TSgt Brent Whitby NCOIC, Quality Assurance 375 Medical Group, Scott AFB, IL

TSgt Brent WhitbyNCOIC, Quality Assurance

375 Medical Group, Scott AFB, IL

Let’s Draw a Pig

AFSO21 Implementation Linking AFSO21 to Organizational Goals OODA Loop process of AFSO21

Launched in 2005 Obstacles to deployment

◦ Quality Air Force Conundrum◦ Senior Leadership buy-in

AFSO21 vs. QAF◦ Value stream mapping vs. process mapping◦ Results

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Assess outlook/future path◦ Current state map◦ Future state map

Evaluate current organizational performance Review system change/improvement

capacity

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Which process needs the most attention Where can biggest cost savings occur How can quality be improved (to what

degree?)

Customers are important Speed, quality, low cost are linked Variation/defects minimized Time trap elimination Data driven improvements Teamwork

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Q1 - Immediate attention

Q2 - Hardest decision Q3 - Sometimes

beneficial Q4 - Avoid

1 2

3 4

High

Low

Low High

Benefit

Effort

Process elements Stakeholder analysis Customer data Quality function deployment Benchmarking

Supplier (provide inputs) Input (services provided) Process (value added steps) Output (final product) Customer (internal/external)

Suppliers Inputs Process Output Customer

MLTs Perform Test Verify Patient Acceptable Specimen to analyze

Patient

Patients Provide Specimens Accession Test Accurate Results

Physician

Phlebotomist Collect specimens Collect Sample Timely treatment

Technical Supervisor Report Results Process Sample

Physician Put on Analyzer

Report Results

Control resistance (reduce or remove)◦ Provide alternatives◦ Remove pitfalls◦ Ensure buy-in

Perceived value drives feedback ◦ Positive ◦ Negative

Use Service Delivery Assessment data (customers define quality/expectation)

Listen to external/internal customers◦ WoW Forms◦ Internal customer surveys

CQFA◦ Cost◦ Quality◦ Features◦ Availability

Often referred as “Voice of Customer” House of Quality

◦ Customer needs◦ Design features/technical requirements◦ Customer priorities◦ Benchmarking (targeted values)◦ Inter-relationship between design features

Types◦ Process◦ Performance◦ Project◦ Strategic

Sequence◦ Determine current practices◦ ID best practices◦ Analyze best practices◦ Model best practices◦ Repeat

Originated by Col John Boyd (USAF)

◦ Also known as Decision Cycle

Four Overlapping and Interacting Processes

◦ Observe Unfolding

Circumstances and Information

◦ Orient Analysis and Synthesis

◦ Decide◦ Act (and Test)

1. Clarify The Problem

2. Break Down The Problem/Identify Performance Gaps

3. Set Improvement Target

4. Determine Root Causes

5. Develop Countermeasures

6. See Countermeasures Through

7. Confirm Results & Process

8.Standardize Successful Processes

Observe

Orient

Decide

Act

Plan

Act

Check

Do

Logical Thinking Process Objectivity Focus on Results and Processes Synthesis, distillation, and visualization Alignment Coherence & Consistency Systems Viewpoint

Strong emphasis on cause and effect Focuses organization to maximize

resources by focusing on the “critical few” Minimizes wasted time by management

by using a robust problem solving process

Process drives employees to think with quantitative data as opposed to emotion and opinions

Fosters a collaborative process as opposed to a “silo mentality”

Example:Insurance company is losing business due to

5 day turnaround on quotes.

Possible Solutions:1. Hire more people to reduce time2. Incentivize employees to work harder3. Find the root cause for lengthy

turnaround and implement permanent corrective action

Minimizes “Death by PowerPoint” Forces brevity and clarity Only most vital points used for proper

understanding Utilizes graphs, pictures, and sketches to

promote understanding (visualization)

3D Communication◦ Up and down the hierarchy◦ Horizontally across the organization◦ Back and forth in time

Heavy emphasis on consensus decision making

Avoids: Tackling problems that are not important

to organizational goals Solutions that do not address root

cause(s) Incomplete implementation plans Omission of follow up plans and standard

work

The impact of the proposed solution must not adversely impact other parts of the organization (i.e. transferring a problem from one department to another)

The good of the whole organization takes clear precedence over the individual departments

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SA&DSWOTVoice of CustomerVSMGo & See

