Untangling Quality Improvement Tools

1. Untangling Quality Improvement Tools CAH/Small Rural Learning Community Lynne Hall

2. s2 Histograms Flow Charts Run Charts Check sheets Scatter Diagrams Cause and Effect Diagrams Force Field Analysis Bar Charts Pareto Charts Nominal Group Technique Root Cause Analysis Brainstorming

3. Objectives • Describe 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

4. What is Quality? According to Merriam-Webster Online Dictionary, Quality is: • A degree of excellence :grade • A distinguishing attribute :characteristic <possesses many fine qualities>

5. Total Quality Management (TQM) • A management approach to achieve long-term success • Everyone 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

6. Quality Tools • Key: Manage what you measure • What process needs work? Gather data Gather data Change process Act on data Act on data

7. Quality Tools • Key: Manage what you measure • What process needs work? • Present data to leadership!! Gather data Gather data Change process Act on data Act on data

8. Tools and Techniques

9. How do I decide which improvement area needs to be address first? You can use: • Flow Chart • Check Sheet • Pareto Chart • Brainstorming • Nominal Group Technique • Root Cause Analysis

10. Brainstorming • Process • 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

11. Brainstorming • Methods • 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!!

12. Nominal Group Technique • Can 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

13. 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.

14. 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.

15. Flow Chart • Identifies problems and opportunities • Helps define scope of process • Documents a process • Analyzes process for improvements

16. Flow Chart Get Bread Toasted? Not toasted Toasted Add Peanut Butter Add Jelly Enjoy!

17. Check Sheet • Used for data collection • Measure/track: • Process • Problems • Causes • Other performance factors • Helps with pareto charts and other display tools (pie charts, run charts)

18. Check Sheet • Application for Check Sheets: • Provides consistent data collection • Identifies and defines problems / opportunities • Sets priorities • Identifies root causes • Used for follow-up and verify results

19. Check Sheet • Getting 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

20. Check Sheet Making a PB & J Sandwich Data Analyst ___________

21. Pareto Chart • A special type of bar chart • Helps 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 causes • The data are easy to gather • They are easy to construct • Easy to interpret

22. Pareto Chart

23. Root Cause Analysis Interdisciplinary 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 Steps • Who – Organizational Leadership AND Frontline Caregivers • How – Correct Process to Prevent Future Event FOCUS on process NOT person • Appropriate use • Consistent use

24. Next: Describe the problem • Check Sheet • Pareto Chart • Histogram • Pie chart • Stratification

25. Next: Arrive at a statement that describes the problem in terms of what is specifically, where it occurs, when it happens, and its extent • Check Sheet • Pareto Chart • Histogram • Pie chart • Stratification

26. Stratification • Utilizes the data to “slice and dice” • What are the differences • What are the similarities • Consider this application anytime you want to collect data

27. Stratification

28. Histograms • Used with either continuous data or counts of attributes (discrete data) • Shows distribution of the data • Highs and lows • Allows you to see variation in the data • Helps answer questions: • Is the process centered on the customer requirement • Does the process miss the customer requirement • Is the process skewed with unexpected points

29. Histograms

30. Pie Chart • A circular chart that illustrates a proportion of the data • Works particularly well when the slices represent 25 to 50% of the data

31. Pie Chart

32. What are all the possible Causes of the Problem? • Check Sheet • Cause & Effect Diagram • Brainstorming • Root Cause Analysis • Failure Mode Effect Analysis • Force Field Analysis

33. What are all the possible Causes of the Problem? • Check Sheet • Cause & Effect Diagram • Brainstorming • Root Cause Analysis • Failure Mode Effect Analysis • Force Field Analysis

34. Cause and Effect Diagram • Also know as Fishbone • Basically a structured Brainstorming • Establishes categories of potential causes • Gives focus to help begin process and data analysis • This IS NOT a way of identifying which idea is the “culprit”

35. Cause and Effect Diagram People Equipment Nurses not rounding Floor is wet No handrails Call lights not answered Falls Non-skid footwear Education of family Methods

36. Failure Modes and Effects Analysis • Helps 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

37. Failure Modes and Effects Analysis • Brainstorm all the potential ways the change in the process could fail • List these failure modes • Identify the potential cause of these failures • Develop a rating scale • Rate each of the factors • Multiply the 3 numbers together to get the Risk Priority Number

38. Failure Modes and Effects Analysis Multiply 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

39. Force Field Analysis • Helps 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

40. Force Field Analysis • Clarify the change or solution to be analyze • Divide a flipchart page into two halves • Brainstorm forces for and against the change • Start with the driving forces and and identify ways to: • Reinforce the support • Make the support more visible in your plans • Link your solution to that support

41. Force Field Analysis 5. 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 forces 7. Determine which neutralizing actions are necessary and build into your plans

42. Force Field Analysis

43. Agree on basic cause(s) of the problem • Check Sheet • Pareto Chart • Scatter Diagram • Brainstorming • Nominal Group Technique

44. Agree on basic cause(s) of the problem • Check Sheet • Pareto Chart • Scatter Diagram • Brainstorming • Nominal Group Technique

45. Scatter Diagram • Allows you to test hypothesis about the causes of the problems • Uses paired data: Do these have an effect on one another?

46. Scatter Diagram

47. Scatter Diagram • Positive correlation between the two data points • Example: Positive correlation between more falls at change of shift

48. Scatter Diagram • Negative correlation between the two • Example: Less falls happen during shift change

49. Scatter Diagram • Indicates a complex relationship • Example: More falls happen at change of shift on Tuesdays

50. Scatter Diagram • No correlation at all between the two • Example: Falls don’t depend on shift change