Process Improvement
Practical Tools
& Techniques
Toolkit
Training Team:
Sam Ludolf
Margaret Balla
Bernadette McDonald
Les Taylor
Table of Contents
Introduction ................................................................................................................. 3
How To Use This Tool Kit ........................................................................................... 3
Tool Chart ................................................................................................................... 4
Step 1: Identifying Problems ....................................................................................... 5
Affinity Diagram ....................................................................................................... 6
Brainstorming ........................................................................................................ 10
Cause & Effect Diagram........................................................................................ 11
Pareto Diagram ..................................................................................................... 13
Prioritisation Criteria .............................................................................................. 15
Step 2: Defining the Stakeholders ............................................................................ 16
Step 3: Defining the Scope ....................................................................................... 17
Control Chart......................................................................................................... 18
Step 4: Identifying What The Project Is Trying To Accomplish ................................. 20
Step 5: Forming The Project Team & Project Planning ............................................ 20
Step 6: Defining the Current Process ....................................................................... 21
Process Flow Chart ............................................................................................... 21
Value Analysis ...................................................................................................... 25
Value Analysis Definitions ..................................................................................... 27
Value Analysis Check Sheet ................................................................................. 28
Summary of Value Analysis Flow Chart ................................................................ 28
The Process Walk Through................................................................................... 29
Process Walk Through Checklist .......................................................................... 30
Step 7: Process Redesign ....................................................................................... 31
De Bono - Six Hats Thinking ................................................................................. 31
Cost-Benefit Analysis ............................................................................................ 32
Parking Lot ............................................................................................................ 33
TERMINOLOGY ....................................................................................................... 34
REFERENCES/READINGS & RESOURCES .......................................................... 39
2
Introduction
This tool kit is designed for process improvement project facilitators and project
leaders but there is something for everyone – team members and prospective
members, or anyone simply wanting tips on data analysis, problem solving and
continuous quality improvement.
The tool kit is also about quality improvement teams and how they work best and
how process improvement leaders and facilitators can add the most value to the
Team. The handbook can help you avoid pitfalls. It will certainly help your Team
reach its goals.
How To Use This Tool Kit
This tool kit is a how-to. Tool kits and manuals are not always the first place we look
when setting out to do a job. Sometimes we go to the Tool Kit or manual like a map,
when we are lost of in over our head or when we need help.
The learning events will follow the “Designing Care Framework for Process
Improvement” and will step you through the tools enclosed in this kit. During the
learning events you will have an opportunity to try the tools and decide if they would
be good for you to use in your project teams. After the learning events you and your
team can access support the apply the tools to your own projects.
3
This Tool Box contains the tools to support “Framework for Improvement” process.
They are organised within the Steps they support. However, some tools may be
used within several steps.
Tool Chart
Steps Appropriate Tools
1 Problem Identification - Affinity Diagram
- Root Cause Analysis Cause & Effect Fishbone
Diagram
- Root Cause Charts
- Pareto Charts
- Prioritisation Criteria
- Process Selection Checklist
2. Stakeholder Analysis - Stakeholder table
3. Scoping Study - Aim
- Objectives Cause & Effect Fishbone Diagram
- Outcome Measures
- Run Charts
- Control Charts
- Exclusion and Boundaries Table
4. What are we trying to - Literature searches
accomplish - Networks
- Ideas Transfer
- Peer Collaboration
- Visualisation
- Targets
5. Forming the Project - Please refer to facilitation session
Team
6.The Current Process - Flowcharts
- Value Analysis
- Elapse Time
7. Redesign - Brainstorming
- De Bono‟s Six Hats
- Parking Lot
4
Step 1: Identifying Problems
The process of problem identification is often ad hoc and inconsistent. Much too
often the solution does not work for the staff or the solution works for some people
but creates a new problem for others. Using structured problem solving processes
with a team of people who understand the process and who understand the system
within which the process work, can help to identify the real problems, deliver
innovative ideas which are practical, achievable and realistic.
