Quality Tools - by - Dr. Doaa Hussein - 4-3-2014

Dr . Doaa Hussein Quality Management Consultant.
MBA,CPHQ ,TQMD, TOT, HRMD,APD TQM AUCians Group member
Outline
Using Quality Improvement tools throughout
the Quality improvement process
Dr.Doaa Hussein QM consultant
Effective Outcome
Effective outcome
Unique Well-crafted Items Solve Problem Situations.
Effective outcome
provide care to individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life.
Effective outcome
Solve problems Improve quality
Quality Improvement Process

Using tools to improve quality and increase effectiveness
Define preferred state, problems, and improvement opportunities.
Identify barriers and root causes.
Develop improvement solutions, strategies, tactics, and plans
Implement plans.
Monitor results.
Standardize and generalize
How To Write A Problem Statement

Should be SMART:

specific Measurable Attainable Realistic Timeframe
And should not:
include any causes or solutions or blame anybody

How To Identify the Problem or opportunity for improvement ?
Flow Charts
A pictorial representation displaying the actual sequence of steps and their inter-relationships in a specific process
Flowchart
Identify : Hand-off (Appropriate And Inappropriate), Inefficiencies, Redundancies, Waiting Steps;
Flowchart
Decide whether to : Correct Steps Within The Current Process, Design A New Process Do corrections first, then redesign in the future.
Flowchart
Questioning whether actual process meets
current policy/procedure Analyzing problems to determine causes Redesigning the process as part of the action Designing a new process
Symbols Used in Flowcharts

Start / End Process Step Decision
Yes
No
Connector
Linear Flowchart Example

Producing the Plan of the Day
Start Collect inputs Draft POD
A
Type smooth
Sign POD
Type rough Retype POD Submit to XO Distribute

No
Make copies
OK ?
Yes
End
Levels of Flowcharts
MACRO
Start Start
MINI
Turn on computer
MICRO
Draft POD
Get rough draft of POD
Start word proc. apply.
Type POD
Is it approved ? Yes Type smooth
No
Get approval
Is rough in word proc. apply. ?
No
Type rough POD
Yes
Edit POD
Distribute POD
End End
Are there any corrections ? No Print POD
Yes
Make corrections
Interpreting a Flowchart
Step 1 - Examine each process step Bottlenecks? Poorly defined steps? Ineffective sequence? Delays? Weak links? Step 2 - Examine each decision symbol Can this step be eliminated? Step 3 - Examine each rework loop Can it be shortened or eliminated? Step 4 - Examine each activity symbol Does the step add value for the end-user?
Draw Flowchart ?
Getting to Work From: Waking Up to Entering Building.
Level ? Steps? Decisions? Interpretation?
What is the scope of the problem?
Who are the Stakeholders?
Brainstorming
Create as many ideas as possible in as short a time as possible
What is the impact of this problem on Patient Care?
What are the possible solutions ?
Brainstorming
Structured Brainstorming:
Everyone in the group
Unstructured Brainstorming:
Everyone in the group
gives an idea in rotation or passes until the next round.
gives ideas as they come to mind.
Five Steps of Brainstorming

Establish a time limit for the entire session; Define the subject and direction of the session; Allow time for initial, individual thought; Request ideas according to the predetermined structure; keep circling the issue until all ideas are recorded Clarify all ideas generated to assure accuracy and understanding.
What can be done to improve employee morale?
Affinity Diagram
Organize large volumes
of ideas or issues into major categories
Affinity Diagram
"
Affinity" means close relationship or
connection, or similarity of structure; When developing an Affinity Diagram, it is most important to determine the primary issue and major related subgroups in order to grasp the appropriate relationships, links, or connections.
Affinity Diagram
Steps:

Define the primary issue, using neutral, broad language; Brainstorm - use cards or adhesive notes which can be moved and sorted; Display in random fashion all ideas for the team (on a wall or table);
Cont..
Display the Generated Ideas

Issues in Implementing Continuous Process Improvement
Data collection process needs Pressure for success Lack of followup by management Which comes first, composing the team or stating the problem?
Everybody needs to change but me
Want to solve problem before clearly defined
Lack of training at all levels
What are the rewards for using tools
Unrealistic allotment of time
Need new data collection system Too busy to learn
Lack of management understanding of need for it
Developing product without developing process
Not using collected data
Dont know what customer wants
Some people will never change
Lack of trust in the process
Behavior modifications may take longer than time available
Short-term planning mentality
Need to be creative Competition versus cooperation
Too many projects at once
Sort Ideas into Related Groups

Lack of follow-up by management
Competition versus cooperation Pressure for success
Data collection process needs
Which comes first, composing the team or stating the problem?
Need new data collection system
Need to be creative Behavior modifications may take longer than time available
Dont know what customer wants Too busy to learn Want to solve problem before clearly defined
Unrealistic allotment of time Not using collected data
Lack of management understanding of need for it
Too many projects at once
Create Header Cards

