Untangling Quality Improvement Tools

CAH/Small Rural Learning CommunityLynne Hall

s2 Histograms

Check sheets

Brainstorm

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Pareto ChartsNominal Group Technique

Root Cause

Analysis

Flow Charts

Scatter

DiagramsCause and

Effect Diagrams

Force Field Analysis

Run

Charts

Bar Charts

ObjectivesDescribe the quality control and

the management and planning tools used in quality improvement

Explain how to use the various performance improvement tools to implement the quality management

What is Quality?

According to Merriam-Webster Online Dictionary, Quality is:A degree of excellence : gradeA distinguishing attribute :

characteristic <possesses many fine qualities>

Total Quality Management (TQM)A management approach to

achieve long-term successEveryone in the organization

participates in improving processes, services, patient care, and the culture where they work

TQM takes strong commitment from leaders in your organization

Quality ToolsKey: Manage what you measure

◦What process needs work?

Gather data

Act on data

Change process

Gather data

Act on data

Quality ToolsKey: Manage what you measure

◦What process needs work?

◦Present data to leadership!!

Gather data

Act on data

Change process

Gather data

Act on data

TOOLS AND TECHNIQUES

How do I decide which improvement area needs to be address first?

You can use:Flow ChartCheck SheetPareto ChartBrainstormingNominal Group TechniqueRoot Cause Analysis

BrainstormingProcess

◦Define the topic◦Ask each person for 5 ideas on the

subject◦Give them a couple of minutes to

write them down◦Ask for ideas and list them on a

flipchart◦Review / clarify / combine like ideas◦Revisit and revise the list later in the

meeting or at the next meeting

BrainstormingMethods

◦Have people use sticky notes and stick on a flipchart

◦Take turns around the room until everyone says pass

◦Have each team member write one idea on a sheet of paper and pass it to the next person can add to or build off other statements

◦This is your chance to think outside the box!!

Nominal Group TechniqueCan enhance one or more

dimensions of effectiveness of decision-making groups

NGT provides:◦more unique ideas, ◦more balanced participation between

group members, ◦increased feelings of

accomplishment, and◦greater satisfaction with idea quality

and group efficiency

Nominal Group Technique

The nominal group technique is particularly useful:When some group members are

much more vocal than others.When some group members think

better in silence.When there is concern about some

members not participating.When the group does not easily

generate quantities of ideas.

Nominal Group Technique

The nominal group technique is particularly useful:When all or some group members

are new to the team.When the issue is controversial or

there is heated conflict.When there is a power-imbalance

between facilitator and participants or participants: the structure of the NGT session can balance these out.

Flow ChartIdentifies problems and

opportunitiesHelps define scope of processDocuments a processAnalyzes process for

improvements

Flow Chart Get Bread

Toasted?

Not toasted

Toasted

Add Peanut Butter

Add Jelly

Enjoy!

Check SheetUsed for data collectionMeasure/track:

◦Process◦Problems◦Causes◦Other performance factors

Helps with pareto charts and other display tools (pie charts, run charts)

Check SheetApplication for Check Sheets:

◦Provides consistent data collection ◦Identifies and defines problems /

opportunities◦Sets priorities◦Identifies root causes◦Used for follow-up and verify results

Check SheetGetting started:

◦Determine the data to be gathered◦Decide on the frequency◦Design a checksheet◦Train users◦Mark appropriately (checks or

hashmarks)◦Compile results◦Analyze and graph data

Check Sheet

Making a PB & J SandwichData Analyst ___________

Process Step Date/Time start Date/Time Stop

Pareto ChartA special type of bar chartHelps focus team on components of

the problem that has the biggest impact

Based on the Pareto Principle◦80% of the effects we see are due to

20% of the causesThe data are easy to gatherThey are easy to constructEasy to interpret

Pareto Chart

Root Cause AnalysisInterdisciplinary REVIEW of the process surrounding an event (actual or near)

to develop prevention strategies

When – Unplanned Event (REACTIVE)What – Tool for Review Why - Review Process StepsWho – Organizational Leadership AND Frontline

CaregiversHow – Correct Process to Prevent Future Event

FOCUS on process NOT personAppropriate use Consistent use

Next:

Describe the problem Check SheetPareto ChartHistogramPie chartStratification

Next:

Arrive at a statement that describes the problem in terms of what is specifically, where it occurs, when it happens, and its extentCheck SheetPareto ChartHistogramPie chartStratification

StratificationUtilizes the data to “slice and

dice”◦What are the differences◦What are the similarities

Consider this application anytime you want to collect data

StratificationFactors Examples

Who • Department• Individual• Customer Type

What • Type of Complaint• Defect Category• Reason

When • Month, quarter• Day of week• Time of Day

Where • Region• Department• Unit

HistogramsUsed with either continuous data or

counts of attributes (discrete data)Shows distribution of the data

◦Highs and lowsAllows you to see variation in the dataHelps answer questions:

◦ Is the process centered on the customer requirement

◦Does the process miss the customer requirement

◦ Is the process skewed with unexpected points

Histograms

Pie ChartA circular chart that illustrates a

proportion of the dataWorks particularly well when the

slices represent 25 to 50% of the data

Pie Chart

What are all the possible Causes of the Problem?Check SheetCause & Effect DiagramBrainstormingRoot Cause AnalysisFailure Mode Effect AnalysisForce Field Analysis