The important this when using a structured problem solving process is that we:
Are sure we know what the problem is
Have the right people available to solve it
Use a structured process in its entirety to get the best results
This sounds easier than it is, but once you have experienced it and seen the
outcomes, you will know that there is no other way.
In the next section, two common ways of structure problem solving are outlined.
FOCUS-PDCA was developed in the USA health care system and it used in many
health service organizations. The steps are:
1. Find a process to improve.
2. Organise a team that knows the process.
3. Clarify the current knowledge of the process.
4. Understand the “customers” and the process.
5. Select the process improvement.
6. Plan the improvement and continue to collect data.
7. Do the improvement, data collection and analysis.
8. Check and study the results
5
Step 1: Identifying Problems
Affinity Diagram
Description
To allow a team to generate ideas/issues. To then organise and summarise natural
groupings of ideas and issues and to understand the essence of a problem.
Purpose
Encourages creativity by everyone on the team at all phases of the process
Breaks down longstanding communication barriers
Encourages non-traditional connections among ideas/issues
Allows breakthroughs to emerge naturally, even on long-standing issues
Encourages “ownerships” of results that emerge because the team creates
both the detailed input and general results
Overcomes „team players” which is brought on by an overwhelming array of
options and lack of consensus
Steps
1. Phrase the issue under discussion in a full sentence
What are the issues involved in planning fun
family vacations?
Tip: From the start, reach consensus on the choice of words you will use. Neutral
statements work well, but positive, negative, and solution-orientated questions also
work.
2 Brainstorm at least 20 ideas or issues
a) Follow guidelines for brainstorming.
b) Record each idea on a Post-it note in bold, large print to make it visible
4-6 feet away. Use at minimum, a noun and a verb. Avoid using single
words. Four to seven words work well.
6
What are the issues involved in
planning fun family vacations?
Find a good Consider
range of price everyone‟s
Ask kids alternatives hobbies
for ideas
Use a Combine
Recall good creative vacation with
vacations of travel agent business trip
the past
Determine total Find locations
Look at family budget with activities
pictures for all ages
Illustrations Note: There are 10 to 40 more ideas in a typical Affinity
Diagram
Tip A “typical” Affinity has 40 – 60 items; it is not unusual to have 100-200
ideas.
3. Without talking: sort ideas simultaneously into 5-10 related groupings.
a) Move Post-it notes where they fit bets for you; don‟t ask, simply move
any notes that you think belong in another grouping.
b) Sorting will slow down or stop when each person feels sufficiently
comfortable with the groupings.
7
What are the issues involved in
planning fun family vacations?
Ask kids Find a good Use a
for ideas range of price creative travel
alternatives agent
Consider Combine Find locations
everyone‟s vacation with with activities
hobbies business trip for all ages
Look at family Determine Recall good
pictures total budget vacations of
the past
Illustration Note: There are 5 to 10 more groupings of ideas in a typical
Affinity Diagram
Tips:
Sort in silence to focus on the meaning behind and connections among all
ideas, instead of emotions and “history” that often arise in discussions.
As an idea is moved back and forth, try to see the logical connection that the
other person is making. If this movement continues beyond a reasonable point,
agree to create a duplicate Post-it.
It is okay for some notes to stand-alone. These “loners” can be as important as
others that fit into groupings naturally.
4. For each grouping, create summary or header cards using consensus
a) Gain a quick team consensus on a word or phrase that captures the
central idea/them of each grouping; record it on a Post-it note and place it
at the top of each grouping. These are draft header cards.
b) For each grouping, agree on a concise sentence that combines the
grouping‟s central idea and what all of the specific Post-it notes add to that
idea; record it and replace that draft version. This is a final header card.
c) Divide large groupings into subgroups as needed and create appropriate
sub headers.
d) Draw the final Affinity Diagram connecting all finalized header cards with
their groupings.
