Getting on the Telephone 1. Your “GoTo” should be to the right of your screen Expand the audio box Click Telephone option Dial the phone number Enter access code press # To enable audio, please enter your audio pin. We will unmute you when we start the broadcast. If you are have any problems dialing in, please enter your concerns in the question box. 2. 3. 4.,5., 6.

Improvement Approach: Model for Improvement

For Today’s Webinar For today’s call, we will be keeping the phone lines open so that you are able to ask live questions for improved team interactions and timely sharing. Please mute your phone line while listening and unmute when asking a question.

Questions/Comments? Enter your question/comment in the Question Box Question Box? –You will find it on the right hand side of your GoTo meeting screen. Staff will identify next person to share On Telephone? - Staff may unmute you to speak if you indicate you would like to speak. On Mic/Speakers? - Staff will share the question/comment for you. Click here to open box. Slide Owner: Anne

Participant Learner Objectives: Outline how the tool FMEA helps identify interventions Learn the key components of an FMEA: process, failures and interventions Practice laying out a process, identify failures, and interventions

REFRESHER – WHAT HAVE WE LEARNED SO FAR

The Improvement Model

Demonstration – Pizza Delivery GLOBAL AIM Be the Best Pizza Restaurant in Cincinnati and Increase Customer Satisfaction SMART AIM Decrease the time from pizza order to delivery from 55 to 30 minutes by June 19, 2017 2015 © Cincinnati Children’s Hospital Medical Center. All rights reserved

Median is 55 minutes to deliver pizza Demonstration – Pizza Delivery Put our Baseline on a Run Chart Median is 55 minutes to deliver pizza Not actual Data – created for instructional purpose only

Pizza Delivery Project Key Driver Diagram (KDD) Demonstration – Pizza Delivery Project Leader(s): Revision Date: mm/dd/yyyy (v#) Global Aim Key Drivers Interventions (LOR #) Be the Best Pizza Restaurant in Cincinnati and Increase Customer Satisfaction Vehicles available & fully operational SMART Aim Sufficient # of drivers Decrease the time from pizza order to delivery from 55 to 30 minutes by June 19th, 2017 . Create standard order form Put standard form on a computer screen Automated phone menu Order recorded accurately Logo edit Left most arrows (have to be removed to make them useful) – do we have instructions that you should enter others? Lines around the boxes the same width Clean up syntax by providing examples Make smart AIM box bigger Blue arrow enter (new template) – make it black on entry Add more interventions than key drivers Add the A, B, C, D. And, 1-3 for interventions (add check mark for done). Timely prep of pizza Population Avondale & Price Hill Locations Getting to delivery location efficiently Maps for drivers MapQuest instructions for drivers GPS for drivers Legend Potential intervention Active intervention Adopted/Abandoned intervention Note: LOR # = Level of Reliability Number, e.g., LOR 1

The PDSA Cycle ACT PLAN STUDY DO Objective Change is an improvement? What changes can be made? Next cycle? ADAPT (Plans/ changes next test) ADOPT: (Select changes to implement) ABDANDON: (Discard change & try new one) Objective Change is an improvement? Questions and predictions Plan to carry out the cycle (who, what, where, when) STUDY DO Analyze data Compare results to predictions Summarize what was learned Carry out the plan Record data and observations Document problems and unexpected observations What happened that was not part of the plan? One last thing before you form teams…. What you are practicing… Key parts – form at yoru table. In your exercise today, you will carry out the steps of PDSA. Objective of your test (generically – test an approach to reduce time to throw ball to everyone on the team). PREDICT – based on that approach will time go up or down. DO – do your plan STUDY – what did you learn ACT – based on what you elarned, what would you test on the next cycle.

Pizza Delivery Project Key Driver Diagram (KDD) Demonstration – Pizza Delivery Project Leader(s): Revision Date: mm/dd/yyyy (v#) Global Aim Key Drivers Interventions (LOR #) Be the Best Pizza Restaurant in Cincinnati and Increase Customer Satisfaction Vehicles available & fully operational PDSA – To try out these ideas SMART Aim Sufficient # of drivers Decrease the time from pizza order to delivery from 55 to 30 minutes by June 19th, 2017 . Create standard order form Put standard form on a computer screen Automated phone menu Order recorded accurately Logo edit Left most arrows (have to be removed to make them useful) – do we have instructions that you should enter others? Lines around the boxes the same width Clean up syntax by providing examples Make smart AIM box bigger Blue arrow enter (new template) – make it black on entry Add more interventions than key drivers Add the A, B, C, D. And, 1-3 for interventions (add check mark for done). Timely prep of pizza Population Avondale & Price Hill Locations Getting to delivery location efficiently Maps for drivers MapQuest instructions for drivers GPS for drivers Legend Potential intervention Active intervention Adopted/Abandoned intervention Note: LOR # = Level of Reliability Number, e.g., LOR 1