What are all the possible Causes of the Problem?Check SheetCause & Effect DiagramBrainstormingRoot Cause AnalysisFailure Mode Effect AnalysisForce Field Analysis

Cause and Effect DiagramAlso know as FishboneBasically a structured

BrainstormingEstablishes categories of

potential causesGives focus to help begin process

and data analysisThis IS NOT a way of identifying

which idea is the “culprit”

Cause and Effect Diagram

Falls

Methods

PeopleEquipment

Call lights not answered

Floor is wet No handrails

Nurses not rounding

Education of family

Non-skid footwear

Failure Modes and Effects AnalysisHelps anticipate problems so you

can take steps to correct, reduce and eliminate (PREVENT problems or anticipated) risks

Identifies ways a change in a process, product or service that may cause unintended problems

Failure Modes and Effects Analysis1. Brainstorm all the potential ways

the change in the process could fail2. List these failure modes 3. Identify the potential cause of

these failures4. Develop a rating scale5. Rate each of the factors6. Multiply the 3 numbers together to

get the Risk Priority Number

Failure Modes and Effects AnalysisMultiply the 3 numbers together to get the Risk Priority Number

◦Start with the failures that have the highest RPN’s discuss for each failure ways to eliminate the causes, the chance of it reoccurring, ect

◦Assign responsibilities for each action identified

Force Field AnalysisHelps teams proactively build

support and neutralize blocking factors to an impending change

Application◦Determining solutions◦Identifies and removes obstacles◦Plans and implements a process

change or solution

Force Field Analysis1. Clarify the change or solution to be

analyze2. Divide a flipchart page into two halves3. Brainstorm forces for and against the

change4. Start with the driving forces and and

identify ways to:1. Reinforce the support2. Make the support more visible in your plans3. Link your solution to that support

Force Field Analysis5. Categorize the restraining forces as follows:

◦Blocks – regulations, policies, laws◦Constraints – resources, budget, time◦Illusions – “That’s not what we have done

before”

6. Identify steps to neutralize restraining forces7. Determine which neutralizing actions are necessary and build into your plans

Force Field Analysis

Agree on basic cause(s) of the problemCheck SheetPareto ChartScatter DiagramBrainstormingNominal Group Technique

Agree on basic cause(s) of the problemCheck SheetPareto ChartScatter DiagramBrainstormingNominal Group Technique

Scatter DiagramAllows you to test hypothesis

about the causes of the problemsUses paired data: Do these have

an effect on one another?

Scatter Diagram

Scatter DiagramPositive

correlation between the two data points

Example: Positive correlation between more falls at change of shift

Scatter DiagramNegative

correlation between the two

Example: Less falls happen during shift change

Scatter DiagramIndicates a

complex relationship

Example: More falls happen at change of shift on Tuesdays

Scatter DiagramNo correlation

at all between the two

Example: Falls don’t depend on shift change

Presenting Data to Leaders and Others

Run ChartsPie ChartBar Graphs

Presenting Data to Leaders and Others

Run ChartsPie ChartBar GraphsPareto ChartScatter diagram

Develop an effective and implementable solution and action plan

Run Charts Pie ChartBar GraphsPareto chartScatter Diagram

Run Charts – watching performance over time

Purpose: to measure and track a key input, process, or output measure over time

Run Charts – watching performance over time

Run charts got their name because of the practice of counting “runs” or sequences of consecutive points of either side of the median

Too many or too few clusters are a signal that something special is happening within your process

Graphs of data show improvement over time Tool for assessing the effectiveness of change

RUN CHARTS

Run charts have a variety of benefits: Help improvement teams formulate aims

by depicting how well (or poorly) a process is performing◦ Identifying problems, opportunities (trends,

patterns, or output measure over time)◦Determining potential root cause(s)◦Follow-up and verification of results

Provides a quick look at a process

Monitoring Improvement…RUN CHARTS

1. Plot your data.

2. Find your mean or average

3. Identify runs

4. Look for Special Cause Variation

5. Note any changes made in the process

Monitoring Improvement…RUN CHARTS

1. Plot your data.

2. Find your mean or average

3. Identify runs

4. Look for Special Cause Variation

5. Note any changes made in the process

Implemented new fall process

Monitoring Improvement: Run Chart RulesCommon Cause Variation – the

random variation associated with a process (No process is a straight line)

Special Cause Variation – a difference in the normal process variation◦Six or more consecutive increasing or

decreasing points◦Nine or more consecutive points on the

same side of the median◦14 or more consecutive points alternating

up and down around the median

Bar GraphsUsed for data that is not related

to one another or is not continuous

Use for independent data

Bar Graphs

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What is my improvement area?

Describe the Problem

Cause of the Problem

Flow Charts

Check Sheet

Check Sheet

Nominal Group Technique

Brainstorming

Pareto Charts

Root Cause Analysis

Check Sheet

Pareto Charts

Histogram

Pie Chart

Stratification

Check Sheet

Check Sheet

Check Sheet

Check Sheet

Root Cause Analysis

Referenceshttp://

asq.org/learn-about-quality/total-quality-management/overview/overview.html

Melum, Mara Minerva and Sinioris, Marie Kuchuris; 1992; Total Quality Management

http://www.emathzone.com/tutorials/basic-statistics/scatter-diagram.html