KPI/MetricsPerformance Gap AnalysisBottleneck Analysis

Ideal StateFuture State MappingB-SMART

BrainstormingParetoAffinityFishboneControl Charts

A3Action PlansTimelinesFinancial Reporting Template

6S & Visual MgtStandard WorkCell Design / Variation ReductionError ProofingQuick ChangeoverTPM RIE

KPIs/MetricsPerformance MgtSA&DStandard Work Audit

Checkpoints / Standardization Tbl Report Out Theme StoryBroad ImplementationCPI Mgt Tool

1. Clarify the Problem◦ Strategic Alignment and

Deployment◦ Voice of Customer◦ Value Stream Mapping◦ Go & See

2. Break Down the Problem and Identify Performance Gaps◦ Key Process Indicators / Metrics◦ SWOT◦ Performance Gap Analysis◦ Bottleneck Analysis

OODA

Strategic Alignment & Deployment (SA&D)◦ Ensuring that activities are linked to the key

strategies and directives of the organization Strengths, Weaknesses, Opportunities & Threats

(SWOT) Analysis◦ Assessing the organization from a SWOT perspective

to identify areas of need◦ Needs to be rolled into SA&D at appropriate levels

Voice of Customer (VOC)◦ Understanding who the customer is and what they

need from the process or problem area Value Stream Mapping (VSM)

◦ Overview of Process to determine areas of needed focus

Go & See◦ Determine issues by actually walking the process or

problem area (Gemba or Genchi Genbutsu)

OODA

1. Does this problem, when solved, help meet needs identified by the organization?

◦ Is it linked to the SA&D of organization?◦ Does it help satisfy customer needs (VOC)?

2. Does this problem, when solved, address key issues identified during SWOT analysis?

3. Has this problem been identified and directed by a Value Stream Map at the appropriate level?

◦ What does the “Future State” need?◦ What resources have been identified to address

this issue?4. What opportunities were identified or observed by

the process or problem area “walk”?◦ Will addressing or improving these issues deliver

results that relate to #1 or #2?◦ Will addressing or improving this problem deliver

the desired future state from #3?16

OODA

OODA Gather and Review Key Process Indicators and Metrics◦ Problem Solving and Process Improvement begin

with Data◦ Understanding what data is necessary and what the

data means is critical to true “root cause” problem solving

Performance Gap Analysis◦ Once data has been gathered, analyzing the gap

between the current state and the desired state directs efforts

Bottleneck Analysis◦ Bottlenecks are inhibitors to the flow of the process◦ Understanding bottlenecks (TOC) is critical to flow

1. Does the problem require more analysis or does leadership have enough information to execute a solution?

◦ Is this simply a leadership directive?2. If more data is needed, how do we

measure performance now?◦ What are the Key Performance

Indicators (KPI)?◦ What is the performance gap?

3. Does other “non-existent” data need to be gathered?

4. What does the data indicate are the potential root causes?

5. Does the data review indicate a bottleneck or constraint?

OODA

Ideal State Map◦ Brainstorming “Could-Be” without

constraints Future State Mapping

◦ “Vision” of Future for Process B - SMART Action Plan

◦ Balanced◦ Specific◦ Measurable◦ Action Oriented◦ Results Oriented◦ Time-based

OODA

Target characteristics◦ Must be measurable, concrete,

challenging and achievable Statement of a Target

◦ Do what: (examples include “decrease ____?”, “increase ____?”, eliminate ____?, reduce ____?)

◦ By how much: (measured in the same terms as the standard)

◦ By when: (specific date) Must be output oriented

◦ Things to be achieved, not things to do

OODA

1. Is the Improvement Target measurable?2. Is it Concrete?3. Is it Challenging?4. Is the Target “Output Oriented”?

◦ What is the desired output?◦ Should be “things to achieve”◦ Should avoid “things to do”

– Will be addressed by Action Plans in “Develop Countermeasure”

5. The desired target should:◦ Do What?◦ By How Much?◦ By When?

6. If it is a Process Problem, what is the future state?◦ How will it be realized?

OODA

Root Cause Characteristics◦ The root cause is the most likely source of the

discrepancy or greatest possible improvement target

◦ The root cause can be dealt with directly and a countermeasure can be planned to address it

◦ If root cause is addressed, it will address the performance gap

◦ The root cause must be verified by “go and see”Determining the Root Cause is easier with Data

OODA

OODA Tools for Step 4◦ 5 Whys◦ Brainstorming◦ Pareto Analysis◦ Affinity Diagrams◦ Fishbone Diagrams (also called Cause & Effect)◦ Control Charts

Additional Data Gathering Tools◦ Check Sheets, Chonbo Charts, Scatter Diagrams

1. What root cause analysis tools are necessary?◦ Why are these tools necessary?◦ What benefit will be gained by using them?◦ Who will need to be involved in the root cause analysis?

