Maintaining the Gain

1. Maintaining the Gain Process Ownership & Accountability Teresa Pinter, RN, Managing Master Black Belt Performance Improvement Division OSF Saint Francis Medical Center, Peoria, Illinois

2. Essential elements ofprocess management • An effective measurement system • Performance analysis • Performance to target (gap analysis) • Variation (special cause or routine) • Mean performance and range of performance • Enrolling staff and key stakeholders in performance improvement efforts and goals • Education, training, communication • Developing, implementing, and monitoring action plans for improvement

3. Key components…..process management plan • Process Steps • Key performance indicators • Measurement Plan • Targets • Corrective actions to be taken when performance fails to meet expectations • A measurement plan to assist the Process Owner to implement change and to manage performance of key processes • Provides process owners with all the information needed to evaluate how well the process is meeting the requirements of Those We Serve

4. WHY IS PROCESS MANAGEMENT IMPORTANT? It is how we know that improvement solutions have been implemented and are effective. It is how we know that implementations have achieved projected benefits. It is how we sustain the gains over time. It is how we identify when our environment is changing and additional improvement is needed.

5. PROCESS MANAGEMENT IS NOT JUST ABOUT PERFORMANCE IMPROVEMENT PROJECTS • Process Management is a critical competency that managers need to develop in order to achieve the organization’s strategic goals • Process Management requires measurement • To identify performance gaps • To focus our improvement efforts • To communicate performance objectives • To demonstrate ongoing performance improvement outcomes

6. Why use a control chart with process management? • Control charts are tools used to monitor performance over time • The control chart will allow us to view variation in the process • Variation means that a process does not produce exactly the same result every time the product or service is delivered. • Variation exists in all processes. • Has the ability to determine the presence of routine causes vs. special causes that upset our processes • Help us to detect, diagnose, and correct problems in a timely fashion • Provide an easy to understand visual indicator of process performance • Trending vs. Dashboard (red/yellow/green)

7. SUSTAINING THE GAINS…OBSERVING PERFORMANCE OVER TIME Good Implemented Solution # of Failures Improvement Methods Process Mgmt Project Team Process Owner Y = f (x) Process Errors Time Y = f (x) Financial Benefit ($) Good

8. The Goal of Process Management • Hardwire process management into our daily work • Review measures • Focus on closing your largest performance gaps • First, reduce routine variation by finding and eliminating root causes • Next, work on improving the mean • Process Management may start with: • The control phase of a performance improvement project • Key indicators that you need to improve for your area

9. Control Charts • Provides the “Voice of the Process” • Method to detect process “signal” vs. “noise” • Method to focus process improvement efforts • Simple method for displaying and interpreting process performance over time and in context

10. Control Charts Fundamentals Time series data Central line for detecting shifts and trends Control Limits computed from the data Distance of the limits from the center line = 3σ Statistically there is <1% probability of data point falling outside of Limits • Filters out the process noise so that real signals can be detected • Control Limits help us understand what needs to change by demonstrating the type of variation • Special Cause variation makes the process unpredictable and must be eliminated (dots outside of the control limits) • Common Cause variation can not be eliminated without making fundamental process change (dots within the control limits) Helps us understand when to react…and when not to

11. Why Use Control Charts? • Allows us to focus on the important questions: • Is the process stable and predictable? • Is the amount of common process variation acceptable? • If not, what is the root cause of variation? • Is the average process performance acceptable? • If not, work on eliminating variation. That will usually be sufficient to move the mean.

12. Process Variation • All work occurs in a system of interconnected processes • Variation exists in all processes • Understanding and reducing variation are keys to process and performance improvement

13. There are always inherent chance causes responsible for natural variation in all processes due to “normal” variation in materials, environments, methods, people etc. (common cause) Variation within a stable process is inevitable Do not react to this type of variation (process tweaking) Common Cause Variation

14. Special Cause Variation • Once we have an indication of a shift outside what seems to be normal in a previously stable process, we must discover the reason for the shift (special cause) • We want to remove the influence of a special cause if it is adversely affecting the process • If the special cause influence is improving the process, we want to permanently capture its effect

15. Identifying Special Causes Special Cause Variation UCL UCL Commuting Time (mins) Commuting Time (mins) Mean Mean LCL LCL Days Days • Common Cause • Special Cause

16. Maintaining the gains • Now that we have reviewed tools monitor our processes… • Lets discuss maintaining our gains.

17. How Can I integrate Process Management into my work? • The goal is to hardwire process management into our daily work • Review measures • Focus on closing your largest performance gaps • First, reduce routine variation by finding and eliminating root causes • Next, work on improving the mean • Process Management may start with: • The control phase of a Performance Improvement project • Key indicators that you need to improve for your area • Sustain the gains, pursue perfection • Show me the data • Action plans • Specific Recommendations for action based on analysis

18. PROCESS VARIATION QUESTIONS FOR LEADERSHIP • Leadership Questions to ask… • Reviewing process performance… • Q: Is the new process being followed? • Q: Have the key leading and lagging indicators for your process been identified? • Q: Is the process stable? • (free of special cause variation) • Q: Is the process capable? • (able to meet requirements) • Q: Is your process stability and capability being monitored on an ongoing, regular basis? • Q: Is there a mechanism to monitor feedback from Those We Serve for changes in expectations? • Q: What progress has the team made in implementation of solutions and achieving performance targets? • Q: What are the lessons learned? • Q: What milestones have been reached? Not reached? • Q: What obstacles have been identified? Are anticipated? • Q: What is the action plan to overcome the obstacles and place the team back on schedule or to improve the process? • Q: What support or resources do you need? • Q: What actions needs to be taken and by when?

