Basic QI Tools

1
Basic QI Tools Techniques
2
Why QI?

• By continually working to improve all processes,
  we increase our learning and knowledge.
• QI is not about pass/fail or right/wrong. Rather
  its about testing a theory. You have a learning
  opportunity.

3
Basic Tools of QI

• Effect/Cause Analysis
• 5 Whys
• Fishbone
• Pareto Chart
• Brainstorming
• Interrelationship Diagraph
• Evaluation Decision-Making
• SWOT Analysis
• Evidence-based Literature
• Stakeholder Analysis
• Force Field Analysis
• Nominal Group Technique
• PMI
• Logic Model
• Planning Implementation
• PDCA/PDSA
• Bone Diagram
• Action Plans

• Data collection
• Check Sheet
• Survey Tool / Interviews
• Natl, State, Local stats
• Data Analysis
• Pie Charts
• Bar Graph
• Pareto Chart
• Line Graph
• Process Analysis
• Flow Charts Process Mapping
• 5 Whys
• Idea Creation
• Affinity Diagram
• Brainstorming
• Fishbone Diagram

4
Stage 1Step 1 - Getting StartedDescribe the
Situation

• Writing about the Situation
• Whats the issue?
• Why is this a issue?
• For whom does the issue exist?
• Who has a stake in the issue?
• What do we know about the issue/people involved?
• What do existing research and experience tell us
  about the issue?

5

• Example 1

6
Stage 1Step 1 - Getting StartedDescribe the
Situation

• An invading enemy sought to overthrow the
  kingdom. During the fierce battle the kingdoms
  well trained warriors mounted their warhorses to
  fight the enemy. All in the kingdom were
  confident they would be victorious as the enemy
  forces were outnumbered. Ultimately, not all
  warriors got deployed and in the end -
• THE KINGDOM WAS LOST.

7
Stage 1Step 2 - Assemble the Team

• No one person understands the entire system.
• One cannot change one part of a process without
  influencing other parts in some ways.

8
Stage 1Focus on defining the problem(s) /
improvement needed

• Define the issues(s) before attempting to fix
  something
• Whats important?
• Whats broken / Needs improvement?
• Where is the Mother Lode? (high volume, high
  profile, problem-prone)

9
Stage 1Define the Issue

• The kingdom was lost.

Whats important?
Reduce the likelihood the kingdom can be taken
again
Whats broken? Needs improvement?
Not enough warriors were deployed
10
Stage 1Define the Issue

• The kingdom was lost.

Whats important?
Reduce the likelihood the kingdom can be taken
again
Whats broken? Needs improvement?
Not enough warriors were deployed
Wheres the Mother Lode? (high volume, high
profile, problem prone)
11
Stage 1Step 3 - Examine Current Process/Approach

• May need to interview staff, external partners
• Make a process flow chart
• Check for efficiency, duplicative steps, missed
  steps, steps needed

12
Stage 1Step 3 - Examine Current Process/Approach

• For want of a nail the shoe was lost

For want of a shoe the horse was lost
For want of a horse the warrior was lost
For want of a warrior the battle was lost
For want of a battle the kingdom was lost
All for the want of a nail.
13
Leverage the 5-Whys

• Basically, the five-why analysis is a fundamental
  approach of thinking, based on the logical
  linkage of elements into a root cause analysis.
  It is a tool that works with ideas/concepts
• With each specific answer, repeat the question up
  to five times and you will typically end up with
  a rather solid root cause.
• For each answer, look at WHO is involved

14
Leveraging the 5-Whys

• Lost the kingdom

Lost the battle
Why?
Not enough warriors
Why?
Not enough horses
Why?
Horses were not shod
Why?
Not enough nails
Why?
Root Cause
15
Leveraging the 5-Whys

• The therefore test has proven to be a very
  reliable method to check the logic of the
  five-why analysis.
• To do the therefore test, you read the key
  findings of the analysis in reverse and insert
  the word therefore between each step.

