• Time of Day
Where • Region• Department• Unit
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HistogramsUsed with either continuous data or
counts of attributes (discrete data)Shows distribution of the data
◦Highs and lowsAllows you to see variation in the dataHelps answer questions:
◦ Is the process centered on the customer requirement
◦Does the process miss the customer requirement
◦ Is the process skewed with unexpected points
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Histograms
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Pie ChartA circular chart that illustrates a
proportion of the dataWorks particularly well when the
slices represent 25 to 50% of the data
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Pie Chart
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What are all the possible Causes of the Problem?Check SheetCause & Effect DiagramBrainstormingRoot Cause AnalysisFailure Mode Effect AnalysisForce Field Analysis
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What are all the possible Causes of the Problem?Check SheetCause & Effect DiagramBrainstormingRoot Cause AnalysisFailure Mode Effect AnalysisForce Field Analysis
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Cause and Effect DiagramAlso know as FishboneBasically a structured
BrainstormingEstablishes categories of
potential causesGives focus to help begin process
and data analysisThis IS NOT a way of identifying
which idea is the “culprit”
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Cause and Effect Diagram
Falls
Methods
PeopleEquipment
Call lights not answered
Floor is wet No handrails
Nurses not rounding
Education of family
Non-skid footwear
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Failure Modes and Effects AnalysisHelps anticipate problems so you
can take steps to correct, reduce and eliminate (PREVENT problems or anticipated) risks
Identifies ways a change in a process, product or service that may cause unintended problems
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Failure Modes and Effects Analysis1. Brainstorm all the potential ways
the change in the process could fail2. List these failure modes 3. Identify the potential cause of
these failures4. Develop a rating scale5. Rate each of the factors6. Multiply the 3 numbers together to
get the Risk Priority Number
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Failure Modes and Effects AnalysisMultiply the 3 numbers together to get the Risk Priority Number
◦Start with the failures that have the highest RPN’s discuss for each failure ways to eliminate the causes, the chance of it reoccurring, ect
◦Assign responsibilities for each action identified
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Force Field AnalysisHelps teams proactively build
support and neutralize blocking factors to an impending change
Application◦Determining solutions◦Identifies and removes obstacles◦Plans and implements a process
change or solution
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Force Field Analysis1. Clarify the change or solution to be
analyze2. Divide a flipchart page into two halves3. Brainstorm forces for and against the
change4. Start with the driving forces and and
identify ways to:1. Reinforce the support2. Make the support more visible in your plans3. Link your solution to that support
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Force Field Analysis5. Categorize the restraining forces as follows:
◦Blocks – regulations, policies, laws◦Constraints – resources, budget, time◦Illusions – “That’s not what we have done
before”
6. Identify steps to neutralize restraining forces7. Determine which neutralizing actions are necessary and build into your plans
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Force Field Analysis
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Agree on basic cause(s) of the problemCheck SheetPareto ChartScatter DiagramBrainstormingNominal Group Technique
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Agree on basic cause(s) of the problemCheck SheetPareto ChartScatter DiagramBrainstormingNominal Group Technique
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Scatter DiagramAllows you to test hypothesis
about the causes of the problemsUses paired data: Do these have
an effect on one another?
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Scatter Diagram
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Scatter DiagramPositive
correlation between the two data points
Example: Positive correlation between more falls at change of shift
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Scatter DiagramNegative
correlation between the two
Example: Less falls happen during shift change
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Scatter DiagramIndicates a
complex relationship
Example: More falls happen at change of shift on Tuesdays
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Scatter DiagramNo correlation
at all between the two
Example: Falls don’t depend on shift change
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Presenting Data to Leaders and Others
Run ChartsPie ChartBar Graphs
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Presenting Data to Leaders and Others
Run ChartsPie ChartBar GraphsPareto ChartScatter diagram
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Develop an effective and implementable solution and action plan
Run Charts Pie ChartBar GraphsPareto chartScatter Diagram
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Run Charts – watching performance over time
Purpose: to measure and track a key input, process, or output measure over time
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Run Charts – watching performance over time
Run charts got their name because of the practice of counting “runs” or sequences of consecutive points of either side of the median
Too many or too few clusters are a signal that something special is happening within your process
Graphs of data show improvement over time Tool for assessing the effectiveness of change
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RUN CHARTS
Run charts have a variety of benefits: Help improvement teams formulate aims
by depicting how well (or poorly) a process is performing◦ Identifying problems, opportunities (trends,
patterns, or output measure over time)◦Determining potential root cause(s)◦Follow-up and verification of results
Provides a quick look at a process
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Monitoring Improvement…RUN CHARTS
1. Plot your data.
2. Find your mean or average
3. Identify runs
4. Look for Special Cause Variation
5. Note any changes made in the process
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Monitoring Improvement…RUN CHARTS
1. Plot your data.
2. Find your mean or average
3. Identify runs
4. Look for Special Cause Variation
5. Note any changes made in the process
Implemented new fall process
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Monitoring Improvement: Run Chart RulesCommon Cause Variation – the
random variation associated with a process (No process is a straight line)
Special Cause Variation – a difference in the normal process variation◦Six or more consecutive increasing or
decreasing points◦Nine or more consecutive points on the
same side of the median◦14 or more consecutive points alternating
up and down around the median
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Bar GraphsUsed for data that is not related
to one another or is not continuous
Use for independent data
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Bar Graphs
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s62
What is my improvement area?
Describe the Problem
Cause of the Problem
Flow Charts
Check Sheet
Check Sheet
Nominal Group Technique
Brainstorming
Pareto Charts
Root Cause Analysis
Check Sheet
Pareto Charts
Histogram
Pie Chart
Stratification
Check Sheet
Check Sheet
Check Sheet
Check Sheet
Root Cause Analysis
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Referenceshttp://
asq.org/learn-about-quality/total-quality-management/overview/overview.html
Melum, Mara Minerva and Sinioris, Marie Kuchuris; 1992; Total Quality Management
http://www.emathzone.com/tutorials/basic-statistics/scatter-diagram.html