19. Quotes: “Confusion between common causes and special causes leads to frustration of everyone, and leads to greater variability and to higher costs, exactly contrary to what is needed.” “I should estimate that in my experience, most troubles and most possibilities for improvement add up to proportions something like this: 94% belong to the system (responsibility of management), 6% special.” – W. Edwards Deming

20. Sustaining gains through communication Communicating the performance and action plans locally • Unit/Department/Division/Regional meetings • Standing agenda item • “Takeaway” information • Performance Improvement Display Boards: • Include: What was the baseline data, current performance and the target? • Utilize existing structures: • Professional Committees or Councils • Local communication pathways • Portals

21. Communication tactics • Leverage all current processes, vehicles, and resources • Management structure & processes • Employee newsletters • Internal communication boards etc • Provide consistent key messages that are easy to remember • Use a variety of methods & media • Tailor messages to meet the needs of the specific audience • Uses appropriate language and detail • Addresses audience specific concerns (What’s in it for them or WIFM)

22. Takeaways • All key elements of process management must be in place to sustain gains • Control charts show performance trends over time and focus analysis efforts • Leadership engagement and involvement is essential to success. • Effective communication is a critical function for successful implementation and sustaining change Process management is the first step in process maturity • Remember - a mature process is: • owned and managed, • documented, known, • standardized, • produces consistent quality outputs, • is measured and evaluated’ • and is improved in a disciplined way

23. PMCS: Process Management Control System

24. Who is part of the Process Management Team? • Business Leaders • Directors/Project Sponsors • Managers/Supervisors • Process Owners • PI Coach/MBB • PI Facilitator/BB

25. Process Management Control System • A measurement plan to assist the Process Owner to implement change and to manage performance of key processes • Illustrates the relationship between process performance and outcomes • Focuses on the key process variables that have significant impact on the quality of the process outputs • Defines process priorities • Establishes performance targets and accountabilities necessary to drive change and continuously improving performance • Provides process owners with all the information needed to evaluate how well the process is meeting its customer’s requirements

26. PMCS Example

27. PMCS Process Description • Process Description: • Reflects a key process, job, or group of • work tasks • Uses simple and general terms • Must be understandable for owners, • customers, and users

28. PMCS CCRs of Those We Serve • CCRs of “Those we serve”: • Identified measurable expectations in • regard to service product or experience • Includes the “Voice of the Business”

29. PMCS Outcome Indicators • Outcome Indicator (Y): • Measures how well the requirements • of “Those we serve” are being met”

30. PMCS: Key Process Steps • Process Map or Process Steps: • The set of sequential and parallel activities • that must be completed to ensure the • Customer requirement is met • Shows individual as well as cross-functional • accountability

31. PMCS Outcome Indictors • Outcome Indicators (Ys): • A set of indicators identified during the project • which measure key elements of performance • Based on critical relationship between process • variables and outcomes Y = f(x) • Tied to the specific process activities • Approved by Business Leader Team

32. PMCS Upstream Indicators • Upstream Indicators (Xs): • The description of the data type and operational • definitions to be monitored based on CCRs

33. PMCS Capturing Data • Capturing Data: • Defines the measurement plan the • Process Owner will implement • Defines the frequency at which they • should be checked • Defines the individual accountable • for checking

34. PMCS Recovery Action • Recovery Action: • Defines the actions the Process • Owner will take in response to • certain identified events

35. Next StepsDevelop the turnover agreementCompile the turnover documentsSign the turnover documents

36. Turnover Documents Standard documentation for project turnover includes all of the following: FMEA Implementation Plan PMCS Turnover Agreement Education & Materials • Charter • MGPP • CCRs/CBRs • Root Cause Validation Matrix • Communication Plan

37. Turnover Agreement • Purpose: to formally transfer the project implementation responsibility and management to the process owner. • Elements of a turnover agreement • Define Roles and Responsibilities • Agreed upon project success metrics • Agreed upon time frame for Leadership Reviews • Signatures of those taking ownership

38. Turnover Agreement Document • We are presenting to you on August 24, 2012 a detailed Solution Implementation Plan for the Respiratory Protection Program for Employees Project that was approved on July 5, 2012. This document contains process design, process control management, communication/ education plan, and implementation plan. Upon review of this plan, it is agreed this project team’s work is complete and the process owner will complete the detail as written in the implementation work plan. • Roles & Responsibilities • Black Belt: • Patty McMahill • Provide detailed implementation plan to process owner. • Coordinate quarterly leadership review. • Global Process Owners: • Director of Business and Community Health, Jo Garrison • Occupational Health Manager, Peggy Grace • Serve as Chair of the Environment of Care Safety Sub-Committee • See EOC Safety Committee Charter in Turnover documents • Track completion of employee medical evaluations.

39. Turnover Agreement Metrics Success Metrics & Review The solutions for this project were implemented on July 5, 2012. The following metrics and success criteria will be used to evaluate the success of this project starting July 1, 2012. Operational definitions and collection plans are documented in the Process Management Control plan provided at this meeting. Leadership review of performance will be scheduled as listed below.

40. Turnover Agreement Template Leadership Reviews Leadership Sign Off We, agree with the above, assume the process owner(s) responsibilities and will complete the activities assigned to ensure successful implementation and process control. ____________________________________ __________________ Director of Business and Community Health, Jo G Date Process Owner Signature ____________________________________ __________________ Occupational Health Manager, Peggy G Date Process Owner Signature

41. Takeaways • All key elements of process management must be in place to sustain. • Key elements include clear responsibilities, measurement plan with targets, communication plan • Clear recovery action if not meeting target. • Clear line of sight of accountability. • Provides process owners with all the information needed to evaluate how well the process is meeting its customer’s requirements

42. Questions? • Thank you!