8
Define an Determine the Use multiple
ideal vacation most your sources for
through family budget will vacation
consensus buy research
Use a creative
Ask kids for Find a good travel agent
ideas range of price
alternatives
Consider Find locations
everyone‟s Combine with activities
hobbies vacation with for all ages
business trip
Recall good
Look at family Determine vacations of
pictures total budget the past
9
Step 1: Identifying Problems
Brainstorming
Description
Brainstorming is a simple process for generating information from a
team. There are a number of techniques that can be used depending
on the situation. The information generated can be of a number of
types- ideas, solutions, options, and causes. The team should be
encouraged to feed off and build on to the ideas generated by other
team members.
Purpose
To utilise creatively and divergent thinking to generate the maximum
number of ideas from a team.
When To Use It
This tool can be used whenever there is a need to capture thoughts of
members of a team.
Steps
1. Ensure the team is agreed on what they are brainstorming.
2. Describe the process and agree on the time to be spent.
3. Encourage freewheeling. The aim is to generate a quantity of ideas. This
should include some „way out‟ ideas as these may stimulate others.
4. Do not allow any negative responses. Suggest a fine for any negative
comments being made.
5. Allow a few minutes of silent thought for members to think of and write down
ideas.
6. Go around the team getting an idea from each and continue until their lists are
exhausted. An alternate method is for the first person to register an idea, and
then the others build on that idea until it is exhausted. Number two then starts
the process again.
7. Write and number all ideas on the chart in the speaker‟s own words.
8. Do it quickly to maintain momentum and remember to avoid discussion,
interpretation, evaluation or criticism. Don‟t get bogged down.
9. Review to check that all understand the meaning of each idea.
10
Step 1: Identifying Problems
Cause & Effect Diagram
The Fishbone Diagram or the Ishikawa Diagram
Description
The Cause and Effect Diagram represents a very special and
structured form of Brainstorming. Also known as a fishbone or
Ishikawa diagram, the diagram consists of detailed causes attached to
a small number of main causes. It is an effective tool when determining
multiple causes and identifying the probable root causes of a problem.
Illustrates the interplay between related causes and aides in identifying
the ingredients needed to achieve a targeted improvement.
NB. The diagram only identifies possible causes; actual causes will
have to be verified with data.
Purpose
To identify in a structured way, the possible causes of a problem.
When To Use It
When seeking to understand and determine the possible causes of a
problem.
Steps
1. Write the effect you wish to analyse in the box at the right of the diagram.
2. Conduct a structured brainstorming session to determine causes and select
major cause categories.
3. Write the major cause categories at the end of the fish‟s ribs. Typical
categories include: Administration: - People, policies, procedures and
equipment. Manufacturing:- Manpower, methods, materials and machinery
(environment and measurement may also be added if required)
4. Record the brainstormed causes on the horizontal fish bones attached to the
appropriate rib. (Additional causes may be identified during this and
subsequent stages).
5. Continue developing the network of fishbones by looking at each
brainstormed cause in turn and repeatedly asking; “Why does it happen?”
11
6. The responses as they occur are listed as branches and sub branches of the
original horizontal fishbone until the probable root cause is identified.
7. When all probable causes have been identified and the team has achieved
consensus, data must be gathered to indicate actual causes.
8. Pareto Analysis of the data will identify those root causes which have the
greatest effect and should be addressed first
Cause & Effect Diagram
Example
Environment People
Pedestrians on road Awake too long
Medication
Road obstruction Drinking
Children in car caused
Weather distraction Driver fell asleep
Poor visibility Yanks on wrong side of the road
Increased
Poor vehicle maint.
Accidents
Heavy traffic on Highway
Alternate driving
Vehicle malfunction
patterns not Dangerous intersection
clearly
marked Brakes Tyres Power failure
Road Construction No traffic signal
Methods Machine Materials
12
Step 1: Identifying Problems
Pareto Diagram
Description
Based on the Pareto principal that 80% of the problems come from
20% of the activities undertaken. The Pareto Diagram is a further
refinement of the Histogram aimed at focussing attention on the critical
factors. It visually represents the distribution of occurrences being
studied, drawing attention to the “vital few” important factors where
payback is likely to be greatest. A Pareto diagram displays, in
decreasing order, the relative contribution of each problem to the total
effect.
