This document discusses various improvement models and approaches that can be used to enhance processes and quality, including Lean, Six Sigma, Toyota Production System, Theory of Constraints, and PDSA cycles. It explains that the most appropriate model depends on the goals of the improvement, the organization's maturity level, and available resources. Key aspects covered include using small tests of change to reduce risk, empowering teams, and focusing on incremental daily improvements in addition to discrete projects and events. The overall message is that multiple models can be effective and it's important to match the approach to the specific situation.

1. Beginning an Improvement
Journey II
Improvement Models
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2. Initiatives / Solutions / Tools
• TQM • Toyota Production
• Zero Defects System
• Lean
• SPC
• Kaizen
• PDSA
• RPI
• Six Sigma • MDI
• DMAIC • TPM
• Ritz Carlton • Kanban
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3. What improvement model
should I use?
• It depends on
– What improvement you’re trying to achieve
– Your organization’s improvement maturity
level
– The degree of resource commitment
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4. Many ways, many models
• What are you trying to achieve?
– Improve flow (reduce bottlenecks)?
• Theory of Constraints (Goldratt, 1986)
– Reduce waste?
• Lean/Toyota Production System (1950’s)
– Reduce variation?
• Six Sigma (Motorola, 1980’s)
– All of the above?
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5. Lean and Six Sigma
• We use Lean to eliminate the things that
are not value-added.
• We use Six Sigma to improve the things
that are value-added by reducing variation
in the process.
– We do not want to spend our time improving
something that, ultimately isn’t worth doing!
• Lean and six sigma share many tools
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6. Evolution in approaches to improving
health system quality
Managing for Daily
Improvement
Quality and value
Continuous Improvement Programs
Improvement Projects/Kaizens
Crisis response and quick fixes
Organizational Improvement Maturity
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7. Improvement Resources
“Quality is free.”
Phillip Crosby, 1926-2001
• But…
– It usually requires “activation energy”.
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8. Improvement activation energy
Energy
Net gain
(Improvement)
Time
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9. Improvement resource concepts
• Start small
– “draining the ocean” problems
• Coach
– “My job is to coach process improvement, not
do process improvement”
• Bootstrapping
– saving resources and flying under the radar
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10. Improvement resource concepts
• Leadership
– Champion’s role: Recognize, support, and
encourage
• Recognition
– Celebrate the team’s accomplishments
• Culture change
– Improvement is a team sport
– nurture and grow all players
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11. PDSA Model for Improvement
Model for Improvement* is a method to
guide improvement efforts through three
questions and Plan-Do-Study-Act cycles.
The model's three guiding questions are:
1.Setting Aims: What are we trying to
accomplish?
2.Establishing Measures: How will we
know if the change is an improvement?
3.Selecting Changes: What changes can
we make that will result in improvement?
*Institute for Healthcare Improvement(2011). “Science of Improvement: How
to Improve” (Deming)

12. A Comparison of Models
FADE PDSA DMAIC DMADV
Focus Plan Define Define
Analyze Measure Measure
Develop Analyze Analyze
Design
Execute Do Improve Verify
Evaluate Study Control
Act
Each model reflects a common thread of analysis, implementation, and review.
As in the graphic for the FADE model, each also has deeper meaning (further
levels of analysis) for the headings. Using a methodology ensures that you are
not missing any of the critical steps. No one method is best for everyone or all
situations.
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13. Plan
-What are the objectives?
-What are the predictions (hypotheses)?
-How will the plan be carried out
(Who, What, Where, When)
-What are the metrics?
-How will the data be collected?
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14. Do
-Execute the plan
-Record data
-Document observations
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15. Study
-Analyze the data
-Compare the results to the predictions
-Summarize what was learned
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16. Act
-What are the changes to be made?
