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Quality tools and techniques- 7 tools of quality

This document discusses quality tools and techniques, specifically focusing on the 7 basic tools of quality: histograms, Pareto charts, cause-and-effect diagrams, scatter diagrams, control charts, flow charts, and check sheets. Examples are provided for each tool to demonstrate how they are used. The tools are used to analyze processes, identify problems and priorities, determine relationships between variables, and monitor quality over time. Mastering these 7 basic tools is important for continuous process improvement.

Healthcare◦
7 Tools of Quality Dr. Lallu Joseph Quality Manager, CMC Vellore & Mr. Rabindranath Audit Facilitation Officer, CMC Vellore QUALITY TOOLS AND TECHNIQUES
Recap • Mean - It is a point of reference and also the central point for measuring variability. The only disadvantage of the arithmetic mean is that it is greatly affected by extreme values. • Median - It is the middle value in a series of numbers arranged in an increasing order. – Series odd number - (n+1)/2 – Series even- arithmetic mean of the two middle values QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Recap • Mode - Most frequently occurring value • Variance σ2 = 1/n [∑xi 2 - (∑ xi)2 /n] The Standard Deviation, is a simple square root of the variance. In a frequency distribution, variance is calculated by σ2 = 1/n [∑ fi xi 2 - (∑ fi xi)2 /n] QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Example Daily control measurements of Potassium were made for 25 days during a particular month 5.7 5.9 5.7 5.7 5.8 5.7 5.8 5.7 5.9 5.8 5.6 5.8 5.8 5.7 5.6 5.8 5.8 5.5 5.6 5.8 5.9 5.7 5.8 5.8 5.8 Average x = ∑ xi /25 = 143.7/25 = 5.748 = 5.75 Variance = 1/25 [∑ xi 2 - (∑ xi)2 /25] = 1/25 [826.23 – (143.7)2/25] = 6.06/625 = 0.0097 Standard Deviation = Sq rt of 00.0097 = 0.0985 QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Basic tools of Quality for Process Improvement “The old seven” “The first seven” “The basic seven” – Quality pros have many names for these tools, first emphasized by Kaoru Ishikawa the father of “quality circles.” – These are diagnostic tools to analyze a process and data from that process – They make up the fundamental continuous improvement toolkit QUALITY TOOLS AND TECHNIQUES 7 tools of quality
7 Basic Tools of Quality • Histograms • Pareto Charts • Cause and Effect Diagrams • Scatter Diagrams • Control Charts • Flow Charts • Check sheet QUALITY TOOLS AND TECHNIQUES 7 tools of quality
HISTOGRAM • It is for illustrating the frequency and the extent for two variables. • Histogram is a chart with columns which represents the distribution by mean. • If the distribution is normal, the graph is in the shape of a bell curve. • If not normal, it may take different shapes based on condition of the distribution. • Histogram can be used to measure one variable against another. There should be two variables. • Data should be numerical QUALITY TOOLS AND TECHNIQUES 7 tools of quality
When is it used? • It is used to communicate the distribution of data quickly and easily to others. • Help in decision making • Graphically summarize large data • Compare performance to expectations or specifications QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Reasons for dissatisfaction at OPD # Reasons Number of patients 1 No mike or display board to know the token number 15 2 Problem mixing with ‘follow-up’ patients 25 3 Insufficient doctors 100 4 Insufficient counter Staff 93 5 Staff not following the Queue 12 6 Too many patients at the same time 21 7 Registration time too long 111 8 No name boards of the doctors 13 9 Others 10 10 Total 400 QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Histogram 15 25 100 93 12 21 111 13 10 0 20 40 60 80 100 120 No mike or display board to know the token number Problem mixing with ‘follow-up’ patients Insufficient Doctors Insufficient Counter Staff Staff not following the Queue Too many patients at the same time Registration time is too long No name boards of the doctors Others Reasons for dissatisfaction of patients N =400 QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Pareto Charts – Pareto charts are used to identify and prioritize problems to be solved. – Vilfredo Pareto, 1800, Italian economist noted “80% of wealth was held by 20% of population” – Juran applied the Pareto Principle, stating that 80% variation in process is by 20% of the variables – “Vital few” as opposed to “Trivial many” – 80/20 rule – Need not be 80/20, could be 75/25 or 70/30 or even 65/35 also and even disproportionate like 75/35. – The concept is to priorities and address the issue. QUALITY TOOLS AND TECHNIQUES 7 tools of quality