Purpose
To display data in such a way that the cost or effects of the vital 20% of
the functions Purpose
When To Use It
To display data in such a way that it highlights the effects of a small
number of functions or factors.
Steps
1. Select the problems or their causes, which need to be ranked.
2. Decide on what data you want to collect, how you will collect it and the length
of the collection period (week, month, 6 weeks etc.).
3. Design a check sheet to be used to collect the data.
4. Record data on the check sheet and calculate totals.
5. List the items from left to right, in order of decreasing magnitude, along the
horizontal axis. NB Items displaying the least magnitude may be categorised
as others and placed at the extreme right end.
6. Draw two vertical axes, one at each end of the horizontal axis. The left axis
should be calibrated in the units of measurement and its height equal to the
sum of the magnitudes of all items. The right axis should be the same height
and calibrated from 0 to 100%.
7. Above each item draw vertical bars to the appropriate scaled height.
13
8. Construct a cumulative frequency line by summing the magnitudes of each
item from left to right.
9. Label the diagram so that it is easily read and understood by others.
10. Use the Pareto diagram as a guide to action or further analysis.
Pareto Analysis of Optical Fibres
Number 100
of %
Failures
50%
Misad- Misin- Misfixing Parts Other
justment stallation Lacking
14
Step 1: Identifying Problems
Prioritisation Criteria
Description Tool to utilise for assessing impact of problem or project.
Eleven criteria to measure strategic importance of problem or
project to the organisation and patients.
Purpose To assess & prioritise problems or projects for strategic
importance.
When To Use It When deciding on problems or projects for action.
Steps
1. Identify problem/project for analysis
2. Measure each problem or project against 11 criteria
3. Score High, Medium or low against criteria
4. Score each project/problem
Example
Criteria H M L
1. Impact on Quality of care to patients
2. Involvement of many staff
3. Involvement of many departments
4. Degree of urgency
5. Complexity of process and issues
6. Need for external facilitation
7. Potential for executive support
8. Potential for waste reduction
9. Capacity to generate $ savings
10. Need for redesign before implementing new IT systems
11. Need for critical review prior to budget expenditure
15
Step 2: Defining the Stakeholders
Description
Used to identify and understand the stakeholders in the process.
Purpose
To identify stakeholders and their expectations, impact, importance and level
involvement to the project.
When to use it
When starting a process improvement project and forming a project team.
Steps
1. Identify the problem in the project.
2. Identify all the people who have a “stake” in the process.
3. Identify their expectations, impact on the project and level of involvement required
A - Active involvement in the multi-disciplinary project team
B - Communication (identify what is the best form of communication)
C - Consult on developments
4. Rate the level of involvement.
Example
Process/
Problem Stakeholder Expectations Impact Involvement
16
Step 3: Defining the Scope
Description
Used to understand the boundaries of the project.
Purpose
To identify with the project team the boundaries, inclusions and exclusions of
the project.
When to use it
When starting a process improvement project with the project team.
Steps
Brainstorm with the team:
the starting point and reason why
The finishing point and reason why
The inclusions and reason why
The exclusions and reason why
Example
Process/Project Start Finish Inclusion Exclusion
17
Step 3: Defining the Scope
Control Chart
Description
Used for monitoring a process to check whether it is operating normally.
Control limits are mathematically determined and indicate how the process
usually performs.
Purpose
To identify variations from normal operations.
When to use it
When monitoring the process and/or the implementation of targets or
recommendations.
Steps
1. Create a trend chart with control limits added.
2. Evaluate the position of each point in relation to the entire sequence.
3. Use the following criteria to determine whether the process is in control
(behaving normally), or out of control (behaving abnormally).
The process is in control if:
all points are within the control limits
most of the points are closer to the process average rather than the control limits.
there is an equal distribution of points above and below the process average
no clear pattern exists
The process is out of control if:
one point falls outside the process limits
two consecutive points are close to one of the control limits
the points lie predominantly to one side of the process average
there is a pattern which allows the prediction of where the next point may lie
If the process is out of control, return to the problem tools to identify and tackle the
problem.