-Implement standard work
-Determine next cycle
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17. Do-It
• Simple scope/Single task
• Very short duration (1-2 hours)
• 1-3 people
• Immediate impact
• No decisions or management intervention
required
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18. Burst Event
• Minimal scope/Single issue
• Short duration (2-8 hours)
• 4-6 people
• Quick impact
• Intended for relatively simple tasks
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19. Kaizen Events
• Kai = Change
• Zen = Good (For the Better)
• Kaizen events are used to make a fundamental
process shift
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20. Kaizen Event
• Scope significant - often cross-functional
• 1-5 days
• 6-12 people or more
• Quick impact
– 80% of improvements implemented during event
– 20% of improvements implemented within 30 days
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21. Typical Kaizen Schedule
• Pre-event – Charter, data collection, analysis
• Day 1 – Training, analyze Current Process
• Day 2 – Define new process
• Day 3 – Test & finalize new process
• Day 4 – Test & finalize new process, report out
& celebrate
• Post-event – Follow-up, modify, standardize
Some of these “days” may be
reduced to “hours,” depending
on the scope of the effort
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22. Project
• Long duration (3-12 months)
• Complex scope
• Multiple departments/functions
• Long-term impact
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23. MDI
• MDI = Managing for Daily
Improvements
• A philosophy of incremental
improvements
– Everyday improvement
– Everybody improvement
– Everywhere improvement
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24. How kaizen events & MDI work
together
Kaizen event
Process Plateau
Kaizen event
Current Process
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25. Problem Solving Model – A3
• Developed by Toyota
• Often used in conjunction with a VSM
• The A3 is a way to look with “new eyes” at a
specific problem
• Done on the front side only of an 11x17” (thus
the name, A3) sheet of paper
• Offers a structure that begins by always defining
the Issue through the eyes of the customer
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26. Problem Solving Model – A3
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27. The A3 format
Problem Statement: Future State:
What is the problem to be solved? Pictorial description of the desired state
Background: Containment Action:
brief narrative How do we get to the target condition?
Current State: Action Register:
Pictorial description Who does what?
Problem Analysis: Followup:
Why does the current condition exist? Are the gains sustained?
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28. A3, PDSA, DMAIC
• Problem Statement • Plan • Define
• Background • Plan • Define
• Current State • Do • Measure
• Problem Analysis • Do, Study • Analyze
• Future State • Do, Study • Improve
• Containment • Do, Study • Improve
Action
• Action Register • Control • Control
• Followup • Control • Control
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29. A3 Example
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30. Advantages of using the A3
• Simple format
• Focuses on one issue
– Bite off only what you can chew
• Has a flexible time frame
– Do it in half a day or over several weeks
• Allows for flexible team structure
– Stakeholders and experts can be brought in
as needed
• Creates a record as you go
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31. Pilots
• Pilot is another term for controlled
experiment
• Benefits of pilots
– Reduces risk
– Allows for “tweaking”
– Eases pain of change
– Allows for stakeholder buy-in
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32. Pilot Options
• Limited time
– Try solution for a few process cycles
• Open minds may result with short pilots
• Offers downtime for refinements
• Comparative measures may be more revealing
• Selected items or Customers
– Alternative path where certain type or
select number is sent through new process
– This works well with “parallel”
implementation
• Where more and more work is moved over to new
process
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33. Pitfalls of pilots
• Same team pilots everything
– Pioneers, early adopters (Rodgers)
• Microsystem to microsystem variation
– one size does not fit all!
• Local buy-in
– ownership and stewardship
• x
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34. How do we know which
event type to use?
• Type of activity
• Scope of process/task
• Resources required
Don’t worry about fitting the event type
into a specific category
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35. Key to Successful Improvement:
Teams
• Have the right people in the room
• Agree on measures and how they will be
collected
– Make sure the team understands the
objectives and deliverables
• Empower the team to make immediate changes
to the process
– Each member should be able to speak with
authority about the project
• Attack process, not people
• Review action plan frequently for progress
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36. Questions?