Continuous Improvement: Define, Measure, Analyse, Improve, Control, Lecture notes of Project Management

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Leading Continuous

Improvement

Define Measure^ Analyse^ Improve^ Control

What are we trying to achieve? What’s important? What does success look

like? What steps can we take? Who needs to be involved & when?

Define the goals of the improvement activity, include deliverables & benefits.

Identify the Customer (patients directly or other internal customers) and their goals.

Agree & clearly state scope of activities.

Understand the current processes and performance.

Define team involved and timelines.

Setting up for Success

 Approved PID / Charter

 Action Plan

 Critical Customer

Requirements

 Process Maps

 Quick Win Opportunities

 Prepared Team

Activities Tools Outcomes

Goal Setting

Team PID / Charter

SIPOC Diagram

Process Maps

Stakeholder Analysis

In / Out Scope Diagram

Roles & Responsibilities

How to construct a Flow Chart?

1. Clearly identify where the process starts (inputs) and ends (output).

2. Brainstorm a list of the suppliers, major steps, decisions and customers involved in

the process from start to end.

3. Arrange the steps in the order they occur, use post its until you are certain of the

order then add in the connecting arrows showing the flow of activity.

PROCESS

Outputs

(Customers)

Inputs

(Suppliers)

Resources

Controls

Process step or activity

Decision required, Yes or No, Pass / Fail.

Start or end terminator

Arrow showing Direction of flow.

Process Mapping

Stakeholder Analysis

Stakeholder

Interest

Involvement

Influence^ Concerns

DEFINE Stage Checklist

Task Who Status

1. SMART Goals defined

2. Stakeholders enrolled

3. Team Selection

4. Complete Project PID, all sections

5. Review existing Process documentation

6. Define Timings & Plan

7. Define & Map current “as is” process

8. Review and redefine project scope if necessary

9. Gain approval of Sponsor before next stage

Define Measure Analyse Improve Control

How do we measures our problem? Where does the data come from? What

is the performance now? How will we demonstrate before & after?

 Collect data on the current process.

 Establish a baseline of current performance.

 Establish the metrics to help monitor progress towards the goals stated in the “Define” stage.

 Answer how we measure project success.

 Creating a shared need

 Measures/KPI Definitions  Data Collection Plans  Baseline Performance Metrics  Shared vision

Activities Tools Outcomes

Measures Data collection Balanced Scorecard Stakeholder Engagement

Stakeholders Interview

Background

 What is your official job title?

 Can you please outline your key responsibilities and accountabilities?

 How does performance affect you and your team?

Current Issues

 What in your opinion are the key issues impacting efficiency?

 What is the root cause of these issues?

 How do they manifest themselves – lost time / cancelled patients / more work What is

currently being done to address these issues?

 Who is leading / responsible for driving home these changes?

 What impact are the changes having?

What 3 changes to current working practices would you like?

 Have the biggest impact

 Make your job easier

Influencers / power base

 Who do we need to win over to ensure maximum chances of success in this project

MEASURE Stage Checklist

Task Who Status

1. Identify critical Customer/Patient related measures

2. Define Data Collection process

3. Display the data clearly & simply

4. Identify trends & patterns

5. Develop a balanced set of measures

6. Gather data from stakeholders & understand themes

1. Waiting

Inpatients waiting in ED, patients waiting for discharge, physicians waiting for

test results

2. Inventories

Patients queuing for clinic, lab samples for testing, stocks on wards, dictation

waiting for typing

3. Defects

Needle stick injury, missing patient information, wrong information communicated

4. Excessive Processing

Re-sticks, multiple bed moves, re-testing, multiple assessments

5. Overproduction

Excessive reporting, unnecessary tests, Irrelevant information sent out

6. Movement

working across multiple sites, storage of consumables in disparate places

7. Transportation

Moving patients to tests, patients having to attend different depts.

8. Under-utilisation

Physicians transporting patients, not fully using skill mix of staff

The 8 Wastes in Healthcare

Cause and Effect

Define

What are all the possible solutions? Which ones are best? How can we try it

out? Has it worked as we expected? Which ones will we keep?

 Improve the process.

 Be creative in finding new ways to do things, quicker, cheaper & better.

 Use structured methods to implement changes.

 Collect data on measures to validate improvement/

 Manage & communicate changes.

 Mobilising Commitment to change.

 Tried & tested Solutions  Process Maps and Documentation  Cost/Benefit Analyses  Improvement Impacts and Benefits  Pilot and Solution Results  Storyboard  Staff engagement

Activities Tools Outcomes

 PDSA cycle  Project management  5S’s  Change Curve

Measure Improve

Analyse Control

PDSA Template

5S Scorecard

Level Of Improvement

Steps of Implementation

20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 Area owners identified and responsibilities documented.

Level

Anything not required forimmediate utilization is removed from the area

Immediate actions taken againstabnormalities. Area kept orderly on a continuous basis.

Non-utilized cabinets, benches, tables, Equipment & stock etc.identified and removed from area.

Unneeded equipment & stock removed from area not stored away.

Needed and unneededequipment & stock have been identifiedand separated.

Needed and unneeded equipment & stock are mixed throughout the work area.

Daily cleanliness inspection of equipment and stock. Repeated between cases.

Visual controls established and wellmarked for work area.

Work areas unkempt. No visual controls inplace. Information is difficult to access

Level 4

Level 3

Level 2

Level 1

Immediate actions taken against abnormalities.

Team take ownership; standards are followed.

Daily checks performed by Team Leaders; standards are regularly reviewed and updated.

Periodic checks are performed by Team Leaders.

No area checks are performed; standards are not established.

5S ’ s Sort^ Shine^ Sustain

Establish & follow standard procedures. They are clear, up-to-date, and displayedin work areas.

Area layout, equipment, stock & communications are documented, standardized & followed rigorously.

Labeling of items with requiredquantities are standardized.

Procedures are documented, but not consistently followed.

No procedures in place.

Standardize All items can beeasily retrieved byanyone; they are clearly marked.

Standardized item quantities are established; Correct locations are outlined.

Needed items have dedicated locations which are clearly labeled.

Needed items have been safely stored and organized.

Items are placed randomly throughoutthe work place.

Set in Order

5

Area: Date:

Auditor:

5 S Scorecard

Sample Project Plan

Project Plan updated on: 25-Aug

Tasks Start End Duration^ Owner

Project Name:

01-Oct 02-Oct 03-Oct 04-Oct 05-Oct 06-Oct 07-Oct 08-Oct 09-Oct 10-Oct 11-Oct 12-Oct 13-Oct 14-Oct 15-Oct 16-Oct 1 DEFINE STAGE 1 Kick Off Meeting 21-Jul 22-Jul 2 2 Charter, Plan & Actions Development 22-Jul 23-Jul 1 3 Stakeholder Analysis 25-Jul 05-Aug 10 4 Data Collection Preparation 28-Jul 29-Jul 2 MEASURES STAGE 5 Live Data Collection 01-Aug 31-Aug 23 6 7 8 9 12

Today