The document describes a standardized improvement framework called the Value Summary 2.0. It provides guidance on using the framework to define an improvement project, conduct a baseline analysis, design and implement changes, and monitor outcomes. The framework includes 5 sections - project definition, baseline analysis and investigation, improvement design and implementation, and monitoring and impact. Each section contains elements to address such as defining SMART goals, examining current processes, identifying root causes, designing reliable new processes, and continuously measuring metrics. The framework is intended to promote structured, evidence-based process improvement work.

1. Value Summary 2.0
Standardized Improvement Framework
1
Improvement Design
& Implement
Goals
Baseline Analysis
& Investigation
Team &
Project Vision
Monitoring

2. Use Improvement Science
Why Use the Value Summary
2
Concise – avoids death by PowerPoint
Methodology – promote improvement that works
Measurement – track work at project & enterprise level
Transparency – self-service visibility to value work
Communication – standardize review of value work from director to staff

3. Lean
6s
PDSA
Project Definition
Baseline Analysis
Investigation
Improvement Design
Implement
Monitoring
Value Improvement Framework
UUHC Value Methodology

4. Project Definition + Goals
Baseline Analysis
Investigation
Improvement Design
Implement
Monitoring
Value Improvement Framework
UUHC Value Methodology in Value Summary
1
2
3 4
5

5. 5 Sections of the Value Summary
5
1 2 3 4 5

6. 6
1
Project Definition
Team & Project Vision

7. 7
Project Definition
Engage the People – Team Elements
Ask often: “Do we have the right team”?
Representation of all roles
Upstream / Downstream
Experts who do the work

8. Team Member Roles
8
are not only a great way to
identify individual roles
within a project, they are
also key to creating reliable
reporting of project work to
appropriate department
leaders.

9. 9
Project Definition
Why & How Elements
Why is this an important issue?
Why are you working on this now?
Internal / external drivers
How does this benefit the patient/customer?
How does this benefit the team?

10. 10
Problem & Goals
Specific, Measurable, Attainable, Relevant, & Time-bound
2

11. 11
G O A L S

12. 12
Specific - How specific is based on your judgment.
“Poor communication” and “inefficiency” are not specific. “Readmission rates for ileostomy
patients” is specific enough.
Measureable - Define with an actual number.
Some, more, many are not numbers. “20% increase,” is a number you can track concretely.
Attainable - Is your goal realistic?
Chasing unrealistic goals is demoralizing.
Relevant - This area is another judgment call.
Time-bound – Set the date when you want the goal met.
Problem & Goals
SMART Goals
Source: http://healthsciences.utah.edu/accelerate/blog/2017/01/the-smart-way-to-keep-your-new-years-resolutions.php

13. 13

14. 14

15. 15
Problem & Goals
Goal Type
Process
Action to get to
the outcome
e.g. removed the Foley
before 48 hours
e.g. performed preventive
maintenance within
96 hours
Outcome
Output from the
process
e.g. urinary tract infection
rate
e.g. equipment failure rate
Balancing
Unintended
Consequences
e.g. Reducing length of
stay but increasing
readmissions is not
an acceptable trade-
off.
Strive for a mix. Implementation of a solution is not a goal type

16. 16
Problem & Goals
Measure Elements
Numerator & Denominator
Local
Meaningful
Transparent
When measurement is used effectively, teams can design,
implement, and sustain improvements. Elements of effective and
actionable measures are:
Source: Becoming a Value Driven Organization. Value Collaboration October 2015.

17. 17
Baseline Analysis &
Investigation
3

18. 18
Baseline Analysis & Investigation
Methods / Tools
Examine & Document
Baseline Process
Benchmark
To Peers
Analyze Data

19. 19
Baseline Analysis & Investigation
Tools to Examine + Document Process
What does the
process tell you?
Describe your major
findings from each tool.
Attach related Documents.

20. 20
Baseline Analysis & Investigation
Tools to Analyze Data
What does the data
tell you?
Describe major findings
from each analysis.
Data collection can be:
 Manual e.g. tally sheet, survey
 Automated e.g. data warehouse
Attach related documents
(no VDO/cost data).

21. 21
Baseline Analysis & Investigation
Tools to Benchmark
What did you learn
from others?
Describe what best
practices you learned
from peers.
Attach any related
documents.

22. 22
Baseline Analysis & Investigation
Summary
ROOT CAUSE
What did you learn?
Synthesize the information you’ve collected to target & prioritize opportunities for
improvement.
One method to identify the root cause is to ask ‘why’ 5 times. The reason a
problem exists usually goes deeper; keep going until you feel comfortable
you’ve identified the real reason(s).

