General Approach On How To Use The Basic Tools Of Quality Improvement “AIM” Issue To Consider Brainstorm & Consolidate Data Flow Chart Existing Process Cause & Effect Diagram – Greatest Concern Brainstorming Force and Effect “As Is” State Use 5 Whys To Drill Down To Root Causes Monitor New Process & Hold The Gains Run Charts Control Charts Flow Chart New Process Analyze Information and Develop Solutions Translate Data Into Information Gather Data On Pain Points Solution and Effect Diagram Pie Charts Pareto Charts Histograms Scatter Plots, etc. Data Management Strategy – Ch. 14 “As Is” State to “Should Be” State Source: The Public Health Quality Improvement Handbook, R. Bialek, G. Duffy, J. Moran, Editors, Quality Press, © 2009, p.160

The ABC’s of PDCA, G. Gorenflo and J. Moran Plan Check/ Study Identify and Prioritize Opportunities 7. Develop Improvement Theory 1. Reflect on the Analysis 2. Develop AIM Statement 8. Develop Action Plan 2. Document Problems, Observation, and Lessons learned 3. Describe the Current Process Do Implement the Improvement 4. Collect Data on Current Process Act 2. Collect and Document The data Adopt Standardize 5. Identify All Possible Causes Adapt Do 3. Document Problems, Observations, and Lessons Learned 6. Identify Potential Improvements Abandon Plan

Some Tools To Help Create AIM Statements Current and Future State Model AIM Work Sheet Force Field Diagram Force and Effect Diagram

What is the current state? Driving Forces: Future State: Why is this important? What is it costing us time/dollars/staff/etc? What is the impact on our customer/clients? What is the impact on our division/agency? Driving Forces: Future State: What are the important aspects of the future state? What is driving us to this future state? What might be the consequences of not moving to the future state? What might change? What is the proposed timeline? Pathway Consequences Benefits

(what will it improve and for whom?) AIM or Opportunity Statement An opportunity exists to improve the ________________________________________________________________________ (name process, or area to work on) beginning with ___________________________________________________________ (beginning boundary, starting point) and ending with __________________________________________________________. (ending boundary, finish point) This effort should improve _______________________________________________________________________ _____ __________________________________________________________________ (key characteristics of area the team is working on) for the _________________________________________________________________ ______________ _________________________________________________________. (customers, staff or those affected by the process under improvement) This process is important to work on now because ____ ___________________________________________________________________ (what will it improve and for whom?)

Desired State Current State Force Field Diagram - Basic Positive Forces Negative Forces Desired State Current State

High Level S I P O C+CM Collection Form Constraints: Ends With: Begins With: Process/Activities: Measures Outputs: Inputs: Suppliers: Customers: 8

SIPOC+CM

Flow Chart Symbols Flow Lines Manual Operation Start/End Bookends A Connector Data Base Comment Collector Activity: Operation/Inspection Wait/Delay Decision Display Storage Input/ Output Data Transport Manual Input These symbols are in Microsoft Power Point Document Input Preparation Forms Output Unfamiliar/ Research 10

Flow Chart Summary Matrix PHF E-News, March 2, 2010, http://www.phf.org/pmqi/Flow-Chart-Summary-Matrix.pdf Actual Proposed 1 2 3 4 5 6 7 8 Flow Chart Step Number Type of Step Delta +/- ∑ ∑ P D P T W P D S Touch Point (√) Cost FTEs/Person Hrs. Supplies Required Equipment Required Space Required Time Cost of Quality Partnerships Needed Etc. Value added Type of Step: P – process, D – decision, T – transport, W – wait, S – storage Delta = Proposed – Actual – the more negative the subtraction the better – more savings

LSS 5S is a visual method of setting the workplace in order. It is a system for workplace organization and standardization. The five steps that go into this technique: Seiri – sort – essential items Seiton – set in order – promote work flow Seison – shine – clean workplace Seiketsu – standardize - consistency shitsuke)- sustain – hold the gains

Definition of 8 Types of Waste: Description Public Health Example Overproduction Items being produced in excess quantity and products being made before the customer needs them Insurance filing or immunization record opened before all required information is received Waiting Periods of inactivity in a downstream process that occurs because an upstream activity does not produce or deliver on time. Paperwork waiting for management signature or review Unnecessary Motion Extra steps taken by employees and equipment to accommodate inefficient process layouts. Immunology testing equipment stored in cabinets far from specialist work area. Transportation Handling Unnecessary movement of materials or double handling Department vehicles stored in central facility, requiring constant movement of vehicles to and from other high traffic locations Over-processing Spending more time than necessary to produce the product or service Combining client survey instruments into one form rather than develop specific instruments for each program Unnecessary Inventory Any excess inventory that is not directly required for the current client’s order Over estimating vaccination support materials requiring additional locked storage cages, inventory counting and reconciliation Defects Errors produced during a service transaction or while developing a product. Ineffective scripts for initial intake applications. Unclear directions for filling out required forms Duplication Having to re-enter data or repeat details on forms. Poorly designed client intake computer screens or services checklists

Cause and Effect Diagrams - Construction Generate ideas as to what are the main causes of the effect Label these as the main branch headers Organizes group knowledge about causes of a problem and display the information graphically Header Header Effect Header Header

Root Cause Analysis Rating Form Impact on the Problem Potential Root Cause Improved Customer Satisfaction Improved Quality Reduced Costs Others Total Score Ranking Impact Scoring Scale: Low = 1, Medium = 3, High = 5

Cause and Effect Diagram

Solution and Effect Diagrams - Construction Generate ideas as to what are the main Solutions of the effect Label these as the main branch headers Solution Solution Effect Solution Solution

Root Cause Analysis Solution Impact Analysis Potential Solutions Corrective Action Type Verification Method Cost To Fix Benefit Of Fix Cost Benefit Ratio Selected? Y/N Corrective Action Type: Immediate but Interim – II, Short-term Temporary - ST, Permanent – Short Term – PST, and Permanent – Long Term - PLT

Solution and Effect Diagram

Intervention and Impact Form AIM Statement Description: 1. 2. 3. 4. 5. 6. 7. 8. Intervention Number Date What Was The Change? How Did It Impact The AIM? How Did Your Thinking Change? How Did It Impact Your Procedures? How Did It Impact Your Customer? How Do You Know? Measures  

The following columns can be added to the Intervention and Impact Form when needed to track the impact of unintended consequences. 9 10 11 12 13 14 15 Unintended Consequence Letter Unintended Consequence Description Date It Happened Impact To Aim Statement Need a Sub AIM Statement? Impact to Customer Modifications Made   Intervention and Impact Form when needed to track the impact of unintended consequences.