(Header Cards)
Breaking through old way Dinosaur thinking Old management culture Lack of TQL knowledge
Lack of planning
Organizational issues
Finished Affinity Diagram

Breaking through old way "Dinosaur thinking
Lack of planning
Organizational issues
Old management culture
Lack of TQL knowledge
Lack of follow-up by management
Competition versus cooperation
Data collection process needs
Which comes first, composing the team or stating the problem?
Pressure for success
Need new data collection system
Need to be creative Dont know what customer wants Want to solve problem before clearly defined
Too busy to learn
Unrealistic allotment of time
Behavior modifications may take longer than time available
Not using collected data
Lack of Too many management projects at once understanding of need for it Dr.Doaa Hussein QM consultant
Affinity Diagram
Each team member participates in sorting the ideas into major groupings -- in silence and quickly, without discussion and without time for contemplation -- until team consensus is reached; Discuss the major groupings and create a concise title for each grouping; Draw the affinity diagram, based on major groupings, linking all ideas related to each grouping.
Use the list generated during the Brainstorming Exercise
Prioritization Matrix
Select one option from a
group of alternatives
It promotes objective
decision making.
Steps:
Limit the list of options (of problems or
solutions) to no more than eight (8);
Select the criteria against which each option
will be rated, stated in either positive or negative terms, but not both;
Determine the weight (relative
value) of each criterion; perhaps some are more important Dr.Doaa Hussein QM consultant to meet than others;
Cont..
Select a scoring
Point system:
From 5 = Very important
method, e.g.:
to 0 = Unimportant
Yes/No
system: Criteria Met? Y=Yes; N=No Check mark: Box checked if criteria met + or - system:
+
= Important/criteria met - = Unimportant/criteria not met

Determine the desired score, what number of
criteria must be met.

Prepare the matrix with options down the left
side and criteria/total score column across the top.
Causeand Effect Fish-Bone

Ishikawa Diagram Gather all possible causes as an overview.
The ultimate goal
being to uncover the root cause of a problem.

Basic Layout of Cause and Effect Diagrams

Manpower (People) Methods (Procedures) EFFECT Materials (Policies) Machines (Plant)
Environment
Cause-and-effect Diagram
Determine and define the major categories
which describe the system or process under review, e.g.,

(or) 5ms:
5ps:
People
Provisions Policies Procedures Place
Manpower
Materials Machines Methods Measurements
Brainstorm to identify possible main causes of
the negative outcome

Link each to one of the major categories Using horizontal lines (parallel to the main
outcome line) touching the appropriate

diagonal line;
Identify any possible sub causes of main
causes by using the "Five-Why" technique, linking these to the main cause lines;
Evaluate the draft diagram as a team to
determine the accuracy of the placement of issues and lines;
It is very important to study the relative
frequencies of the different causes before acting to change the process.
Start
Agree on the problem statement Process Classification
Use Dispersion Analysis or Process Classification Format?
Dispersion Analysis
Define major process steps
Define major cause categories
Steps at a Glance: Cause & Effect

No
Draw in the bones of the fish
Brainstorm causes or use data from Check Sheet
Reached the appropriate level of detail? Yes Interpret fishbone
No
Agreement on root causes?
Yes
Act to correct the causes
Cause & Effect Example

Resources
Nursing shortage Unit clerk staffing
Bed Assignment Delay

Wait for MD
Ttiming
Machine (PCIS)
System incorrect Not entered Functions not useful Not used Need more training No trust Not used pending discharge
Patient arrives too early Unit clerk training
Transfer too early from another hospital

Call housekeeping when clean
Discharged patient did not leave Wait for ride Wait for lunch Wait for results Call housekeeping too late Call housekeeping too early Think it will take more time
Patient waits for bed

Double rooms Physician did not write order Medicine admit quota Many transfers Specialty beds Cardiac monitors Admitting unaware bed is clean Delayed entry Too busy Sandbag Physician misuse inpatient Inappropriate ER admittance Unit switch bed Reservation unaware Not entered Unit clerk unaware of discharge or transfer Shift change Not told On break
MD procedures
Hospital procedures
Communication
Information provided courtesy of Dr.Doaa Hussein QM consultant Rush-Presbyterian-St. Lukes Medical Center
Pareto
Identify the vital few
and useful many

Pareto principle
Pareto Chart
Bar chart arranged in
descending order of height from left to right
Budget Allocation
100 80 60 40 20 0
Code 20 Code 10 Code 50
80
Thousands
Bars on left relatively more
important than those on right from the "useful many" (Pareto Principle)
38 27 14 11
Code 30 Code 40
Separates the "vital few"
5
Code 60
Start
Select problem to study Is data Yes available? No Barnstorm possible categories Choose categories Select unit of measure
Steps at a Glance: Pareto
Choose time period
Check Yes Sheet available?
Review data from Check Sheet
No
Gather new data Create Check Sheet
Construct data table
Record scale on y axis (vertical)
Construct vertical bars on x axis (horizontal)
Indicate Yes cumulative percent? No
Plot percent line
Interpret results
Use in problem-solving process
Example #1 - Pareto Chart

2225 2007 1784 1561 1338 1115 892 669 446 223 0 Break point
100 % 90 80 70 60 50 40 30 20 10 0
Number of Complaints
Temp Storage TV Towels Roaches Lighting Stereo Water Furn
Type of Complaint
Dr.Doaa Hussein QM consultant LEGEND: COMPLAINTS RECORDED IN BEQ / BOQ, 1 FEB - 30 APR 95.
Find Solution
Ensure support from formal and
informal leaders management.
Make the Remedy part of day to day
Issue policies, procedures, or guidelines
to facilitate the implementation process.