– 10 heads are better than one– Remember “cultural” issues related to problem

2. What is (are) the root cause(s) according to the tools?3. How will the root cause be addressed?4. Will addressing these address the performance gap?5. Can the problem be turned on or off by addressing the root

cause?6. Does the root cause make sense if the problem solving 5

Whys are worked in reverse?◦ Working in reverse, say “therefore” between each of the

“whys”

OODA

OODA

Decide Stage – Develop Countermeasures◦ A3 Problem Solving and Reporting Format

Common Structure and Concise Reporting◦ Action Plans

SMART Action Items◦ Timelines & Project Management

Managing complex Problem Solving in a project fashion

◦ FM Tool Understanding the impact of the improvements

OODA

Develop potential countermeasures◦ Tools and philosophies from Lean, TOC, 6 Sigma

and BPR as appropriate Select the most practical and effective

countermeasures Build consensus with others by involving all

stakeholders appropriately◦ Communicate, communicate, communicate

Create clear and detailed action plan◦ SMART Actions◦ Reference Facilitation Techniques as appropriate

OODA

Process Improvement Philosophies◦ Lean, TOC, 6 Sigma, BPR

Lean and Process Improvement Tools◦ 6-S & Visual Management◦ Standard Work◦ Cell Design◦ Variation Reduction◦ Error Proofing◦ Quick Changeover◦ Total Productive Maintenance (TPM)◦ Rapid Improvement Events (RIE)

OODA

Which philosophy best prescribes tools that address root cause(s)?

Which tools best address root cause(s)? Which method for implementation fits the

tool and improvement need?◦ Rapid Improvement Event?◦ Improvement Project?◦ Point Improvement or “Just Do It”?

If RIE or Project, create “Charter” and communicate

What training or education is needed? By Whom?

OODA

1. How are we performing relative to the Observe phase (Steps 1 & 2)?

2. How are we performing relative to Step 3?3. How are we performing relative to FM Tool

projections?4. If we are not meeting targets, do we need to

return to OODA Step #4?◦ Most problem solving “breakdowns” occur relative

to improper root cause identification

OODA

Checkpoints and Standardization Tables Report-out Storyboards Board Implementation Capture Results in Powersteering Sharing of Results

◦ Communication of Best Practices Restart OODA Loop

OODA

1. What is needed to Standardize Improvements?◦ Tech Order changes?◦ Air Force Instruction changes?◦ Official Instruction changes?

2. How should improvements and lessons learned be communicated?◦ Powersteering◦ Key meetings?

3. Were other opportunities or problems identified by the Problem Solving Process?◦ Restart OODA Loop

OODA

Checkpoints and Standardization Tables Report-out Storyboards Board Implementation Capture Results in Powersteering Sharing of Results

◦ Communication of Best Practices Restart OODA Loop

OODA

1. What is needed to Standardize Improvements?◦ Tech Order changes?◦ Air Force Instruction changes?◦ Official Instruction changes?

2. How should improvements and lessons learned be communicated?◦ Powersteering◦ Key meetings?

3. Were other opportunities or problems identified by the Problem Solving Process?◦ Restart OODA Loop

Problem Solving Process & Related Toolsets SA&D SWOT Voice of Customer Value Stream Mapping Go & See

KPI/Metrics Performance Gap Analysis Bottleneck Analysis

Ideal State Future State Mapping B-SMART

5 Whys Brainstorming Pareto Affinity Fishbone Control Charts

6S & Visual Management Standard Work Cell Design Variation Reduction Error Proofing Quick Changeover TPM RIE

KPIs & Metrics Performance Management SA&D Standard Work

Checkpoints & Standardization Table Report Out theme Story Board Implementation Powersteering Start OODA

Effective Problem Solving must follow the Observe, Orient, Decide and Act process

Following OODA ensures actions will result in desired results

Following OODA ensures results will meet the needs of the organization

Meeting the needs of the organization will lead to a stronger Air Force (Culturally as well)

A stronger Air Force leads to a Safer Country!