2 Run Chart Rules #ACTNOWCINCY SHIFT TREND = Changed = Changing Shift: Eight or more consecutive (all in a row) points either above or below the centerline.  Trend: Six or more consecutive (all in a row) points all going up or all going down. #ACTNOWCINCY

POLL QUESTION: How far are you in your project? MY SMART AIM IS COMPLETE I GATHERED MY MEASURE BASELINE I HAVE MY KEY DRIVER DIAGRAM I HAVE STARTED PDSAs I HAVE SEEN RESULTS NOT SURE

FMEA – Failure MODES and EFFECTS ANALYSIS FANCY NAME FOR TOOL WHICH MEANS WHERE DO THINGS GO WRONG THE MOST

FAILURE MODES INTERVENTIONS Process Name ____________________________ CURRENT PROCESS CURRENT PROCESS FAILURE MODES Black Boxes: High level process steps Red Boxes: Real or potential failures that do or can occur at this step Green Boxes: Real or potential interventions that reduce or remove the associated failures in the red box. FAILURE MODES

Pizza Delivery Project Key Driver Diagram (KDD) Demonstration – Pizza Delivery Project Leader(s): Revision Date: mm/dd/yyyy (v#) Global Aim Key Drivers Interventions (LOR #) Be the Best Pizza Restaurant in Cincinnati and Increase Customer Satisfaction FMEA HELPS US COME WITH IDEAS TO TRY BASED ON THE EXPERT EXPERIENCE OF THE PROCESS Vehicles available & fully operational SMART Aim Sufficient # of drivers Decrease the time from pizza order to delivery from 55 to 30 minutes by June 19th, 2017 . Create standard order form Put standard form on a computer screen Automated phone menu Order recorded accurately Logo edit Left most arrows (have to be removed to make them useful) – do we have instructions that you should enter others? Lines around the boxes the same width Clean up syntax by providing examples Make smart AIM box bigger Blue arrow enter (new template) – make it black on entry Add more interventions than key drivers Add the A, B, C, D. And, 1-3 for interventions (add check mark for done). Timely prep of pizza Population Avondale & Price Hill Locations Getting to delivery location efficiently Maps for drivers MapQuest instructions for drivers GPS for drivers Legend Potential intervention Active intervention Adopted/Abandoned intervention Note: LOR # = Level of Reliability Number, e.g., LOR 1

Process Name ____________________________ STEP 1: INTERVENTIONS CURRENT PROCESS CURRENT PROCESS Black Boxes: High level process steps Red Boxes: Real or potential failures that do or can occur at this step Green Boxes: Real or potential interventions that reduce or remove the associated failures in the red box. FAILURE MODES

STEP 1: Document a Process… Identify the “process” that impacts your AIM & name it, and define the “customer(s)” of the process – make sure they are involved (e.g. families and children) Define the “start” (beginning boundary) & “stop” (ending boundary) Brainstorm all the action steps & decisions as a team (use post-its - do not worry about order) Put the action steps & decisions in order Share the process map with others in the process to get their input – is anything missing or not in the right order? 2015 © Cincinnati Children’s Hospital Medical Center. All rights reserved

“Process” Worksheet 2015 © Cincinnati Children’s Hospital Medical Center. All rights reserved

Process Mapping Exercise: Producing and Delivering Pizza SMART AIM Decrease the time from pizza order to delivery from 55 to 30 minutes by June 19, 2017 Will use a non clinical example to learn from initially…can apply each of these things to your projects. Customer: anyone calling the pizza place, ordering the pizza Output: get a hot pizza delivered on time Name Process: Delivering pizza on time Identify the “process” that impacts your AIM & name it 2015 © Cincinnati Children’s Hospital Medical Center. All rights reserved

Process Mapping Exercise: Producing and Delivering Pizza Process Boundaries: START? Phone call comes in, start getting the order ready, STOP? Once the pizza is delivered Define the “start” (beginning boundary) & “stop” (ending boundary) 2015 © Cincinnati Children’s Hospital Medical Center. All rights reserved

Process Mapping Exercise: Producing and Delivering Pizza Process Boundaries: START – Customer Order STOP – Return to Shop Process Steps Brain Storm Steps: costumer orders, give order to cook, make the order, checking the order, packaging, Brainstorm all the action steps & decisions as a team (use post-its - do not worry about order) 2015 © Cincinnati Children’s Hospital Medical Center. All rights reserved

High Level Process: Producing and Delivering Pizza Receive Order Mix Ingredients Assemble Order Bake Pizza Deliver Order Collect payment Return to Shop This is what Joe La Rosa’s team decided was the high level process. Were any of yours like this? 2015 © Cincinnati Children’s Hospital Medical Center. All rights reserved

High Level Process: Producing and Delivering Pizza Collect payment Receive Order Return to Shop Mix Ingredients Bake Pizza Assemble Order Deliver Order This is what Joe La Rosa’s team decided was the high level process. Were any of yours like this? 2015 © Cincinnati Children’s Hospital Medical Center. All rights reserved