18
Control Chart Format (example)
Time
UCL
Average Time
LCL
A B C D E F G H I J K L M N O P
Event
19
Step 4: Identifying What The Project Is Trying To
Accomplish
Step 4 includes:
Identifying best practice
Visioning the ideal process
Setting targets for improvement
Step 5: Forming The Project Team & Project Planning
Step 5 is covered in the Project Management Training and Handbook.
20
Step 6: Defining the Current Process
Process Flow Chart
Description
A drawing that represents in time sequence the steps of a work
process. Flow charts can take a number of forms:
Simple Flowchart: (See example)
A simple chart which highlights the major steps in a process
Only shows those steps that are essential
Allows essential processes to be compared with existing practices
to identify unnecessary complexity
Deployment Flowchart: (See example)
Presents most or all of the steps in a process
Includes the loops caused by rework
Presents the steps in columns showing the organisational element
responsible
Work Flow Diagram
Presents the information on a plan or map of the work site
Shows the work flow and movements of people, materials, documents
or information
Highlights excessive or unnecessary movement
Purpose
To identify and document in an easy to follow format the actual steps
on a process. The more complex formats highlight the interaction of the
process and either the organisational structure or the work site layout.
When to use it
It is usually used initially to gain an understanding of and agreement
about the current process. It may also be used to document the team‟s
recommended process.
21
Steps
1. Using the teams knowledge or by actual observation, identify the start and
end of the process within the scope of the project.
2. Identify process steps, decision points and Document generation and
represent these in the flow chart with the symbols shown in the
3. Format section. The flow chart should be recorded so all can se it i.e. on a
Flip Chart.
4. Work through the process asking, “What happens next”?
5. When the process has been described, have the team review it and if there
are areas of uncertainty have these verified with the people performing the
process.
It is important that the team determines the level of detail required to meet the
requirements of the project.
Format
The following are commonly used symbols.
Represents the Beginning and End of the Process
Represents a Process Step
Represents a Decision Point
Indicates a Document
has been Generated
Indicates the Process is
Continued elsewhere on the page
Indicates the direction of the flow
22
Simple Flow Chart
Collect
Dishes
Are
YES Put in
They
Cupboard
Clean
NO
Wash
Dishes
Dry
Dishes
23
FLOWCHART: LEAVE APPLICATION PROCESS
Activity Employee Supervisor Personnel off. Info. needed
1. Fill out leave Do
application form
No
2. Decide - Amount of
Approve
whether to leave available
?
approve leave
request. - Leave roster
Yes
No
3. Check form
for accuracy. If Check
incorrect return ?
to employee for
correction. Yes - PIMS access
4. Process Do
details on PIMS
5. Check
changes on Do
PIMS
- Advice slip
6. Return advice
Receive Do
slip
24
Step 6: Defining the Current Process
Value Analysis
Description
An analysis of the value-adding and non-valuing steps in the process.
Purpose
To analyse a process to identify the value-adding steps that should be kept or
enhances, to identify the necessary but non-valuing adding steps that should
be made as inefficient as possible, and to identify the unnecessary steps that
should be eliminated or reduced.
To challenge the status quo and the team‟s assumptions about why the work
is done.
When to use it
Undertaken after a flow charting the current process and prior to redesign of a
process. It can also help to prepare a specification for work to be done.
Background
People mostly believe the way they currently do their work is the right way
because,
It is how they were trained;
It is how they learned to do it by trial and error;
It is how they have been doing for a long time;
It is how they are told to do it;
It is what they believe they have to do to meet their organisations
policies and rules;
There are betters ways to do work, even if they are sometimes not obvious.
We therefore need to challenge our beliefs and assumptions to ensure we
recognise opportunities to do things better.
25
Steps
1. Discuss with the team the definition of value adding, necessary work and
unnecessary work.
2. Identify everyday examples of each and then identify example related to the
current process the team is reviewing. Ensure everyone in the team understands
what the terms mean.
