Interrelationship DiGraph ASQ Orlando Section 1509 Technical Session May 26, 2016 Grace Duffy, CMQ/OE, LSSMBB, CQA, ASQ Fellow, DSM

Interrelationship Digraph Sometimes called a Relations Diagram Process to find critical issues - not reactions to symptoms More a communications than a technical tool Easy to find remedies to symptoms Too Much OT - Reduce OT: Work harder Shorter breaks/lunches Monitor telephone/internet usage Apathetic employees Is the Workforce composition correct for what we have to do?

Interrelationship Digraph Instead of one item following another in a logical sequence, each item is connected to many other pieces, showing that they have an impact on each one. Once all the relevant connections between items have been drawn, the connections are counted. Those with the most connections will usually be the most important factors to focus on.

Interrelationship Digraph Why are they worthwhile? Because they make it easy to pick out the factors in a situation which are the ones which are driving many of the other symptoms or factors.

Interrelationship DiGraph Concept

How To Create An Interrelationship Digraph Process Steps: Use the Header Cards from an Affinity Diagram Compare each Header Card to all others Use an "influence" arrow to connect related Header Card The arrows should be drawn from the Header Card that influences to the one influenced Does this card cause any others to happen or is it a result from another card(s) If two Header Card influence each other, the arrow should be drawn to reflect the stronger influence Put an arrowhead on the end of the line that shows the direction of the cause and effect relationship. Use only one way arrows. The arrow should point toward the effect and away from the cause

How To Create An Interrelationship Digraph Process Steps: Use only one way arrows. The arrow should point toward the effect and away from the cause Outgoing arrow = basic cause – if solved spill over reaction on large number of other issues Incoming arrow = secondary issue or bottleneck Count the arrows – Number of In Arrows and Out Arrows The Header Card with the most outgoing arrows will be a driver or root causes The one with the most incoming arrows will be a bottleneck, outcome or result

ID Questions Start with a pair of cards for comparison Any relationship between the two cards? Yes – proceed to step 2 No – pick another pair of cards for comparison Which way is the cause direction? Does the first card cause the second card to happen? Y/N Does the second card cause the first to happen? Y/N Draw the arrow direction to the card that results from the driving card How strong is the strength of the relationship? 1 – weak 5 – medium 10 - strong

Interrelationship Digraph (ID) – Driver/Root Cause Issue Statement Issues Affecting The Alignment of Statewide Resources with Priorities in a State Health Improvement Plan Feedback on Progress Flexibility In State Funding Local Leadership Commitment Advocacy that Demands Change People with Adaptable Skills Performance Management. to Track $/Priorities IN 0 Out 5

Interrelationship Digraph (ID) – Bottleneck/Outcome/Result Issue Statement Issues Affecting The Alignment of Statewide Resources with Priorities in a State Health Improvement Plan Feedback on Progress Flexibility In State Funding Local Leadership Commitment Advocacy that Demands Change People with Adaptable Skills Performance Management. to Track $/Priorities In 4 Out 0

Interrelationship Digraph 1. Feedback on Progress 2. Flexibility In State Funding 3. Advocacy that Demands Change 4. Local Leadership Commitment 5. People with Adaptable Skills 6. Performance Management to Track $/Priorities 1 2 3 4 5 6 # In # Out

Interrelationship Digraph Completed 1. Feedback on Progress 2. Flexibility In State Funding 3. Advocacy that Demands Change 4. Local Leadership Commitment 5. People with Adaptable Skills 6. Performance Management to Track $/Priorities 1 2 3 4 5 6 # In # Out

Arrows Tell A Story All Out – Driver/Root Cause/ All In – Bottleneck/ Effect/Outcome/Result Can Add Another Dimension Strength of the Arrow (relationship) 1 – Weak 5 – Medium 10 - Strong Arrows Out – base cause Arrows In – secondary issues/bottlenecks

Interrelationship Digraph (ID) – Driver/Root Cause Issue Statement Issues Affecting The Alignment of Statewide Resources with Priorities in a State Health Improvement Plan Feedback on Progress Flexibility In State Funding Local Leadership Commitment Advocacy that Demands Change People with Adaptable Skills Performance Management. to Track $/Priorities IN 0 Out 5 10 5 1

Interrelationship Digraph (ID) – Bottleneck/Outcome/Result Issue Statement Issues Affecting The Alignment of Statewide Resources with Priorities in a State Health Improvement Plan Flexibility In State Funding Feedback on Progress Advocacy that Demands Change 5 Local Leadership Commitment 10 5 5 Performance Management. to Track $/Priorities People with Adaptable Skills In 4 Out 0

Interrelationship Digraph 1. Feedback on Progress 2. Flexibility In State Funding 3. Advocacy that Demands Change 4. Local Leadership Commitment 5. People with Adaptable Skills 6. Performance Management to Track $/Priorities 1 2 3 4 5 6 # In # Out 10 35 25 Strength How to Capture the ID Data Use #3 to show how to check

Interrelationship Digraph Summary Process to find critical issues not reactions to symptoms The conversation that takes place during the development of an ID graph is very valuable since people are exposed to a wide variety of knowledge and experience

Discussion How do we advance/achieve these future drivers identified? Who? What When? How?

Based On What I Have Heard These Are The Things We Should: Continue Doing Start Doing Stop Doing Best Practices Aha Learnings . To Build A Healthier Chicago

Team Reports Discussion