STEP 2: FAILURE MODES FAILURE MODES Process Name ____________________________ INTERVENTIONS STEP 2: FAILURE MODES Receive Order Mix Bake Assemble Deliver Collect Return CURRENT PROCESS FAILURE MODES Black Boxes: High level process steps Red Boxes: Real or potential failures that do or can occur at this step Green Boxes: Real or potential interventions that reduce or remove the associated failures in the red box. FAILURE MODES

STEP 2 – Where are our failures? Identify a representative familiar with each step For Pizza delivery, who would that be? Get together over coffee with the FMEA tool, and talk about where things go wrong in the process Ask the team to go back and count over the next week when they see those failures (or you can ask to observe and count for them) This helps you prioritize in Step 3 – Interventions (Things you want to try to out to see if they work See building blocks slides in PPT—Pam will put them in an envelope. QICs will help the table shorten the steps in the process to prioritize the top 5 blocks. 2015 © Cincinnati Children’s Hospital Medical Center. All rights reserved

Enter order incorrectly Process Name ____________________________ Repeat order back INTERVENTIONS STEP 3: INTERVENTIONS Receive Order Mix Bake Assemble Deliver Collect Return CURRENT PROCESS Short staffed Not right ingred Enter order incorrectly Not knowing how to get there INTERVENTIONS Black Boxes: High level process steps Red Boxes: Real or potential failures that do or can occur at this step Green Boxes: Real or potential interventions that reduce or remove the associated failures in the red box. FAILURE MODES

Pizza Delivery Project Key Driver Diagram (KDD) Demonstration – Pizza Delivery Project Leader(s): Revision Date: mm/dd/yyyy (v#) Global Aim Key Drivers Interventions (LOR #) Be the Best Pizza Restaurant in Cincinnati and Increase Customer Satisfaction FMEA HELPS US COME WITH IDEAS TO TRY BASED ON THE EXPERT EXPERIENCE OF THE PROCESS Vehicles available & fully operational SMART Aim Sufficient # of drivers Decrease the time from pizza order to delivery from 55 to 30 minutes by June 19th, 2017 . Create standard order form Put standard form on a computer screen Automated phone menu Order recorded accurately Logo edit Left most arrows (have to be removed to make them useful) – do we have instructions that you should enter others? Lines around the boxes the same width Clean up syntax by providing examples Make smart AIM box bigger Blue arrow enter (new template) – make it black on entry Add more interventions than key drivers Add the A, B, C, D. And, 1-3 for interventions (add check mark for done). Timely prep of pizza Population Avondale & Price Hill Locations Getting to delivery location efficiently Maps for drivers Mapquest instructions for drivers GPS for drivers Legend Potential intervention Active intervention Adopted/Abandoned intervention Note: LOR # = Level of Reliability Number, e.g., LOR 1

WORD DOCUMENT HANDOUT TO USE

Getting Ready for Next 90 Days… Apply tools to your project 6/19 -Graduation!

Graduation – Sneak Peak June 19th – 8:30 AM to 4 PM 10:40 – 11:40 -- You will prepare a poster and share in Storyboard session. Posters will be hung around the room, and others from our network All Children Thrive will circulate. Bootcamp teachers will also circulate and look for these items: SMART AIM KDD MEASURE PDSAs WHAT YOU LEARNED & HOW YOU WILL USE TOOLS IN FUTURE Reflections at 11:45 AM with broader group Certificates will be provided to graduates! Next slides are examples of presentations from last class

Graduation Please register today Graduation Please register today! Email invitations were sent out on Wednesday, April 26

____________________________ 4C– Family Child Care STATION ____________________________

BACKGROUND Quality early childhood programs are important because research has shown that these programs increase school readiness, have lasting positive impacts on child/adult success rates, and decrease incarceration rates. The problem we address in this project is the amount of time it takes to support programs to be ready to register for a Step Up To Quality rating.

AIM & DRIVERS Easily accessible resources to complete process Note – Print your actual KDD and bring with you as handout AIM & DRIVERS AIM HIGHLIGHTED DRIVERS Increase the % of weekly goals/action steps met by center or FCC providers from 10-25% to 80% by 11/22/16.   Easily accessible resources to complete process *Clients can be parents and or children dependent on the programs’ target. *“Enroll” is as defined by individual programs and includes engagement beyond intake. Sub-measure: New families enrolled by program Clear, transparent, and easy to follow process

CHANGE WE ARE TRYING Driver: Easily accessible resources to complete process TEST: Phone call/e-mail and homework assignments when time constraints prohibit onsite visit. Measure: Number of Goals Met – Predicted 7 Results: Adapt – 3 goals met – Simplify goals when onsite meeting can’t be held.

Measures & Results From 11 mos average to 7 weeks (1 center) test

POLL QUESTIONS: This hour was a good use of my time: Not at all A little bit It was okay So glad I came Will tell others they should have been here My confidence in trying to use the FMEA tool in my project: I wouldn’t know where to start I could probably do some of it I am ready to use the tool

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