3. Using the Value Analysis check sheet review each step in the process. At each
step
Identify if the step is value adding, necessary or unnecessary. In some cases
it may only be part of the step that is valuing adding, necessary or
unnecessary.
Give the reason why the step is valuing adding, non-value adding but
necessary or unnecessary. You need to know why to really understand the
activity. For value-adding step what must be achieved helps you find ways to
enhance the value-adding work. For non-value-adding but necessary work it
helps identify the essential or critical outcomes required and in most cases
more efficient ways can be achieved for delivering the outcome. For
unnecessary work knowing why guides you in what to eliminate from the
process.
Challenge the team‟s views and belief about why they think the work fits into a
category.
Estimate the percentage of the steps that is value-adding.
4. Prepare a summary flow chart showing the percentage of valuing adding, non-
value adding but necessary and unnecessary non-value-adding.
26
Step 6: Defining the Current Process
Value Analysis Definitions
Term Definitions Examples
Value-adding Improves the product or service Responsive service
in a way that the Trust & confidence in
customer/patient recognises as people and processes
worthwhile Speedily service
How easy it is to get what
you want.
Non value adding What the organisation requires, Compiling and using
but necessary usually records in a form that are performance records and
suitable for decision making. cost records
Unnecessary Non value adding and Duplication
unnecessary Rework
Loss of data at handover
Excessive inspection and
checking
Bottlenecks
Inappropriate escalation
to higher authority
Excessive acceleration
Wait time
Idle time
Move time
Excess stock
Legal penalties
Special charge
Lost bonuses
Loss of pride
Customer complaint
27
Step 6: Defining the Current Process
Value Analysis Check Sheet
Step Assessment of value Comments &
Give reason for each Observation
VA = Value adding N = Necessary but not adding NVA = Non value
value adding
Summary of Value Analysis Flow Chart
VA
NVA
N
VA
VA
NVA
NVA
NVA
28
Step 6: Designing the Current Process
The Process Walk Through
Description
Process Walk Through is a practical way to flow chart all the steps
involved in the current process. The team walks through the existing
process in the actual work location and records each step, the time
taken in each step and how often each step is carried out. Sample
documents used in the process are gathered.
Purpose
To identify and record the actual steps in a process, to gather
information on the effort involved in each step, and to gather samples of
documents used. Generally used in conjunction with Value Analysis.
When to use it
In the analysis phase, to gain an understanding and agreement about
the process. It may also be used to trial a team‟s recommended
process.
Steps
When used in conjunction with Value Analysis, first discuss and agree with the team
examples of value adding and non-valuing adding activities (see steps 1 & 2 of Value
Analysis)
1. Define the process to be described by the Process Walk Through
Briefly describe the process
Identify the start and finish points
List the customers
Outline what the customers want
This gives you a broad understanding of the process we are about to
map in detail.
2. Select the people to participate.
3. Determine the level of detail required to meet the requirements of the project.
29
4. Make arrangements with the person responsible in the work place to have people
who perform the steps available to help, to ensure the Process Walk Through is
safe, and to carry it out with minimal interruptions to normal work.
5. Using the Process Walk Through check sheet, start at the beginning of the
process and walk through each step. At each step
Describe the step: in simple language a 10 year old will understand
Ask why it is done: this is necessary information to help decide if changes
could or should be made.
Record how it long it takes to carry out the step: there are two measures of
time
a) people time – how much of a person‟s time it takes to perform the step,
and
b) elapse time – the time involved for the step even if no-one is involved,
such as how long a document might wait before it is acted on.
Calculate the total time spent: multiply the person‟s time by the number of
people doing the step by how often it is done e.g 2 mins X 10 people X
3times/days = 60 mins
List the documents used and get a copy of each document.
Make comments/observations e.g. on issues, problems, risks and ideas that
relate to the team‟s aim
6. The team meets and consolidates what they have found. If there are any areas of
uncertainty have these verified with the people performing the process.
