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Quality Improvement

Foundational Webinar Series

Webinar 2:

Clarify the Problem & Assess the Current Condition

February 27, 2015

Presenters:

Amanda Cornett, MPH

Greg Randolph, MD, MPH

• Answer questions from previous webinar

• Discuss the importance of clarifying the problem

and assessing the current condition

• Introduce & use QI tools to asses the current

condition

• Share ideas for using the QI tools in your work

Objectives

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Visual adapted from Marni Mason of MCPP Consulting; based on Joseph Juran’s Trilogy

General QI Problem Solving Method

Assess current condition

Prioritize issues & set a target

BIG, VAGUE PROBLEM

Define

POSSIBLE

Changes

IMPROVED OUTCOMES

Clarify problem

Test, implement, & sustain changesAdapted from:

The Toyota Way

(The 8 Steps of the Toyota Business Process)

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The Model for Improvement

What are we trying to accomplish?

(AIM)

How will we know that

changes are an improvement?

(MEASURES)

What changes can we

make that will result in

an improvement?

(CHANGES)

Act Plan

Study Do

TEST ideas & changes with cycles for

learning and improvement

*Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP.

*

What is Lean Thinking?

A systematic approach to

identifying and eliminating wasteful activity

(non-value-added activities)

in the pursuit of perfection

through continuous improvement;

providing increased value to

our clients / community

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*

How Do We Define Waste?• Defects

• Overproduction

• Waiting

• Non Value-Added Processing

• Transportation

• Inventory

• Motion

• Employee (Underutilizing)

*

Typically 40-60% of all lead time is non-value added.

Aim StatementWhat are we trying to accomplish?

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• What are we trying to accomplish?– What specific program/area will our project focus on?

– What is the problem we are trying to fix?

– What is the overall goal of our project (i.e. improve response time, improve satisfaction, improve use of tools,)?

• Why is it important?

• Who is the specific target population?

• When will this be completed?

• How will this be carried out?

• What are our measurable goal?

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Key Components of Aim Statement

Example Aim Statement

The aim of this project is to improve the overall timeliness and efficiency of the update application process for the CACFP by increasing the number of applications that are complete, accurate, and submitted on time to program staff within the Nutrition Services Branch. The timeliness of this process is important to ensure all CACFP institutions receive reimbursements needed to provide nutritious meals to their participants. The QI team aims to achieve this by December 31, 2012; by applying QI tools and methods (Model for Improvement and Lean) to identify opportunities for improvement within the process. Our specific goals include:

• Decrease % of institutions that submit applications with errors from 96% -48%.

• Decrease total time for 1st party reviewer to submit completed application to 2nd party review from 56 days to 30 days.

• Decrease total time to process update application from 63 days to 30 days.

• Increase CACFP Institutions’ satisfaction with application update process.

• Increase staff satisfaction with the application update process.

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Clarify Problem & Assess System

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• Value Stream Map

• Process Flow Diagram

• Swimlanes Chart

• Initial Data Collection

Value Stream Map (VSM)

A simple diagram of every step involved in the

process and information flow needed to provide

a service.

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Actual VSM

11/6/13 13

Process Flow Diagram

• A horizontal display of current, actual work:

– Order or sequence of steps and activities

– Decision points

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Electronic Version: Process Flow

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Swimlane

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Type of flow diagram; process steps placed in lanes

Lanes= a person, group or subprocess

Value Add Non-Value Add

Mail Room Process

Lead

Extr

acto

rS

ort

er

Co

uri

er

Sort the thicks

from the thins

& the smalls

Slice thin & small

envelopes on

machine

Count thick

envelopes, labels

and stack

Pick up tray

from shelf, go

to desk

Thick opened manually,

sorted by type

Thin envelopes have

claims extracted &

sorted

Pick up trays &

place on cart

QC each

tray

take trays to

input prepEnd

Start

Put claims in

trays by type

Put envelopes on

the shelf

Put envelopes in

trays & pull out

labels

Unload bins

from cages

Bring cages

into mailroom

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Which Tool to Use?

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Objective

VSM Provides a high level view of the process;

maps the material and information flow.

Helps identify waste and value-added.

Created from the customer’s perspective.

Process

Flow Diagram

Provides a more detailed level of the

process steps, the decisions, and

connectors.

Swimlanes Identifies interactions of departments or

people involved in a process.

Helps identify handoffs.

Creating a Diagram

Before Creating the Diagram

• Define the process

• Define the purpose of the diagram

• Define who should be involved in mapping

• Define the boundaries of the map (start and end)

• Define the level of detail (macro, mini, or micro)

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Creating a Diagram

While Creating the Diagram

• Go and see the ACTUAL process

• List steps & decisions that occur in the process

• Jot down details of each step in the process

• Collect data on process (e.g. total time, delays, etc.)

• Use adhesive notes to visually display process

steps, decisions, and data

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Mapping Symbols

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Process Flow Diagram Symbols

Value Stream Map Symbols

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Using the Map for Improvement• Review the map with stakeholders and add to

the map (as needed)

• Identify areas for improvement (adapt aim statement as needed)

– No errors

– No waiting (delays, bottlenecks, and handoffs)

– No duplication or unnecessary work

– No underutilized resources

– No communication gaps

• Brainstorm ideas to improve process (align w/ aim & measures)

• Test the ideas using PDSA cycles

Initial Data CollectionRule of Thumb:

Enough to inform; not burdensome

– Demand: How many requests occur per week/month?

– Frequency: How often do you receive requests? When?

– Staffing: How many staff are available to respond to

requests?

– Performance: How long does it take the request to pass

through the process?

– Expectations: What are your customers/stakeholders

expectations of turn-around time? How satisfied are your

customers/stakeholders?

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Try It!: Breakout Session

ABC health department has identified STD screening

as a top priority in their community health assessment.

After reviewing the data it is evident that improvement is

needed within their internal clinic process. The clinic

currently screens 40% of eligible patients. The clinic

assembled a QI team and they collected data on the

current clinic process.

Initial Aim Statement:

Improve STD screening rates for

women 16-24 years old.

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Breakout Instructions• As a group reflect on the following questions:

– What additional data are needed to better understand the

current screening process?

– Where are the opportunities for improvement?

– What areas within the process would you prioritize to

work on for the QI project?

– Based on the VSM, how would you update the aim

statement to make it more specific?

• Report out to larger group

– What were the “aha” moments?

– What updates did you make to the aim statement?

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How might you use these tools

in your work?

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REMEMBER to GIVE US FEEDBACK!!

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Upcoming Webinars

WEBINARS DATES

Webinar 3:

Identifying Changes for Improvement

March

Date/Time TBD

Webinar 4: (Potential)

Testing, Implementing, and Measuring

Change

April

Date/Time TBD