When is it used? • Looking at data on the frequency of problems or causes. • When there are too many problems or causes and you want to focus on the significant ones. • When you want to analyze broad causes by looking at their specific components. • To effectively communicate to others about the problem/ data. QUALITY TOOLS AND TECHNIQUES 7 tools of quality
# Reasons Number of patients 1 No mike or display board to know the token number 15 2 Problem mixing with ‘follow-up’ patients 25 3 Insufficient Doctors 100 4 Insufficient Counter Staff 93 5 Staff not following the Queue 12 6 Too many patients at the same time 21 7 Registration Time too long 111 8 No name boards of the doctors 13 9 Others 10 10 Total 400 QUALITY TOOLS AND TECHNIQUES 7 tools of quality
# Reasons Number of patients 7 Registration Time too long 111 3 Insufficient Doctors 100 4 Insufficient Counter Staff 93 2 Problem mixing with ‘follow-up’ patients 25 6 Too many patients at the same time 21 1 No mike or display board to know the token number 15 8 No name boards of the doctors 13 5 Staff not following the Queue 12 9 Others 10 10 Total 400 Descendingorder QUALITY TOOLS AND TECHNIQUES 7 tools of quality
# Reasons Number of patients In % (N=400) 7 Registration Time too long 111 28 % 3 Insufficient Doctors 100 25 % 4 Insufficient Counter Staff 93 23 % 2 Problem mixing with ‘follow-up’ patients 25 6 % 6 Too many patients at the same time 21 5 % 1 No mike or display board to know the token number 15 4 % 8 No name boards of the doctors 13 3 % 5 Staff not following the Queue 12 3 % 9 Others 10 3 % 10 Total 400 QUALITY TOOLS AND TECHNIQUES 7 tools of quality
# Reasons Number of patients In % (N=400) Cumulative frequency 7 Registration Time too long 111 28 % 28% 3 Insufficient Doctors 100 25 % 53% 4 Insufficient Counter Staff 93 23 % 76% 2 Problem mixing with ‘follow-up’ patients 25 6 % 82% 6 Too many patients at the same time 21 5 % 87% 1 No mike or display board to know the token number 15 4 % 91% 8 No name boards of the doctors 13 3 % 94% 5 Staff not following the Queue 12 3 % 97% 9 Others 10 3 % 100% 10 Total 400 QUALITY TOOLS AND TECHNIQUES 7 tools of quality
28% 53% 76% 82% 87% 91% 94% 97% 100% 0% 20% 40% 60% 80% 100% 0 20 40 60 80 100 120 Registration Time too long Insufficient Doctors Insufficient Counter Staff Problem mixing with ‘follow-up’ patients Too many patients at the same time No mike or display board to know the token number No name boards of the doctors Staff not following the Queue Others Number of patients Cumulative frequency QUALITY TOOLS AND TECHNIQUES 7 tools of quality
28% 53% 76% 82% 87% 91% 94% 97% 100% 0% 20% 40% 60% 80% 100% 0 20 40 60 80 100 120 Registration Time too long Insufficient Doctors Insufficient Counter Staff Problem mixing with ‘follow-up’ patients Too many patients at the same time No mike or display board to know the token number No name boards of the doctors Staff not following the Queue Others Number of patients Cumulative frequency Addressing these 3 issues out of 9, will solve 76% of the problems QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Cause and Effect Diagrams • Dr. Kaoru Ishikawa • Cause & Effect Diagram (Fishbone or Ishikawa diagram) • It is a schematic way of relating the causes of variation in a process • A drawing to organize the contributing causes to a problem in order to prioritize, select, and improve the source of the problem • Problem (Effect) on the right side and the possible causes on the left side • Causes are broadly classified into 5M’s and E Man (People) Methods (Policies and Procedures) Materials (Supplies) Machine (Equipment) Money Environment QUALITY TOOLS AND TECHNIQUES 7 tools of quality
When is it used? • When identifying possible causes for a problem. • Identifies areas for collecting data • Good process knowledge from multiple stake holders • Useful for teams: focusing a discussion and organizing large amounts of information coming from a brainstorming session. • Especially when a team’s thinking tends to fall apart and concentration is lacking QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Schematic Effect People /Man Plant / MachineProcedures / Methods PoliciesMaterial QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Cause and Effect Diagram Registration time too long People /Man Plant / MachineProcedures / Methods PoliciesMaterial Staff can cut the queue Registration at any time Irrespective of appointment time Manual registration- No computers Inadequate signage / instruction FIFO not followed Unnecessary