Process Walk Through Checklist
Step Why it is How long it Total time Documents Comments
done takes spent used Observations
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Step 7: Process Redesign
De Bono - Six Hats Thinking
Description
De Bonos Six Hat thinking for creative thinking.
Purpose
To review process and creative thinking.
When to use it
In the redesign phase. it may also be used to trial a team‟s
recommended process. The process can speed up thinking of the
team.
Steps
1. Identify the mode of thinking.
2. All the team members concentrate on that thinking style for a minute to review a
process and the recommendations for change.
3. Change hats after one minute and repeat the exercise.
Six Hat Thinking
White Hat
Pure facts, figures and information, neutral, objective
Red Hat
Emotions and feelings, also hunch and intuition
Black Hat
Devil's advocate, negative judgment, cautious, points out risks and why something
may not work
Green Hat
Creative, growth, energy, ideas, provocation, movement
Blue Hat
Facilitates thinking process, cool and control, thinking about thinking
Yellow Hat
Brightness and optimism, positive, constructive, opportunities
31
Step 7: Process Redesign
Cost-Benefit Analysis
Description
Cost-benefit analysis is a method of comparing the costs and benefits of
plans. It can be used to determine and compare the financial outcomes of
different actions.
Purpose
To compare the financial outcomes in terms of the benefits received for the
costs outlaid for different options.
When to use it
When there are different benefits available in return for different cost outlays
for each of the options being considered.
Steps
1. Determine the time period for analysis.
2. Brainstorm a list of cost factors.
3. Determine the cost of each factor.
4. Add the total costs for the action.
5. Determine the benefits, in dollars, of the action. Remember you may need to
convert this to today‟s dollars.
6. Put the total cost and benefit figures into a cost-benefit ratio:
Cost-benefit ratio: Benefits
Costs
The ratio indicates how many dollars are made (or saved) for every dollar of
cost.
7. Compare the ratios of different actions to help select the
best option.
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Step 7: Process Redesign
Parking Lot
Description
The Parking Lot is a tool that does not clearly fit in any particular phase. It is
a chart where members of the team can record ideas or issues when they
think of them so they can be retrieved after appropriate time.
Purpose
To record ideas or issues that are not appropriately dealt with at the time
they are thought of or „come up‟. It has a secondary function as a control
tool that allows the team to move forward and not get trapped on a
discussion that may be important but that is a distraction at that time.
When To Use It
It is established at the start of the project. Ideas or issues can be recorded
at any time. They are retrieved at an appropriate time.
Steps
1. Explain the purpose of the Parking Lot and how it is to be used.
2. Head a large sheet of „butcher‟s paper‟ Parking Lot and attach it to the wall in
a highly visible place.
3. Retrieve ideas or issues at appropriate times.
33
TERMINOLOGY
Boundaries The portion of a process from a Supplier to a Customer
that will be the focus of the process improvement.
Process boundaries define what is in and out of scope.
Brainstorming A group decision-making technique designed to generate
a large number of creative ideas through an interactive
process. Brainstorming is used to generate alternative
ideas through an interactive process. Brainstorming is
used to generate alternative ideas to be considered in
making decisions.
Cause and Effect Chart A graphic tool used to explore and display opinions about
possible causes, ie those components of a process that
effect the Key Quality Characteristic (KCQ). A Cause and
Effect Chart is used to clearly illustrate the various causes
affecting a given KCQ by sorting and relating the causes
to the effect and to create a starting point for determining
the Key Process Variable. (This chart is also called an
Ishikawa Diagram or Fishbone Chart.)
Check Sheet A data collection form consisting of multiple categories.
Each category has an operational definition and can be
checked off as it occurs. Properly designed, the Check
Sheet helps to summarise the date, which is often
displayed in a Pareto Chart. A Check Sheet is simply a
tool for recording and tallying observations, eg times that
a test report arrived late.
Common Cause
Variation The variation due to the process. It is produced by the
interaction of various aspects of the process that affects
every occurrence and their interaction is often referred to
as the common cause system.