16
Leveraging the 5-Whys
Result

• Lost the kingdom

Therefore
Lost the battle
Why?
Therefore
Not enough warriors
Why?
Therefore
Not enough horses
Why?
Therefore
Horses were not shod
Why?
Therefore
Not enough nails
Start
Why?
Root Cause
17
Stage 1Define the Issue

• The kingdom was lost.

Whats important?
Reduce the likelihood the kingdom can be taken
again.
Whats broken? Needs improvement?
Not enough warriors mounted on warhorses
Wheres the Mother Lode?
Not enough nails to shod all the warhorses
18
Problem Statement

• Not enough nails to shod all the warhorses.

Analyze the Problem

• Root cause -
• Brainstorming 6-3-5
• Affinity Diagram
• Fishbone Diagram all possible causes

19
Fishbone Diagram
Main Cause 2
Main Cause 1
Minor Cause
Minor Cause
Minor Cause
Minor Cause
influence
influence
Minor Cause
Minor Cause
Not enough nails to shod all the warhorses
Minor Cause
Minor Cause
Minor Cause
Minor Cause
Minor Cause
influence
influence
Minor Cause
influence
Minor Cause
influence
Main Cause 1
Main Cause 1
Main Cause 1
20
Stage 1Step 4 - Potential Solutions

• Avoid making your first QI effort a large-scale
  project.
• Solving issues is usually easiest when you focus
  on decreasing/reducing the negative driving
  forces rather than increasing the positive
  driving forces.

21
Expand-Focus Sequence
POSSIBLE PROBLEMS
Expand
Focus
PROBLEM DEFINED
POSSIBLE CAUSES
Expand
Focus
ROOT CAUSE IDENTIFIED
POSSIBLE SOLUTIONS
Expand
Focus
SOLUTION CHOSEN TO TEST
22
Imposing a Change

• Before imposing a change, begin by asking three
  key questions
• What are you trying to accomplish?
• How will you know that a change is an
  improvement?
• What changes can you make that will result in an
  improvement?
• Define changes you believe will achieve your goal
• Countermeasures

23
Stage 1Step 5 - Develop an Improvement Theory

• Make a prediction How will you know that a
  change is improvement? (Measurement is
  essential!)
• Plan
• What
• Where
• Who
• How
• When timeline

24
Stage 2Step 6 - Test the Theory

• Just Do It!!!!
• Carry out the plan
• During the process collect, chart, and display
  data to determine efficiency.
• Document problems, unexpected observations

25
Stage 3Step 7 - Study the Results

• Based on measurements
• What worked?
• What didnt work?

26
Stage 4Step 8 - ACT

• Sustain if improvement
• Monitor
• Develop new theory
• If successful, plan another cycle to test it on a
  larger scale or under different conditions
• If unsuccessful, test a different theory

27
Stage 4Step 9 - Establish Future Plans

• Recognize, review, refocus your efforts
• What went right?
• Where can we apply what weve learned?
• Whats next?

28
9 Steps of Improvement

• Focus
• Improve
• Sustain
• Honor

Plan Do Study Act
29
Describe Situation
Collect supportive data -Surveys /
Interviews -Natl, State, Local stats
Assemble Team
Develop aim statement
-Whats important? -Whats broken/needs
improvement? -Wheres the Mother Lode?
Define problem(s) / improvement needed
-Flow Charts -5 Whys
Examine Current Process
-Fishbone -Brainstorming -5 Whys -Affinity
Diagram -Pareto chart
Analyze the problem
-SWOT Analysis -CIC Analysis -Stakeholder
Analysis -Force Field Analysis -Bone Diagram
Decide on potential solutions
PDSA Cycles -Develop theory -Test improvement
theory -Study Results -ACT -CELEBRATE!
STAGE 1
CQI
-Logic Model -Flow charts -Surveys -Pareto
chart -Line graph -Include qualitative
information -Check sheets -Standardization -Flow
charts -Documentation -Training
STAGE 2
STAGE 3
STAGE 4
30

• Example 2
• QI Feud

31
Stage 1Step 1 - Getting StartedDescribe the
Situation

• During the last 5 months of the year there has
  been a increase in errors in paychecks

32
(No Transcript)
33
Stage 1Step 2 Assemble the Team
34
Define the Problem / Improvement Needed

• Errors in paychecks.

