QUALITY TOOLS FOR PROCESS IMPROVEMENT

PDCA/PDSA

PDCA/PDSA

PDCAPlan. Do. Check. Act

PDSAPlan. Do. Study. Act

Cyclic approach

Managing a project

Problem solving process

Increasing your knowledge with each cycle

Recording resultsEmphasizes

understanding results not recording them

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PDSA CYCLE FOR LEARNING AND IMPROVEMENT

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Plan

Do

Study

Act

Objective, questions and predictions (why) Plan to carry out the cycle (who, what,

where, when)

Carry out the plan Document problems

and unexpected observations

Begin analysis of the data

What changes are to be made?

Next cycle?

Complete the analysis of the data to predictions

Summarize what was learned

Continuous Improvement

THE MODEL FOR IMPROVEMENT

When you combine these three questions with the PDSA cycle, you get the Model for Improvement.

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What are we trying to accomplish?

How will we know that a change is an improvement?

What change can we make the will result in

improvement?

P

D

S

A

ROOT CAUSE ANALYSIS

ROOT CAUSE ANALYSIS – 5 WHY PROCESS

• The first “Why?”• This is the top reason

behind the problem• Answer that question

• The second “Why?”, third “Why?” and so on• This should follow the same idea• Continue until you have drilled down to the root of

the problem or root cause of your issue

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WHY IS THE FRENCH TOAST BURNT?

• Why is the French toast burnt?• The flame on the stove was too hot

• Why was the flame too high?• Staff didn’t know how to work

the stove

• Why didn’t the staff know how to work the stove?• The staff was never instructed in

use of stove

• Why wasn’t the staff instructed in the use of the stove?• It is not in the job description training

• Why is it not in the job description training?• French toast is a new item on the menu

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SUPERSTORM SANDY EXAMPLE

• Why were there not enough oxygen concentrators?• There were not enough working electrical outlets

• Why were there not enough working electrical outlets?• Some outlets were cracked or did not work

• Why were the outlets cracked or not working?• The staff did not check/test the outlets

• Why didn’t the staff check the outlets?• It is not in the preparation checklist

• Why is it not on the preparation checklist?• We never had a problem before

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FISHBONE DIAGRAM

FISHBONE DIAGRAM (ISHIKAWA DIAGRAM)

• Represents cause and effect

• Effect forms the head of the fish

• Potential causes form the skeleton

• Structured way to represent contributors to problems

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FISHBONE DIAGRAM CONTINUED

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Environment System Facilities

ManpowerPatients Materials

s

FISHBONE DIAGRAM

Reasons to use a Fishbone Diagram:• Organizes causes/potential causes• Helps the team discuss the issues• Provides framework to organize issues• Visual presentation by areas• Living document

Limitations of the Fishbone Diagram:• Based on opinion• Lost energy spent on “potential” causes• Comes down to a democratic vote

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PROCESS MAPPING

PROCESS MAPPING FOR CONTINUOUSQUALITY IMPROVEMENT

• Simple method• Highlights wasteful steps in

your process• Maps out the actual

processes• Not processes in procedures

and manuals

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PROCESS MAPPING SYMBOLS

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Oval shows input to start process or output at end of process

Box or rectangle shows task or activity performed in process

Diamond shows places

in process where yes/no

question is asked or

decision is required

There is usually only one arrow out of an activity box. If there is more you may need a decision diamond.

Oval shows input to start process or output at end of

processNo

Yes

Process Mapping

Source: wikipedia/commons/9/91/Proposed_Patient_Appointment_Procedure.png.

PROCESS MAPPING CONTINUED

Now What?• Discuss “reality” with the leadership• Use recommendations to create a new map• Change one thing- not everything• Test the new process map• Gather key information to support the change

• Saves time, supplies, staff time• Increased accuracy, consistency• Better definition of task= improved teamwork

• Discuss updating policies and procedures

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REFERENCES

• Knoth, J., Miller, J. (2014). Quality Tools for Process Improvement. Healthcare Quality Strategies. Inc.