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Beginning an improvement journey ii introduction to improvement models

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Beginning an improvement journey ii introduction to improvement models

  1. 1. Beginning an Improvement Journey II Improvement ModelsUIHC Lean Training
  2. 2. Initiatives / Solutions / Tools• TQM • Toyota Production• Zero Defects System • Lean• SPC • Kaizen• PDSA • RPI• Six Sigma • MDI• DMAIC • TPM• Ritz Carlton • KanbanUIHC Lean Training
  3. 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 commitmentUIHC Lean Training
  4. 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?UIHC Lean Training
  5. 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 toolsUIHC Lean Training
  6. 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 MaturityUIHC Lean Training
  7. 7. Improvement Resources“Quality is free.” Phillip Crosby, 1926-2001• But… – It usually requires “activation energy”.UIHC Lean Training
  8. 8. Improvement activation energy Energy Net gain (Improvement) TimeUIHC Lean Training
  9. 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 radarUIHC Lean Training
  10. 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 playersUIHC Lean Training
  11. 11. PDSA Model for ImprovementModel for Improvement* is a method toguide improvement efforts through threequestions and Plan-Do-Study-Act cycles.The models 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: Howto Improve” (Deming)
  12. 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 ActEach model reflects a common thread of analysis, implementation, and review.As in the graphic for the FADE model, each also has deeper meaning (furtherlevels of analysis) for the headings. Using a methodology ensures that you arenot missing any of the critical steps. No one method is best for everyone or allsituations.UI Healthcare
  13. 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?UIHC Lean Training
  14. 14. Do -Execute the plan -Record data -Document observationsUIHC Lean Training
  15. 15. Study -Analyze the data -Compare the results to the predictions -Summarize what was learnedUIHC Lean Training
  16. 16. Act -What are the changes to be made? -Implement standard work -Determine next cycleUIHC Lean Training
  17. 17. Do-It• Simple scope/Single task• Very short duration (1-2 hours)• 1-3 people• Immediate impact• No decisions or management intervention requiredUIHC Lean Training
  18. 18. Burst Event• Minimal scope/Single issue• Short duration (2-8 hours)• 4-6 people• Quick impact• Intended for relatively simple tasksUIHC Lean Training
  19. 19. Kaizen Events• Kai = Change• Zen = Good (For the Better)• Kaizen events are used to make a fundamental process shiftUIHC Lean Training
  20. 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 daysUIHC Lean Training
  21. 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 effortUIHC Lean Training
  22. 22. Project• Long duration (3-12 months)• Complex scope• Multiple departments/functions• Long-term impactUIHC Lean Training
  23. 23. MDI• MDI = Managing for Daily Improvements• A philosophy of incremental improvements – Everyday improvement – Everybody improvement – Everywhere improvementUIHC Lean Training
  24. 24. How kaizen events & MDI work together Kaizen event Process Plateau Kaizen eventCurrent Process UIHC Lean Training
  25. 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 customerUIHC Lean Training
  26. 26. Problem Solving Model – A3UIHC Lean Training
  27. 27. The A3 formatProblem Statement: Future State:What is the problem to be solved? Pictorial description of the desired stateBackground: 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? UIHC Lean Training
  28. 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 • ControlUIHC Lean Training
  29. 29. A3 ExampleUIHC Lean Training
  30. 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 goUIHC Lean Training
  31. 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-inUIHC Lean Training
  32. 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 processUIHC Lean Training
  33. 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• xUIHC Lean Training
  34. 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 categoryUIHC Lean Training
  35. 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 progressUIHC Lean Training
  36. 36. Questions?

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