Whats important?
Reduce errors
Whats Broken? Needs Improvement?
Printed checks
Wheres the Mother Lode?
35
Stage 1Step 3 Examine Current Process/Approach

• Printed Checks

36
Wheres the Mother Lode?
37
Defining the Problem

• Errors in paychecks.

Whats important?
Reduce errors
Whats broken?
Printed checks
Wheres the Mother Lode?
Time codes
38
Problem Statement
During the first five months of the year, time
code errors accounted for 47 of all incorrect
printed paychecks, which was 2X higher than the
next highest contributor (non-printed).
39
All Possible Causes
40
Next Steps

• Step 4 - Potential Solutions

41
Expand-Focus Sequence
POSSIBLE PROBLEMS
Expand
Focus
PROBLEM DEFINED
POSSIBLE CAUSES
Expand
Focus
ROOT CAUSE IDENTIFIED
POSSIBLE SOLUTIONS
Expand
Focus
SOLUTION CHOSEN TO TEST
42
Next Steps Impose a Change

• Step 5 - Develop Improvement Theory
• Target 50 reduction in time code errors by
  6/1/09
• Step 6 Do
• Test the Theory
• Step 7 Study
• The Results
• Step 8 Act
• Step 9 Honor
• CELEBRATE!!!

43
Improvement
44

• Example 3

45
Stage 1 Step 1 - Getting StartedThe Situation

• It appears (staff observations) WIC clients are
  not keeping scheduled appointments

46
Collect supportive data
47
Stage 1Step 2 Assemble the Team

• Nurses
• Dietitians
• Clerks

48
Stage 1Defining the Problem

• WIC no-show rates.

Whats important?
Reduce no-show rates.
Whats broken / Needs improvement?
FU Appts
Wheres the Mother Lode?
49
Stage 1Step 3 Examine Current Process/Approach

• Scheduling FU Appointments

50
Collect supportive data
51
Whats Broken / Needs Improvement?
52
Defining the Problem

• WIC no show rates.

Whats important?
Reduce no-show rates.
Whats broken / Needs improvement?
Re-cert appts
Wheres the Mother Lode?
53
Defining the Problem

• WIC no show rates.

Whats important?
Reduce no-show rates.
Whats broken?
Re-certs
Wheres the Mother Lode?
??
54
Stage 1Step 3 Examine Current Process/Approach

• Scheduling Re-cert Appointments

55
Problem Statement
During May 2008-July 2008. WIC Recertification
(RC) appointments accounted for 33 of WIC
No-show rates.
56
Analyze All Possible Causes
57
Defining the Problem

• WIC no show rates.

Whats important?
Reduce no-show rates.
Whats broken?
Re-certs
Wheres the Mother Lode?
1) Staff training
58
Client Satisfaction Survey
59
Defining the Problem

• WIC no show rates.

Whats important?
Reduce no-show rates.
Whats broken?
Re-certs
Wheres the Mother Lode?
1) Staff training 2) Prompt return of
phone calls
60
Next Steps

• Step 4 Potential Solutions
• Cross train staff
• Prompt return on phone calls
• Need to conduct a phone call tally

61
Next Steps Impose a Change

• Step 5 Develop Improvement Theory
• Target
• Step 6 Do
• Test Theory
• Step 7 Study
• The results
• Step 8 Act
• Step 9 Honor
• CELEBRATE!!!