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How to Manage Your Improvement
Metrics More Efficiently and
Effectively
@MarkGraban (Presenter)
VP of Improvement & Innovation Services
Mark@KaiNexus.com
@Jeff_Roussel (Host)
VP of Sales
Jeff.Roussel@KaiNexus.com
Agenda & Logistics
• Presentation	(45	minutes)
• Q&A	(10	minutes)
– Use	the	GoToWebinar
Meeting	Panel	to	
submit	a	question	at
any	time
• Recording	link	&	slides	will	be	sent	via	email
– Also	– see	the	“Handouts”	feature	and	Chat	box
About Mark Graban
• 20+	years	practicing	Lean
– 10	years	in	manufacturing
– 11+	years	in	healthcare
• Books:
– Lean	Hospitals
– Healthcare	Kaizen
(co-author	Joe	Swartz)
• www.MarkGraban.com
New	3rd Edition!
Why
Measure?
Are We
Improving?
My Most Favorite Book Ever
http://www.spcpress.com/
http://amzn.to/2jJ4fiN
Donald	J.	Wheeler,	PhD
Are We
Improving?
Daily Lean Management
Source:	Thinking	Lean	at	ThedaCare (DVD)
How Are We
Doing Compared
to Our Goal?
"Bowling Chart"
Are We
Improving?
Can We Tell From This?
A Better Dashboard
Limited	information	you	need	to	make	decisions
Easier to Tell From This?
400
450
500
550
600
650
Aug-05
Sep-05
Oct-05
Nov-05
Dec-05
Jan-06
Feb-06
Mar-06
Apr-06
May-06
Jun-06
Jul-06
Aug-06
Total	Cases
In KaiNexus…
Are We
Improving?
Need to Avoid Bad Conclusions
“The	average	patient	satisfaction	
increased	from	87.2	to	89%”
86%
87%
88%
89%
90%
Before After
Need to Avoid Bad Conclusions
“The	average	patient	satisfaction	
increased	from	87.2	to	89%”
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Before After
Need to Avoid Bad Conclusions
“The	average	patient	satisfaction	
increased	from	87.2	to	89%”
Need to Avoid Bad Conclusions
“The	average	patient	satisfaction	
DECREASED	from	87.2	to	85%”??
Are We Improving?
76
78
80
82
84
86
88
90
92
Patient	Satisfaction	(Different	Data	Set)
Linear Trendlines are Easy
Can Linear Trends Be Misleading?
76
78
80
82
84
86
88
90
92
Patient	Satisfaction
Same Chart Different Timeframe
78
80
82
84
86
88
90
92
Patient	Satisfaction
Are We
Improving?
How Can
We Tell?
How Should
We React?
0
10
20
30
40
50
60
3/1/07
3/2/07
3/3/07
3/4/07
3/5/07
3/6/07
3/7/07
3/8/07
3/9/07
3/10/07
3/11/07
3/12/07
Responding to Daily Changes
KB
GOAL
Daily	Production	Average
Praise	
Team
PT PT
Are	we	helping?			Is	this	process	stable?
KB
Kick	
Butt
Isn’t	it	always	the	system?
It’s	(almost)	always	the	system.
Signal vs. Noise?
"While	every	data	set	contains	noise,
some	data	sets	may	contain	signals.
Therefore,	before	you	can	detect	a	signal
within	any	given	data	set,
you	must	first	filter	out	the	noise.
“X” Control Chart
(Chart for Individual Values)
Goal	=	25	minutes
Upper	Control	Limit
Lower	Control	Limit
In KaiNexus…
Surgical Cases Table
Surgical Control Chart
0
100
200
300
400
500
600
700
800
Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06
Total	Cases
NOISE
Patient Satisfaction Run Chart
“The	average	patient	satisfaction	
increased	from	87.2	to	89%”
Patient Sat. Control Chart
78
80
82
84
86
88
90
92
Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09
Patient	Satisfaction	
NOISE
Lab Turnaround Time
What
Happened?
SIGNAL
Another "Special Cause"
What
Happened?
SIGNAL
X and MR Chart Combo
Does This Small Business Have
Predictable Revenue?
X	chart
MR	chart
SIGNAL
Is My Blog
Traffic
Increasing?
Evaluate Over Time
0
500
1000
1500
2000
2500
3000
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51
LeanBlog.org	Daily	Page	Loads
“Western Electric” Rules
• Any	single	point	above	or	below	3-sigma	LCL	or	UCL
• 8	consecutive	points	on	same	side	of	mean
• 6	consecutive	points	moving	same	direction
• 14	alternating	up/down	points	in	a	row
Full	rules	à http://bit.ly/WErules
Evaluate Over Time
0
500
1000
1500
2000
2500
3000
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51
LeanBlog.org	Daily	Page	Loads
Shift the Limits as Indicated
0
500
1000
1500
2000
2500
3000
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51
LeanBlog.org Daily	Page	Loads
Example of Process Shift
• If	you	made	a	change	that	you	expected	to	improve	the	system,	
use	a	control	chart	to	test	the	hypothesis
0
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Process	Shift
Daily	TAT
Example of Process Shift
• If	you	did	NOT	make	a	change,	you	need	to	investigate	to	
determine	the	cause	of	this	signal	
0
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Process	Shift
Daily	TAT
Are We Hitting
Our Goals?
Performance vs. Goals
System View vs. Reactive
Control Chart View
Another Example
Goal
Control Chart View
Goal
So We Should
Do Nothing?
Improve the
System!
NOT Understanding Variation Leads To…
• Pressuring	people	to	get	better	results	
by	working	harder	within	the	same	
system
• Wasting	time	looking	for	explanations	
of	a	perceived	trend	when	nothing	has	
changed
• Not	focusing	on	systemic	improvements	
that	would	shift	the	mean
Our Next Webinar
"The	Intersection	of	Culture	and	
Technology:	Capturing	Improvement	
Where	it	Happens"
– Matthew	Cannistraro
– Thursday	February	23,	1	PM	ET
• KaiNexus.com/webinars
Ask Us Anything!
• Mark	Graban	&	Dr.	Greg	Jacobson
• Next	Episode	Feb	14,	1	pm	ET
• Register	&	submit	questions	via	
http://kainexus.com/webinars
• Past	episodes	available	
on	YouTube
Other Resources
www.KaiNexus.com
Podcasts
• www.KaiNexus.com/podcasts
• Subscribe	via:
– iTunes
– Google	Play
– Stitcher
Thanks!
• Web:
– www.kainexus.com
– blog.kainexus.com
– www.MarkGraban.com
• Webinars	on	Demand:
– www.kainexus.com/webinars
• Social	Media:
– www.twitter.com/kainexus
– www.linkedin.com/company/kainexus
– www.facebook.com/kainexus
@MarkGraban
VP of Services
Mark@KaiNexus.com
@Jeff_Roussel
VP of Sales
Jeff.Roussel@KaiNexus.com
BONUS	RECORDING	WILL	BE	SENT:
HOW	TO	CREATE	CONTROL	CHARTS

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