23. 23
Baseline Analysis & Investigation
Check your Goals
Process
Action to get to
the outcome
e.g. removed the Foley
before 48 hours
Outcome
Output from the
process
e.g. urinary tract infection
rate
Balancing
Unintended
Consequences
e.g. Reducing length of
stay but increasing
readmissions
Now that you have a better understanding of your problem and what changes will
be made to your process, add/adjust SMART goals.

24. 24
Improvement Design
& Implement
4

25. 25
Improvement Design & Implementation
How to Improve a Process
 Make it Reliable e.g. Standard Work
 Make it Simple e.g. Workplace Organization
 Make it Visible e.g Visual Management
 Make it Flow e.g. Eliminate Waste
There is no one-size-fits-all solution; find what works for your team.

26. 26
Improvement Design & Implementation
Elements for Success
Design Changes
to Process / Workflow
Communication Plan
for improved design
Forcing Functions
to guide use of
improved design

27. 27
Improvement Design & Implementation
Changes to Process / Workflow
Provide information in the value summary such that others can
understand and potentially replicate.
What are your process change(s), Who (role) is accountable, and
When / Where is it happening in the process?
What major findings does the improvement design address?

28. 28
Improvement Design & Implementation
Customer / Patient Elements
Convenient
Empathetic
Coordinated
Reliable
Don’t forget about your customer! Improvements should be:

29. 29
Improvement Design & Implementation
Communication plan
Plan to communicate the improved design:
 Policy (re)written
 Communication campaign
 Education, internal
 Education, patient/customer
Plan a communication strategy for anyone affected by the process -
upstream & downstream. Attach related documents.

30. 30
Improvement Design & Implementation
Create a Reliable Process
Tools to ensure the improved design is followed:
MANUAL
TOOLS
COMPUTER /
AUTOMATION
PHYSICAL
MECHANISMS
VISUAL
REMINDERS
Person will be
expected to fill
out and check/
monitor their
work.
The step is
automatically
performed or
resides in a
trackable system.
The new process or
step will happen on
it’s own or the error
can’t happen
because of design.
Person will be
expected to notice
reminder and take
additional steps as
needed.
E.g. paper checklist,
nursing whiteboard
E.g. EMR order set,
telemetry monitor
E.g. barcodes, RFIDE.g. poster, best
practice alert

31. 31
Improvement Design & Implementation
Forcing Functions
Forcing functions ensure that the right step is done right every time. The more
automated, the more effective it is at preventing errors. Automation (system) is not
always practical; determine your needs by considering the severity, likelihood, and
the detectability of the error.
MANUAL
TOOLS
E.g. paper checklist,
nursing whiteboard
COMPUTER /
AUTOMATION
E.g. EMR order set,
telemetry monitor
PHYSICAL
MECHANISM
E.g. barcodes,
RFID
VISUAL
REMINDERS
E.g. poster, best
practice alert
[-] EFFECTIVE [+]
Source: http://healthsciences.utah.edu/accelerate/blog/2017/01/sepsis-using-emr-as-a-forcing-function.php
PEOPLE FOCUSED SYSTEM FOCUSED

32. 32
Monitoring & Impact
5

33. 33
Monitoring & Impact
What Gets Measured Gets Managed
Monitor data continuously
Monitor process (Goals/Gemba)
Reflect on effectiveness &
adjust design, if needed.
At least 1 year of monitoring is
recommended; 2-3 years to
ensure sustainability.
Is it working?

34. 34
Monitor & Impact
Measure Elements
Numerator & Denominator
Local
Meaningful
Transparent
Providing results to individuals can engage team members in their
ability to contribute to the improvement. This is often done outside of
the Value Summary reporting & monitoring.

35. Value Summary 2.0
http://pulse.utah.edu/go/valuesummary
35

36. http://healthsciences.utah.edu/accelerate 36
The Smart Way to Keep your New Year's Resolutions
Can improvement science help you keep your new year’s resolutions? Every
year, Chrissy Daniels coaches leaders throughout the system as they set goals.
She knows what works.
Lean Guard Rails: Using the EMR as a Forcing Function
This post is about the Sepsis project’s technical achievement using a process
improvement principle. Our system taught Epic, Utah’s electronic medical record
(EMR) how to provide urgent, life-saving information to clinicians.

37. WHAT IMPROVEMENT (REALLY) LOOKS LIKE
identify problem
JK
START END
AHA! found the real problem
keep going!
set goals
assemble the team
now we have the
right team
analysis &
investigation
design improvement
implement