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Lecture 5: Continuous Improvement
Learning Objectives
• explain the purpose of a systematic approach to
improving performance,
• discuss common performance improvement
models,
• recognize the similarities and differences among
improvement models, and
• demonstrate an understanding of the steps in a
performance improvement project.
Performance Improvement
• Analyzing performance of various processes and
improving them repeatedly to achieve quality
objectives.
• The last phase of quality management.
• An opportunity for improvement (a problem of
performance failure).
• Some performance problems can be resolved
quickly, but in other situations, an in-depth
evaluation of the complex factors affecting
performance may be required.
The Improvement Step
• Find and fix the cause of
unfavorable performance
• Two factors influence the
decision to initiate an
improvement project:
– Results of performance
assessment
– Improvement priorities
Performance Improvement Steps
• Performance improvement projects should be
systematic.
• A methodical improvement process has
several benefits:
– Performance problems are permanently
solved.
– Work-life quality improves
– Communication among employees and
managers improves.
Performance Improvement Steps
1.
2.
3.
4.
Define the improvement goal.
Analyze current practices.
Design and implement improvements.
Measure success.
Performance Improvement Models
Walter A. Shewhart
Act Plan
Check Do
W. Edwards Deming
Performance Improvement Models
• Plan a change includes:
– State the objectives of the improvement project
– Determine needed improvement
– Design process changes to achieve the
improvement objectives
– Identify data that need to be collected to
determine whether changes produced desired
results.
Performance Improvement Models
• Do the change includes:
– Implement the changes on a small scale
– Document problems and unexpected
events
– Gather data to assess the changes’ impact
on the process
Performance Improvement Models
• Study the results include:
– Analyze data to determine whether the
changes were effective
– Compare results with expectations
– Summarize lessons learned during and
after implementation of the changes
Performance Improvement Models
• Act on the results include:
– If changes were not successful, repeat the
PDSA cycle
– If changes were successful, or partially
successful, implement them on a wiser
scale or modify them as necessary
– Predict results
Rapid Cycle Improvement
Performance Improvement Models
FOCUS-PDCA
Performance Improvement Models
FADE
Performance Improvement Models
• Lean: eliminate inefficiencies adversely
affecting performance.
• Lean manufacturing or Lean thinking
• Lean project goal: Minimize waste
• Lean principles of process improvement
(Value, Value stream, Flow, Pull, Perfection)
• Aim to add value to customers by adding
service features and/or ‘removing waste’ (nonvalue added steps) activities
Lean Project Steps
1.
2.
3.
4.
5.
6.
7.
8.
Identify performance problem.
Evaluate current work processes.
Identify areas of opportunity.
Find root causes of problems.
Design a better way of working.
Create an implementation plan.
Identify expected improvements,
Make process changes and measure
results.
Performance Improvement Models
• Six Sigma: Reduce performance
variability.
• The higher the sigma level, the lower the
defect rate.
– 1 sigma = 32% defect rate
– 2 sigma = 5% defect rate
– 6 sigma = 99.999% defect rate (near perfect)
• Six Sigma project goal: Create processes
that operate within Six Sigma quality.
Six Sigma Project Steps
DMAIC
Six Sigma
• Characteristics of the Six Sigma improvement
methodology:
– Process variation control
– Orientation toward results
– Use of data
Key messages
• Various improvement models are used to
improve healthcare quality.
• The different models share a common thread of
analysis, implementation, and review.
• Organizations don’t choose one approach to the
exclusion of the others.
• The approach most likely to achieve
improvement goals for a particular project is
used.
Lecture 6: Performance
Improvement Tools
Learning Objectives
• describe how quality improvement tools are used
throughout an improvement project,
• identify commonly used quantitative and
qualitative improvement tools,
• apply improvement tools in an improvement
project, and
• explain the difference between improvement
models and improvement tools.
Improvement Tools
• Diagrams, charts, techniques, and methods
used during an improvement project (also
called analytic tools)
– Quantitative improvement tools are used to
measure performance, collect and display data,
and monitor performance.
– Qualitative improvement tools are used to
generate ideas, set priorities, maintain direction,
determine causes of problems, and clarify
processes
Quantitative Tools
• Used in performance assessment and
performance improvement
– Bar graph
– Check sheet
– Control chart
– Histogram
– Line graph
– Pareto chart
– Scatter diagram
Qualitative Tools
• Brainstorming
– Used for creative exploration of options in an
environment free of criticism
– Structured, unstructured brainstorming
• Multi-voting
– Used to pare down a broad list of ideas and to
establish priorities
• Nominal group technique
– A structured form of multi-voting
Qualitative Tools
• Affinity diagram
– Used to organize ideas, issues, or opinions into
groupings based on the relationships between items
Qualitative Tools
• Cause-and-effect diagram
– Used to identify all possible causes of an effect (a
problem or an objective)
Environment
Procedures
Effect
Equipment
People
Qualitative Tools
• Decision matrix
– Used to systematically identify, analyze, and rate the
strength of relationships between sets of information
Qualitative Tools
• Five Whys
– Used to find the underlying causes of performance
problems
Qualitative Tools
• Flowcharts
– Used to identify and document the flow or sequence
of events in a process
– Used to develop an optimal new process during the
solution stage
Most Common Symbols Used in Flowcharts
Start/End
Decision
Process Step
No
Yes
Types of Flowcharts
• High-level flowchart
– Maps major process steps
Types of Flowcharts
• Detailed flowchart
– Maps all process
steps and activities
Types of Flowcharts
• Deployment flowchart
– Maps process steps and
identifies the people
involved in each step
Types of Flowcharts
• Top-down flowchart
– Maps major steps
across the top;
shows minor steps
under each major
step
Qualitative Tools
• Workflow diagram
– Used to show the movement of people, materials,
paperwork, or information during a process
Qualitative Tools
• Surveys (also considered a quantitative tool)
– Used to gather quantitative and qualitative
information
• Types of surveys
– Questionnaires: paper or electronic instruments
that the respondent completes independently
– Interviews: conducted with the respondent face to
face or over the phone
Creating and Using Surveys
•
•
•
•
•
•
Define the survey objectives.
Identify the people to be surveyed.
Select the survey population.
Construct the survey.
Test the survey and prepare the final draft.
Administer the survey.
Qualitative Tools
• Force field analysis
– Used to identify and
visualize the relationships
between significant forces
that influence a problem
or goal
Qualitative Tools
• Stakeholder analysis
– Used to identify the individuals or groups that would
be affected by a proposed process change for the
purpose of gaining stakeholder support for the
change
Qualitative Tools
• Planning matrix
– Used to show the tasks needed to complete an
improvement activity, the people or groups
responsible for completing the tasks, and the
deadlines for completion
• Gantt Chart
– Graphic representation
of a planning matrix
Communicating Improvement Projects
• Quality storyboard
– Used to summarize the major elements of a
completed improvement project