Find Solution
Implement on a Pilot basis Collect Data to check Effectiveness and
Efficiency of the solution.

Monitor the impact of the solution on
performance over time
Find Solution
Get ready for a wider scale of Implementation. Educate Staff and prepare them for the
upcoming change
Get ready to replicate your experience in other
areas or other projects

Monitoring the Impact

Collect data using data collection tools. Analyze data, transform data into information
Present your data using line, Bar and Pie Charts

Study Common/Special Cause Variations Use Control Charts
Force Field Analysis

Driving Forces Restraining Forces
Force field analysis is used by the team
when a proposed solution to a problem will require significant change.

And it is important to analyze the potential impact and chances of success.
If no change occurs, it is because the opposing
forces are equal, or the restraining forces are too strong.

Steps: List in two groups all the driving and restraining forces affecting a desired change; Discuss the overall value of the proposed change; Come to team consensus about priorities for effecting change; Include in the planned solution, actions to diminish or eliminate the restraining forces. Dr.Doaa Hussein QM consultant
Gantt Chart
Goal:.
1 2 3 4 5 6 7 8 9 10
1-
2-
3Dr.Doaa Hussein QM consultant
GANTT CHART
Is a graphic displaya type of bar
chartof the individual parts of a quality improvement process as bars on a horizontal time scale.
Is a project-planning tool for developing
schedules;
Action Planning
Action Planning
Once the team selects a solution, an
action plan need to be developed.
The team leader is responsible of
monitoring the implementation process using a mean of verification that a certain task
has been done (target , KPI).
STORYBOARD
Storyboards are valuable displays:

Promote the teams commitment to quality and the positive
impact on the organization;

Communicate quality improvement progress and outcome
to the entire organization;

Summarize the
effort for leader, Quality Council, governing
body approval;
Provide visual description of QI/PI activity for training.

Quality Tools - by - Dr. Doaa Hussein - 4-3-2014

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Dr . Doaa Hussein Quality Management Consultant.

MBA,CPHQ ,TQMD, TOT, HRMD,APD TQM AUCians Group member

the Quality improvement process

Dr.Doaa Hussein QM consultant

Dr.Doaa Hussein QM consultant

Dr.Doaa Hussein QM consultant

Dr.Doaa Hussein QM consultant

Quality Improvement Process

Dr.Doaa Hussein QM consultant

Define preferred state, problems, and improvement opportunities.

Identify barriers and root causes.

Develop improvement solutions, strategies, tactics, and plans

Standardize and generalize

Dr.Doaa Hussein QM consultant

How To Write A Problem Statement

specific Measurable Attainable Realistic Timeframe

And should not:

include any causes or solutions or blame anybody

How To Identify the Problem or opportunity for improvement ?

Dr.Doaa Hussein QM consultant

Dr.Doaa Hussein QM consultant

Dr.Doaa Hussein QM consultant

Dr.Doaa Hussein QM consultant

Symbols Used in Flowcharts

Dr.Doaa Hussein QM consultant

Linear Flowchart Example

Type rough Retype POD Submit to XO Distribute

Get rough draft of POD

Start word proc. apply.

Is it approved ? Yes Type smooth

Is rough in word proc. apply. ?

Type rough POD

Are there any corrections ? No Print POD

Dr.Doaa Hussein QM consultant

Dr.Doaa Hussein QM consultant

What is the scope of the problem?

Who are the Stakeholders?

What is the impact of this problem on Patient Care?

What are the possible solutions ?

Dr.Doaa Hussein QM consultant

gives an idea in rotation or passes until the next round.

gives ideas as they come to mind.

Dr.Doaa Hussein QM consultant

Five Steps of Brainstorming

Dr.Doaa Hussein QM consultant

What can be done to improve employee morale?

Dr.Doaa Hussein QM consultant

of ideas or issues into major categories

Dr.Doaa Hussein QM consultant

Affinity" means close relationship or

Dr.Doaa Hussein QM consultant

Display the Generated Ideas

Everybody needs to change but me

Want to solve problem before clearly defined

Lack of training at all levels

What are the rewards for using tools

Unrealistic allotment of time

Need new data collection system Too busy to learn

Lack of management understanding of need for it

Developing product without developing process

Not using collected data

Dont know what customer wants

Some people will never change