![Steps in Performance Improvement ,[object Object],[object Object],[object Object],[object Object],[object Object],Source: NPHPSP Users’ Guide](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Semelhante a 2011 NPHPSP Annual Training Applying QI Techniques
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2011 NPHPSP Annual Training Applying QI Techniques
- 1. Applying Quality Improvement Techniques to Analyze Problems and Find Solutions Jack Moran and Julia Gray Public Health Foundation
- 10. We are not a patient people! Always in a hurry to move on to the next thing.
- 11. P D C/S A P D C/S A P D C/S A Knowledge & Experience Project Difficulty Hold the Gains Rapid Cycle
- 12. Topic Big ‘QI’ – organization-wide Little ‘qi’ – program/unit Improvement Quality Improvement Planning Evaluation of Quality Processes Quality Improvement Goals Individual ‘qi’ Contrasting Big “QI”, Little “qi”, and Individual “qi System focus Tied to the Strategic Plan Responsiveness to a community need Cut across all programs and activities Strategic Plan Specific project focus Program/unit level Performance of a process over time Delivery of a service Individual program/unit level plans Daily work level focus Tied to yearly individual performance Performance of daily work Daily work Individual performance plans
- 13. Sales Functional Goals Marketing Operations Customer Service Functional Goals Functional Goals Functional Goals Calls/sale Number of Marketing Events Units Processed Call Time Little q Problems – functional (silos) goals result in process gaps, overlaps, rework, etc. Customer wants may not be in sync with what each department wants
- 14. Sales Functional Goals Marketing Operations Customer Service Functional Goals Functional Goals Functional Goals Calls/sale Number of Marketing Events Units Processed Call Time Little q Customer wants may not be in sync with what each department wants Now the focus is on providing the customer with product knowledge, right cars for their needs, easy access, multiple locations, insurances, and safe vehicles Big Q Fleet Management Rental Process Product Availability
- 15. MACRO MESO MICRO INDIVIDUAL Turning Point/ Baldrige QFD LSS Daily Management P D C A P D C A P D C A S D C A Big ‘QI’ Little ‘qi’ Individual ‘qi’ QI Teams Rapid Cycle Advance Tools of QI Basic Tools of QI Continuous Quality Improvement System in Public Health MAPP
- 17. Large Issue, Cross Functional Problem, or Sensitive Situation Explore Brainstorming Affinity Diagram Sort & Prioritize Interrelationship DiGraph Prioritization Matrix Understand & Baseline Radar Chart SWOT Analysis Develop Actions & Tasks Tree Diagram Prioritize Actions & Tasks Control & Influence Plots Prioritization Matrix Know & Don’t Know Matrix Develop Project Plans Monitor PERT Gantt Chart SMART Chart PDPC Problem Prevention General Approach on How to Use the Advanced Tools of Quality Improvement Source: The Public Health Quality Improvement Handbook , R. Bialek, G. Duffy, J. Moran, Editors, Quality Press, © 2009, p.190
- 20. Continuous Improvement The continuous improvement phase of a process is how you make a change in direction. The change usually is because the process output is deteriorating or customer needs have changed Act Do Check/ Study Plan
- 21. Plan 1. Identify and Prioritize Opportunities 2. Develop AIM Statement 3. Describe the Current Process 4. Collect Data on Current Process 5. Identify All Possible Causes 6. Identify Potential Improvements 7. Develop Improvement Theory 8. Develop Action Plan 1. Implement the Improvement Do 2. Collect and Document The data 3. Document Problems, Observations, and Lessons Learned Check/ Study 1. Reflect on the Analysis Act 2. Document Problems, Observation, and Lessons learned Adopt Adapt Abandon Standardize Do Plan The ABC’s of PDCA, G. Gorenflo and J. Moran
- 22. Maintenance and Standardization The Maintenance and Standardization phase of a process is how we hold the gains. If our process is producing the desired results we standardize what we are doing Standardize Check/ Study Act Do
- 23. Integrated Cycle The SDCA and PDCA cycles are separate but rather integrated. Once we have made a successful change we standardize and hold the gain When the process is not performing correctly we go from SDCA to PDCA and once we have the process performing correctly we standardize Again This switching back and forth between SDCA and PDCA provides us with the opportunity to keep our process customer focused
- 26. Flow Charting
- 27. “ If you can't describe what you are doing as a process, you don't know what you're doing” W. Edwards Deming
- 33. Flow Chart Symbols Activity: Operation/Inspection Decision Start/End Bookends Document Wait/Delay Storage Data Base Transport Input Output Flow Lines A Connector Forms Comment Collector Input/ Output Data Manual Operation Preparation Manual Input Display Unfamiliar/ Research
- 35. Adding Time Lines As Is Flow Chart Could Be Flow Chart Should Be Flow Chart Time Time
- 39. Cause and Effect Diagrams
- 40. Cause and Effect Diagrams Moving from Treating Symptoms To Treating Causes
- 41. Problem Solving – What we usually see is the tip of iceberg – “The Symptom” The Symptom The Root Causes Invisible Hidden
- 49. Obese Children Life Style Policies Environment TV Viewing No Time For Food Prep No Outdoor Play Unsafe Juices Bottle Pacifier Less Fruits and Veg. Less Income Maternal Choices Less Vigorous Exercise Curriculum No Sidewalks Unhealthy Food Choices Few Community Recreational Areas or Programs Built Environment For Strollers Not Toddling Less Indoor Mobility TV Pacifier Unsafe Housing Sodas/Snacks Decreased Breast Feeding Early Feeding Practices Genetics Syndromes Genes Pre Natal Practices Excess Maternal Weight Gain Over Weight Newborn Over Weight Pre School At School At Home
- 50. Problem (Effect) 5 Why’s Technique Why? Why? Why? Why? Why?
- 52. Root Cause Analysis Rating Form Potential Root Cause Improved Quality Reduced Costs Improved Customer Satisfaction Others Total Score Ranking Impact Scoring Scale: Low = 1, Medium = 3, High = 5 Impact on the Problem
- 53. Cause and Effect Exercise
- 54. Why Employees Are Late For Work? Cause and Effect Diagram
- 55. Stages Of Team Development Adjourning Bruce Tuckman, 1965 1970
- 56. Three Step Process for Healthy Teams Teaming Process Coaching and Facilitation Process Planning and Problem Solving Process
Notas do Editor
- First step is to organize participation for performance improvement Which includes Establishing or identify structures – I.e. organizations – that will be included in the process. This will often include many of those that were part of the local assessment in the first place. It also requires that leadership support and accountability are ensured. Change is difficult enough without pushing against institutional and leadership barriers. REFER TO USERS’ GUIDE FOR MORE INFO. The second step is to prioritize areas for action. Discuss the results. Put the data into context … of other assessments (e.g., health status and community assessment data such as in the 3 other MAPP assessments), existing strategic directions and community priorities Consider both quantitative data (like the reports that are generated when the data is submitted to CDC) and qualitative information generated from the assessment discussions. Set priorities. Address common priority-setting barriers. The third step is to explore “root causes” of performance. ‘ Once NPHPSP participants have prioritized which of the EPHS or indicators need to be addressed, finding a solution entails delving into possible reasons, or “root causes,” of the weakness or problem. In this next step, “root causes analysis,” sites pause to identify how and why events occur problems occur before jumping to quick conclusions and superficial causes. Only when participants determine why performance problems (or successes!) have occurred will they be able to identify workable solutions that improve future performance. Most performance issues can be traced to some well-defined system causes, such as policies, leadership, funding, incentives, information, personnel, or coordination. [MORE ON THIS IN GUIDE] Step 4 is to develop and implement improvement plans Include Specific targets, and we’d provided an example here… Also, make sure the Strategies address root causes And identify Accountable parties Keep in mind that Performance improvement may require targeted strategies at the system, organizational, managerial, and individual levels Step 5 is to regularly monitor and report progress. Planning doesn’t really do much without implementation. So you plan…implement…evaluate how it’s going…and them make changes based on how its going so that you stay on track towards performance improvement. From Users’ Guide: “Regular reporting of progress is an essential part of the improvement process. A regular reporting cycle promotes accountability for results; helps to sustain momentum; and enables decision making around improvement efforts, resources, and policies. The key to reporting is to provide the right people with the right information at the right time. As examples: A one-page “scorecard” of public health system performance measures with a brief analysis of progress and priorities for future action might be suitable for legislators, boards of health, funders, and the media… A high-level update on NPHPSP performance improvement plans and work group measures might be appropriate for the NPHPSP Steering Committee, health officials, assessment participants, and organizational partners… A detailed update may be useful to work group participants, who need to track information as part of the “Plan-Do-Check-Act” cycle... ”
- First step is to organize participation for performance improvement Which includes Establishing or identify structures – I.e. organizations – that will be included in the process. This will often include many of those that were part of the local assessment in the first place. It also requires that leadership support and accountability are ensured. Change is difficult enough without pushing against institutional and leadership barriers. REFER TO USERS’ GUIDE FOR MORE INFO. Leadership – top up and bottom down, in order to do QI, the follow-up teams, etc., there needs to be a commitment from leadership or otherwise the time won’t be there. Build in the process strategically – spread, so if you use it in more things, then there is a greater chance for spread. So, look at HP 2020 objectives and where you are and how you can get there via QI MAPP piece is about the entire system – involving others… Alignment with other opportunities for spread…
- The second step is to prioritize areas for action. Discuss the results. Put the data into context … of other assessments (e.g., health status and community assessment data such as in the 3 other MAPP assessments), existing strategic directions and community priorities Consider both quantitative data (like the reports that are generated when the data is submitted to CDC) and qualitative information generated from the assessment discussions. Set priorities. Address common priority-setting barriers.
- ‘ Once NPHPSP participants have prioritized which of the EPHS or indicators need to be addressed, finding a solution entails delving into possible reasons, or “root causes,” of the weakness or problem. In this next step, “root causes analysis,” sites pause to identify how and why events occur problems occur before jumping to quick conclusions and superficial causes. Only when participants determine why performance problems (or successes!) have occurred will they be able to identify workable solutions that improve future performance. Most performance issues can be traced to some well-defined system causes, such as policies, leadership, funding, incentives, information, personnel, or coordination. [MORE ON THIS IN GUIDE]
- Step 4 is to develop and implement improvement plans Include Specific targets, and we’d provided an example here… Also, make sure the Strategies address root causes And identify Accountable parties Keep in mind that Performance improvement may require targeted strategies at the system, organizational, managerial, and individual levels There’s no one right to do this. Not every pathway you take works… Need to stop and take stock of where you are and re-do… All you can get is a paper-cut….
- Step 5 is to regularly monitor and report progress. Planning doesn’t really do much without implementation. So you plan…implement…evaluate how it’s going…and them make changes based on how its going so that you stay on track towards performance improvement. From Users’ Guide: “Regular reporting of progress is an essential part of the improvement process. A regular reporting cycle promotes accountability for results; helps to sustain momentum; and enables decision making around improvement efforts, resources, and policies. The key to reporting is to provide the right people with the right information at the right time. As examples: A one-page “scorecard” of public health system performance measures with a brief analysis of progress and priorities for future action might be suitable for legislators, boards of health, funders, and the media… A high-level update on NPHPSP performance improvement plans and work group measures might be appropriate for the NPHPSP Steering Committee, health officials, assessment participants, and organizational partners… A detailed update may be useful to work group participants, who need to track information as part of the “Plan-Do-Check-Act” cycle... ”
- Focus on: Plan Plan changes aimed at improvement, matched to root causes PDCA in Users’ Guide: Plan : Plan changes aimed at improvement, matched to root causes; identify measures of improvement. Do : Carry out changes; try first on a small scale. Check : See if you get desired results. Act : Make changes based on what you learned; spread success or try again. *Also called Plan–Do–Study–Act (PDSA), Deming, or Shewhart cycles.
- Current state accuracy is important since it will be the point from which all improvements will be measured. Show all the problems – don’t try to cover them up
- Flowcharts don't work if they're not accurate or if the team is too far removed from the process itself. Team members should be true participants in the process and feel free to describe what really happens. A thorough flowchart should provide a clear view of how a process works. With a completed flowchart, you can: Identify time lags and non-value-adding steps. Identify responsibility for each step. Brainstorm for problems in the process. Determine major and minor inputs into the process with a cause & effect diagram. Choose the most likely trouble spots with the consensus builder.
- Flowcharts don't work if they're not accurate or if the team is too far removed from the process itself. Team members should be true participants in the process and feel free to describe what really happens. A thorough flowchart should provide a clear view of how a process works. With a completed flowchart, you can: Identify time lags and non-value-adding steps. Identify responsibility for each step. Brainstorm for problems in the process. Determine major and minor inputs into the process with a cause & effect diagram. Choose the most likely trouble spots with the consensus builder.
- These symbols are in Microsoft Power Point
- The more questions everyone asks the better.
- Unnecessary Tasks-usually paperwork or approval Duplication-identical activities occurring at different places in the process flow Disconnects- process activities that are missing making the rest perform poorly