information being collected at the reg. counter New staff Aggrieved StaffInadequate stationeries Separate line for men and women QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Scatter Plots • Scatter diagram shows co-relation between two variables • If correlated – does not necessarily mean a direct cause and effect • If one variable can be predicted based on the value of the other, then correlated QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Scatter Plots- correlation • 2 Dimensional X/Y plots (with dots) • To check if there is correlation b/w two variables – Used to show relationship between independent(x) and dependent(y) variables Positive correlation Negative correlation No correlation QUALITY TOOLS AND TECHNIQUES 7 tools of quality
When is it used? • Trying to determine if the two variables are related, such as… – to identify potential root causes of problems. – After brainstorming session and identifying causes and effects using a fishbone diagram, to determine whether a particular cause and effect are related. – To determine whether two effects that appear to be related both occur with the same cause. QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Time spent by doctor and patient satisfaction Patient hosp number Time Spent by doctor (In minutes) Satisfaction Score 1 24 5 2 8 1 3 9 1 4 22 4 5 10 3 6 19 4 7 10 2 8 16 4 9 13 4 10 15 3 11 23 4 Patient hosp number Time Spent by doctor (In minutes) Satisfaction Score 12 12 3 13 12 2 14 14 3 15 11 2 16 16 3 17 20 4 18 18 3 19 14 2 20 14 4 21 17 3 22 17 4 23 13 3 QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Scatter plot 0 1 2 3 4 5 0 5 10 15 20 25 30 Satisfactionscore-5beingthehighest Time spent by doctors (In minutes) Satisfaction Score QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Scatter plot 0 1 2 3 4 5 0 5 10 15 20 25 30 Satisfactionscore-5beingthehighest Time spent by doctors (In minutes) Satisfaction Score QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Scatter plot • A Scatter plot cannot prove that one variable causes another, but it does show how a pair of variables is related and the strength of that relationship. • Statistical tests quantify the degree of correlation between the variables. QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Control charts • Influence of special causes on process and out of control situation • Monitor processes to show how the process is performing over time • Following needs to be calculated. – Mean variable – Upper control limit (UCL) – Lower Control limit (LCL) • UCL and LCL can be calculated based on • data from scientific literature • Historical data • Statistical data like Standard deviation QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Time between glucose measurements (in Hours) Day Hours 1/1/2017 5 1/2/2017 5.5 1/3/2017 5.5 1/4/2017 5 1/5/2017 7 1/6/2017 5 1/7/2017 5 1/8/2017 6 1/9/2017 6 1/10/2017 10 1/11/2017 11 Day Hours 1/12/2017 5 1/13/2017 6 1/14/2017 6 1/15/2017 5 1/16/2017 4.5 1/17/2017 5 1/18/2017 6 1/19/2017 5.5 1/20/2017 6 1/21/2017 5 1/22/2017 5 1/23/2017 5 QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Time between glucose measurements (in Hours) Day Hours 1/1/2017 5 1/2/2017 5.5 1/3/2017 5.5 1/4/2017 5 1/5/2017 7 1/6/2017 5 1/7/2017 5 1/8/2017 6 1/9/2017 6 1/10/2017 10 1/11/2017 11 Day Hours 1/12/2017 5 1/13/2017 6 1/14/2017 6 1/15/2017 5 1/16/2017 4.5 1/17/2017 5 1/18/2017 6 1/19/2017 5.5 1/20/2017 6 1/21/2017 5 1/22/2017 5 1/23/2017 5 Calculate Mean and Standard deviation Mean= 5.869565 SD = 1.575 QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Time between glucose measurements (in Hours) Day Hours 1/1/2017 5 1/2/2017 5.5 1/3/2017 5.5 1/4/2017 5 1/5/2017 7 1/6/2017 5 1/7/2017 5 1/8/2017 6 1/9/2017 6 1/10/2017 10 1/11/2017 11 Day Hours 1/12/2017 5 1/13/2017 6 1/14/2017 6 1/15/2017 5 1/16/2017 4.5 1/17/2017 5 1/18/2017 6 1/19/2017 5.5 1/20/2017 6 1/21/2017 5 1/22/2017 5 1/23/2017 5 Calculate UCL (upper control limit) and LCL (Lower control limit) Mean= 5.869565 UCL = Mean + 3 *(Standard Deviation) = 10.59 LCL = Mean -3 *(Standard Deviation) = 1.14 QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Time between glucose measurements (in Hours) Day Hours Mean UCL LCL 1/1/2017 5 5.869565 10.59 1.14 1/2/2017 5.5 5.869565 10.59 1.14 1/3/2017 5.5 5.869565 10.59 1.14 1/4/2017 5 5.869565 10.59 1.14 1/5/2017 7 5.869565 10.59 1.14 1/6/2017 5 5.869565 10.59 1.14 1/7/2017 5 5.869565 10.59 1.14 1/8/2017 6 5.869565 10.59 1.14 1/9/2017 6 5.869565 10.59 1.14 1/10/2017 10 5.869565 10.59 1.14 1/11/2017 11 5.869565 10.59 1.14 Day Hours Mean UCL LCL 1/12/2017 5 5.869565 10.59 1.14 1/13/2017 6 