Improvement Events

1. Improvement Events Anne Brittain PhD RT(R)(M)(QM), CPHQ, FASRT SCAHQ Immediate Past President Palmetto Health Corporate Quality Performance Improvement Project Manager

2. Session Objectives • Discuss the basic concepts of facilitating an improvement event • Demonstrate the use of various improvement tools • Participate in a mock-improvement event • Facilitate the use of improvement tools “Please note that this Power Point presentation is an educational tool that is general in nature. It is not intended to be an exhaustive review of the subject matter or the opinion of Palmetto Health. Materials presented in this presentation should not be considered a substitute for actual statutory or regulatory language. Always refer to your legal counsel and the current edition of a referenced statute, code and/or regulation for precise language.”

3. Ground Rules • They are rules- • concerning how the meeting will be run • about how team members will interact • on what behaviors are acceptable/unacceptable • Consider ground rules related to: • attendance & promptness • breaks • participation • courtesy • decision making

4. Parking Lot • Topics that will be addressed at the end of the event • Items that should be handled in a separate forum • Items that are out of scope for the event or non-negotiable The parking lot helps keep the team focused and on task

5. Team Roles • Leader/Facilitator • Guides group through activities • Ensures full participation • Refocuses group, as needed • Promotes discussion • Time Keeper • Monitors agreed-upon timeframes • Gives updates on use of time • Scribe • Records verbatim • Makes sure all documentation is clearly labeled and visible to all • Presenter • Presents groups work during debriefs for other workgroups

6. Team Building • Want to move through phases rather quickly • Icebreakers help with forming • Ground rules and parking lot integral to getting through storming • Norming and Performing lead to successful selection and implementation of solutions

7. Facilitation Challenges • Silence from group • Do an icebreaker • One person monopolizes • Thank them and specifically ask someone else’s opinion, you could make them the scribe • Negative attitude from past experience • Acknowledge and explain how new process will help lead to success • Absent- either physically or mentally • Do not hold up group if late or not there, ask them a specific question to refocus them, remind of the ground rules • Story-teller • Remind of the 80/20 rule • Definitely wrong • Avoid embarrassing them however clarify question to ensure team stays on the right track

8. Planning an Improvement Event • Information gathering • Well defined goal • Agenda • Participants • Invitations • Meeting space • Supplies • Refreshments

9. The Improvement Event As you facilitate, you will follow the basic divergent and convergent processes. Both steps are needed for effective solutions. Opening and Set-up consensus consensus Converge Diverge Converge Diverge Selecting Think Freely Think Freely Selecting Break* Issues and Barriers Solutions Action Plan/Report out

10. Improvement Event Agenda-Sample

11. During the Break/Lunch Before Solution Generation* • Right before the break have group determine based on “problems identified” if the right people are in the room to generate solutions • If so, awesome… drive on • If not, use the break to contact those people and see if they can join the event either in person or on the phone • If they cannot, it might be best to delay the solution generation portion of the meeting until they can attend

12. Consensus Defined • Means everyone agrees to proceed with no hidden reservations • It does not mean that everyone agrees • It does mean that everyone agrees to implement and actively support the decision of the group • Each team member will live with the decision because their concerns were heard and considered by the group prior to the decision being made

13. Consensus Reaching Tools • Voting • Each member gets 1 vote • Multi-voting • Each member gets multiple votes to disperse as they please • Full ranking • Could be based on number of criteria met • Fist to five • 5 = best • 4 = good • 3 = okay • 2 = needs more discussion • 1 = not good • 0 = totally against

14. The tools

15. Process mapping • A diagram of the steps in a process in chronological order including decision points • Created by a cross functional team • Increases collaboration & teamwork across department boundaries • Its best to create through direct observation • Map the current state to identify the future state

16. Process Map Source: AHRA

17. Brainstorming • A process for gathering a large number of idea’s associated with the topic. • Free-for-all verbal exchange • No judging of ideas • Build ideas on other ideas • This is all about quantity not quality • No discussion • Record all ideas • Everyone is equal

18. ‘Silent’ Brainstorming • Everyone writes down their ideas • 1 idea per sticky note • Ideas are shared one at a time, round robin • No discussion of quality, only clarifying questions allowed • Record all ideas shared • Everyone is equal • Still want quantity, not quality • Good technique to use if there are introverts in the group or if a couple of people are dominating the conversation • Only give as much time as needed, no need to do this for a long time. Ideas come quickly

19. Fishbone Diagram • Also known as the Ishikawa Diagram • Used to explore and display possible causes of a certain effect • Helps focus attention on root cause of the problem, not symptoms of the problem • Demonstrates relationships • Two types: • Process type- used when causes of effect group naturally around steps in the process • Classic type- used when causes of effect group naturally around categories

20. Fishbone Diagram- Process Type Source: IHI

21. Fishbone Diagram- Classic Type Source: IHI

22. Circle of Influence/Circle of Control • Helps team understand what is within their authority to effect or change • This can be a scoping tool • Circle of- • Control- team can make it happen • Influence- team can influence it but doesn’t control it • Concern- team doesn’t touch this at all. Out of scope or need to add team members Circle of Concern Circle of Influence Circle of Control

23. Affinity Diagram/Storyboarding A tool that gathers large amounts of qualitative or language data (ideas, opinions, issues) and organizes them into groupings based on their natural relationships Source: Six Sigma Material

24. Priority/Payoff matrix or 2x2 • Tool used to look at an option from 2 different angles at one time • Common perspectives to evaluate are: benefit and ease of implementation, but could be anything High Sweet spot Benefit Low Worth the trouble? Easy Difficult Ease of Implementation

25. Threat/opportunity matrix Used to evaluate proposed changes as a combination of threat & opportunity over the short- and long-term. Can include the “devils advocate column”

26. Action Plan/WWW Used to ensure everyone is aware of assignments and due dates

27. Report-Out Template Issue/Topic: Recommendation/Action Steps: Benefit: Resources to Implement: Recommendation Owner(s): Timing:

28. Plus Delta Used to evaluate event and make improvements for future events +