1. Process Improvement George Mason University Storyboard “Improving Exercise Habits” JH Summer 06

2. Statement of the Problem The habit that I need to change is not getting enough exercise and overeating high caloric foods I know this is a problem because my fitness has decreased and weight increased Benchmark Data will include: Measurement of daily exercise time. Not included in this report for my own personal use I will also measure my weight. (this will be compared to recommended exercise time of 20mins daily and average BMI for my gender, age, and height) Key: By sharing with others my personal goals for improvement I became more committed to the process

3. Lifestyle I work full time as a registered Nurse at Inova Fairfax Hospital on the day shift. My position is in management. Each day I work from 0700 to 1530+. I have an hour commute if there is good traffic flow (to and from work) During my eight hour shift which often extends to 9+ hours I remain very active often dealing with stressful staffing and patient situations For the past three years I have been working on my RN to MSN degree at GMU. I have averaged 6 credits each semester When I arrive home I have to think about cooking dinner for my family, marinating housework and staying up to date with course work I frequently collapse into bed at around 2230 setting my alarm for 0500 to wake up and start the next day Many days I fall asleep having made unhealthy food choices and without taking tome to exercise

4. Cycles Among The Routines Skip Breakfast Eat more at lunch Long commute Snack on high caloric foods Arrive home-lots to do Enjoy Sedentary activities GMU Assignments Too tired to exercise Go to bed!

5. Ideas for Systemic Change The resolution I made was to increase daily exercise My husband was designated as the process owner I examined how cycles in my life style were interconnected The solution I chose needed to fit into my daily routine. I decided to take the stairs in the employee garage am and pm always parking on the 5 th Floor To increase intake of fruits/vegetables and decrease intake of fast food and calorie dense foods, such as carbohydrates and fatty foods To take healthy lunches to work instead of going to the cafeteria. Using my process owner to help me keep only healthy foods in the house

6. Pilot Study What was the intervention? Walking steps daily and increasing intake of fruits and vegetables Who was involved? Myself Who collected the data? Myself How was the data analyzed? Using “Time Between Exercise Chart”

7. Did it work? As of 7/1/06 I feel that I have made a good start but have also experienced failures

8. Lessons Learned “A big stone is a sign that a person is not planning to throw it” My environment plays a huge role on my behavior “System thinking is about changing the environment and letting the new world you have created guide you” (Alemi) I have tried to make sure I am hungry not just wanting to eat because I am tired, under stress, or upset

9. Face the facts; you have been fooling yourself! After starting a new diet I altered my drive to work to avoid passing my favorite bakery. I accidentally drove by the bakery this morning and as I approached, there in the window were a host of goodies. I felt this was no accident, so I prayed... "Lord, it's up to you, if you want me to have any of those delicious goodies, create a parking place for me directly in front of the bakery." And sure enough, on the eighth time around the block, there it was!

10. What's Next? From July 2 to 23 I will visit family in Australia this will present two challenges. First I want to try foods that I have not had for a long time. Second will be the challenge of sticking to my exercise plan with a busy agenda. Because Australians walk more and use public transportation I might actually increase my total exercise!

11. Look to the environment My trip to Australia became my post intervention period of process improvement as I was able to take long hikes in the bush and along the ocean. Run to catch the train from my sisters house and return walking up a long steep incline (1.5 miles). I also ate more fish and fresh vegetables.

13. Joy’s Exercise Progress Tukey Chart: This data represents my "Personal Improvement Project" over a period of 12 weeks (starting 5/22/06 to 7/31/06). The data shows the pre intervention period of six weeks followed by the post intervention period of 6 weeks. In this case my post intervention period was marked by my trip to Australia with increased opportunity to use the change in environment to exercise more (weeks 7,8,9). This is reflected in a sudden shift above the UCL. Since return from Australia (weeks 10,11,12) and return to the daily grind I have had a decrease in weekly exercise time however it remains above the UCL.

14. Intervention Results “System thinking starts when one seeks solution and causes in the environment - not in one’s commitment or motivation” Alemi

15. What is next? Personal improvement takes perseverance to continue to maintain favorable results