5.869565 10.59 1.14 1/14/2017 6 5.869565 10.59 1.14 1/15/2017 5 5.869565 10.59 1.14 1/16/2017 4.5 5.869565 10.59 1.14 1/17/2017 5 5.869565 10.59 1.14 1/18/2017 6 5.869565 10.59 1.14 1/19/2017 5.5 5.869565 10.59 1.14 1/20/2017 6 5.869565 10.59 1.14 1/21/2017 5 5.869565 10.59 1.14 1/22/2017 5 5.869565 10.59 1.14 1/23/2017 5 5.869565 10.59 1.14 QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Control Chart 0 2 4 6 8 10 12 1-Jan-17 2-Jan-17 3-Jan-17 4-Jan-17 5-Jan-17 6-Jan-17 7-Jan-17 8-Jan-17 9-Jan-17 10-Jan-17 11-Jan-17 12-Jan-17 13-Jan-17 14-Jan-17 15-Jan-17 16-Jan-17 17-Jan-17 18-Jan-17 19-Jan-17 20-Jan-17 21-Jan-17 22-Jan-17 23-Jan-17 Timebetweenglucosemeasurements (inHours) Date Hours Mean UCL LCL In this case, the variation was detected on January 11 because the corresponding data point was above the upper control limit. Root cause for the variations needs to be investigated. QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Control Chart • Control charts are made with the existing data. Suggestions, if necessary, are implemented based on the chart. • Post Implementation, the mean and the control limits of the control charts will vary depending on the effectiveness of the implementation • They are helpful for analyzing a process before and after an improvement as well • Helps to see how process mean and variability change as a result of the improvement. QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Timetakenforadmittingthe patient(inMinutes) Days Timetakenforadmittingthe patient(inMinutes) Days Time taken for ICU admission Time taken for ICU admission QUALITY TOOLS AND TECHNIQUES 7 tools of quality
160 180 200 220 240 260 280 300 320 2/9 3/9 4/6 5/4 6/1 6/29 Week EDStay(minutes) Reducing Delays for Patients Admitted to the Emergency Department Goal QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Work Days ACA Initiative begun Optimize the Team 0 10 20 30 40 50 60 70 80 90 100 'Oct01 'Jan02 'Apr02 'Jul02 'Oct02 'Jan03 'Apr03 'Jul03 'Oct03 'Jan04 'Apr04 'Jul04 'Oct04 'Jan05 'Apr05 'July05 'Oct05 'Jan06 'April06 'July06 SI Initiative Optimize the Team Imaging – MRI Backlog 7 tools of quality
Flow Chart • Process flow chart of flow diagram • A powerful improvement tool to define, describe, and communicate clinical, administrative and operational processes. • A flowchart represents an algorithm or process with the help of pictorial symbols. • They trace the steps the “object” of the process goes through from start to finish. (a lab test, a clinic visit, a specialty visit, an imaging study, etc. ) • Boxes of pictorial symbols connecting with arrows to represent sequence of activities. • Flowcharts help in identifying points or bottle necks where problems might occur. QUALITY TOOLS AND TECHNIQUES 7 tools of quality
• Develop understanding of how a process is done. • Study a process for improvement. • Communicate to others how a process is done. • When better communication is needed between people involved with the same process. • In order to document a process. • While planning a project. When is it used? QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Flow chart- Symbols One step in the process Direction of flow Link to another page or flowchart Input or output Document Start and end points Decision based on a question Delay or wait 7 tools of quality
The Process Flow Diagram (Flow Chart) Used to understand the current process and identify opportunities for improvement. It shows the work flow through the process including all activities, decisions, delays, and measurement points. DELAY DELAY ACTIVITY ACTIVITYDECISION ACTIVITY DECISION ACTIVITY BEGIN END YES ACTIVITYNO NO YES QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Flow chart QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Check Sheet • Defect concentration diagram • A check sheet is a structured, prepared form for collecting and analyzing data. This is a generic tool that can be adapted for a wide variety of purposes • A simple document used for collecting data in real time and at the location where the data is generated. QUALITY TOOLS AND TECHNIQUES 7 tools of quality
When is it used? • When data can be observed and collected repeatedly by the same person or at the same location. • When collecting data on the frequency or patterns of events, problems, defects, defect location, defect causes, etc. • When collecting data from a production process. QUALITY TOOLS AND TECHNIQUES 7 tools of quality
Check sheet Wrong admission Wrong diet Late Discharges Staff not punctual for duty Missing CSSD item Problems identified in the Wards 7 tools of quality
7 tools of quality