1. Getting on the Telephone1.
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.

2. Improvement Approach: Model for Improvement

3. 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.

4. 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

5. 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

6. REFRESHER – WHAT HAVE WE LEARNED SO FAR

7. The Improvement Model

8. 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

9. 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

10. 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

11. 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.

12. 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

13. 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

15. 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

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

17. 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

18. 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

19. 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

20. 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

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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. WORD DOCUMENT HANDOUT TO USE

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

33. Graduation – Sneak Peak
June 19th – 8:30 AM to 4 PM
10:40 – 11: 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

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

35. ____________________________
4C–
Family Child Care
STATION
____________________________

36. 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.

37. 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

38. CHANGE WE ARE TRYING
Driver: Easily accessible resources to complete process
TEST: Phone call/ 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.

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

40. 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

41. Creative Commons
Please note the use of the Creative Commons License in the bottom left corner. It is the Attribution Non Commercial CC BY-NC This license lets others remix, tweak, and build upon your work non-commercially, and although their new works must also acknowledge you and be non-commercial, they don’t have to license their derivative works on the same terms For additional information visit:

42. AUDIO HAS GONE DOWN Please remain on the GoTo Webinar and dial into: Dial-in: Participant Code: