1. Beginning an Improvement
Journey II
Improvement Models
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2. Initiatives / Solutions / Tools
• TQM • Toyota Production
• Zero Defects System
• Lean
• SPC
• Kaizen
• PDSA
• RPI
• Six Sigma • MDI
• DMAIC • TPM
• Ritz Carlton • Kanban
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3. What improvement model
should I use?
• It depends on
– What improvement you’re trying to achieve
– Your organization’s improvement maturity
level
– The degree of resource commitment
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4. Many ways, many models
• What are you trying to achieve?
– Improve flow (reduce bottlenecks)?
• Theory of Constraints (Goldratt, 1986)
– Reduce waste?
• Lean/Toyota Production System (1950’s)
– Reduce variation?
• Six Sigma (Motorola, 1980’s)
– All of the above?
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5. Lean and Six Sigma
• We use Lean to eliminate the things that
are not value-added.
• We use Six Sigma to improve the things
that are value-added by reducing variation
in the process.
– We do not want to spend our time improving
something that, ultimately isn’t worth doing!
• Lean and six sigma share many tools
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6. Evolution in approaches to improving
health system quality
Managing for Daily
Improvement
Quality and value
Continuous Improvement Programs
Improvement Projects/Kaizens
Crisis response and quick fixes
Organizational Improvement Maturity
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7. Improvement Resources
“Quality is free.”
Phillip Crosby, 1926-2001
• But…
– It usually requires “activation energy”.
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8. Improvement activation energy
Energy
Net gain
(Improvement)
Time
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9. Improvement resource concepts
• Start small
– “draining the ocean” problems
• Coach
– “My job is to coach process improvement, not
do process improvement”
• Bootstrapping
– saving resources and flying under the radar
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10. Improvement resource concepts
• Leadership
– Champion’s role: Recognize, support, and
encourage
• Recognition
– Celebrate the team’s accomplishments
• Culture change
– Improvement is a team sport
– nurture and grow all players
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11. PDSA Model for Improvement
Model for Improvement* is a method to
guide improvement efforts through three
questions and Plan-Do-Study-Act cycles.
The model's three guiding questions are:
1.Setting Aims: What are we trying to
accomplish?
2.Establishing Measures: How will we
know if the change is an improvement?
3.Selecting Changes: What changes can
we make that will result in improvement?
*Institute for Healthcare Improvement(2011). “Science of Improvement: How
to Improve” (Deming)

12. A Comparison of Models
FADE PDSA DMAIC DMADV
Focus Plan Define Define
Analyze Measure Measure
Develop Analyze Analyze
Design
Execute Do Improve Verify
Evaluate Study Control
Act
Each model reflects a common thread of analysis, implementation, and review.
As in the graphic for the FADE model, each also has deeper meaning (further
levels of analysis) for the headings. Using a methodology ensures that you are
not missing any of the critical steps. No one method is best for everyone or all
situations.
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13. Plan
-What are the objectives?
-What are the predictions (hypotheses)?
-How will the plan be carried out
(Who, What, Where, When)
-What are the metrics?
-How will the data be collected?
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14. Do
-Execute the plan
-Record data
-Document observations
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15. Study
-Analyze the data
-Compare the results to the predictions
-Summarize what was learned
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16. Act
-What are the changes to be made?
-Implement standard work
-Determine next cycle
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17. Do-It
• Simple scope/Single task
• Very short duration (1-2 hours)
• 1-3 people
• Immediate impact
• No decisions or management intervention
required
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18. Burst Event
• Minimal scope/Single issue
• Short duration (2-8 hours)
• 4-6 people
• Quick impact
• Intended for relatively simple tasks
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19. Kaizen Events
• Kai = Change
• Zen = Good (For the Better)
• Kaizen events are used to make a fundamental
process shift
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20. Kaizen Event
• Scope significant - often cross-functional
• 1-5 days
• 6-12 people or more
• Quick impact
– 80% of improvements implemented during event
– 20% of improvements implemented within 30 days
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21. Typical Kaizen Schedule
• Pre-event – Charter, data collection, analysis
• Day 1 – Training, analyze Current Process
• Day 2 – Define new process
• Day 3 – Test & finalize new process
• Day 4 – Test & finalize new process, report out
& celebrate
• Post-event – Follow-up, modify, standardize
Some of these “days” may be
reduced to “hours,” depending
on the scope of the effort
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22. Project
• Long duration (3-12 months)
• Complex scope
• Multiple departments/functions
• Long-term impact
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23. MDI
• MDI = Managing for Daily
Improvements
• A philosophy of incremental
improvements
– Everyday improvement
– Everybody improvement
– Everywhere improvement
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24. How kaizen events & MDI work
together
Kaizen event
Process Plateau
Kaizen event
Current Process
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25. Problem Solving Model – A3
• Developed by Toyota
• Often used in conjunction with a VSM
• The A3 is a way to look with “new eyes” at a
specific problem
• Done on the front side only of an 11x17” (thus
the name, A3) sheet of paper
• Offers a structure that begins by always defining
the Issue through the eyes of the customer
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26. Problem Solving Model – A3
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27. The A3 format
Problem Statement: Future State:
What is the problem to be solved? Pictorial description of the desired state
Background: Containment Action:
brief narrative How do we get to the target condition?
Current State: Action Register:
Pictorial description Who does what?
Problem Analysis: Followup:
Why does the current condition exist? Are the gains sustained?
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28. A3, PDSA, DMAIC
• Problem Statement • Plan • Define
• Background • Plan • Define
• Current State • Do • Measure
• Problem Analysis • Do, Study • Analyze
• Future State • Do, Study • Improve
• Containment • Do, Study • Improve
Action
• Action Register • Control • Control
• Followup • Control • Control
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29. A3 Example
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30. Advantages of using the A3
• Simple format
• Focuses on one issue
– Bite off only what you can chew
• Has a flexible time frame
– Do it in half a day or over several weeks
• Allows for flexible team structure
– Stakeholders and experts can be brought in
as needed
• Creates a record as you go
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31. Pilots
• Pilot is another term for controlled
experiment
• Benefits of pilots
– Reduces risk
– Allows for “tweaking”
– Eases pain of change
– Allows for stakeholder buy-in
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32. Pilot Options
• Limited time
– Try solution for a few process cycles
• Open minds may result with short pilots
• Offers downtime for refinements
• Comparative measures may be more revealing
• Selected items or Customers
– Alternative path where certain type or
select number is sent through new process
– This works well with “parallel”
implementation
• Where more and more work is moved over to new
process
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33. Pitfalls of pilots
• Same team pilots everything
– Pioneers, early adopters (Rodgers)
• Microsystem to microsystem variation
– one size does not fit all!
• Local buy-in
– ownership and stewardship
• x
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34. How do we know which
event type to use?
• Type of activity
• Scope of process/task
• Resources required
Don’t worry about fitting the event type
into a specific category
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35. Key to Successful Improvement:
Teams
• Have the right people in the room
• Agree on measures and how they will be
collected
– Make sure the team understands the
objectives and deliverables
• Empower the team to make immediate changes
to the process
– Each member should be able to speak with
authority about the project
• Attack process, not people
• Review action plan frequently for progress
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36. Questions?