Control Chart A display of data over time that shows variation of the
data compared to the upper and lower limits of expected
common cause variation. It is used to indicate special
causes of process variation, to monitor a process, and to
determine if process changes have had the desired effect.
Control Limits Expected limits of common cause variation, and found on
Control Charts. Sometimes they are referred to as upper
and lower control limits. They are not specification or
tolerance limits.
Customer/Client The receiver of an output of a process, either internal or
external to a hospital or corporate unit. A customer could
be a person, a department, a company, etc. The person
who gets your work.
Data Collection Gathering facts on how a process works and / or how a
process is working from the customer‟s point of view. All
data collection is driven by knowledge of the process and
guided by statistical principles.
Facilitator Process guide assigned to a team who educates
members in the CQI processes and helps them select and
use the appropriate tools and other resources.
Fines Master A team member allocated responsibility for noting
infringements of ground rules and any behaviour that can
gently be mocked. Fines (10c or 20c only) can be used
for team celebrations.
Fishbone Chart See Cause and Effect Chart
Flowchart A graphical representation of the flow of a process. A
useful way to examine how various steps in a process
relate to each other, to define the boundaries of the
process, to identify customer/supplier relationships in a
process, to verify or form the appropriate team, to create
common understanding of the process flow, to determine
the current “best method” of performing the process, and
to identify redundancy, unnecessary complexity and
inefficiency in a process.
FOCUS-PDCA A method used in structural problem solving by
improvement teams. It is an acronym meaning: Find a
process to improve, Organise a team that knows the
process, Clarify current knowledge of the process,
Understand causes of process of variation, Select the
process improvement, Plan the improvement and
continued date collection, Do the improvement, data
collection, and analysis,
Check and study the results, Act to hold the gain and to
continue to improve the process.
Force Field Analysis A systematic method for understanding competing forces
that increase or decrease the likelihood of successfully
implementing change. It provides a framework for
developing change strategies aimed at decreasing
Restraining Forces and increasing Driving Forces.
Usually it is best to try to reduce opposing forces than
increase driving forces. Attempts to increase driving
forces are often met by retaliatory increases in opposing
forces – an “arms race”.
Ground Rules Used by teams to set a code of conduct which helps the
group perform more effectively. Five to ten points should
be sufficient, and they should be continuously displayed
for the team to see and refer to.
Process Improvement
Team A specially constituted group, usually five to eight people,
chosen to address a specific opportunity for improvement.
Consists of those who have regular contact with the
process. The Process Improvement Leader should be a
major stakeholder in the process and is in charge of the
project. A facilitator guides the process and helps the
team use the tools.
Ice Breaker An exercise conducted at the beginning of meetings to
encourage participation, increase energy levels and help
improve team building.
Ishikawa Diagram See Cause and Effect Chart.
Key Quality
Characteristic (KQC) The most important characteristic to the customer (eg.
Speed, cost, accuracy, courtesy, reliability, design,
comfort, physical attractiveness, variety etc). The KQC
will be operationally defined by combining knowledge of
the customer with knowledge of the process.
Key Process Variable A key component of a process that has a cause and effect
relationship of such magnitude with the Key Quality
Characteristic (KQC) that manipulation and control of the
KPV will reduce variation of, or improve the level of, the
KQC.
Multiple Voting A group decision-making technique designed to reduce a
long list to a few idea.
Opportunity Statement A concise description of a process in need of
improvement, its boundaries, and the general area of
concern where a Process Improvement Team should
usually focus its efforts.
Pareto Chart A bar graph used to arrange information is such a way
that priorities for process improvement can be
established. It displays the relative importance of
improvement opportunity by highlighting the vital few in
contrast to the many others.
Process A series of actions which repeatedly come together to
transform Inputs provided by a supplier into Outputs
received by a Customer. A series of related tasks. eg:
recruitment of candidates for entry level clerical positions
would be a process contained in the general recruitment
system.
Process Improvement The continuous endeavour to learn about all aspect of a
process and to use this knowledge to change the process
to reduce variation and complexity and to improve
customer judgements of quality. Process improvement
begins by understanding how customers judge quality,
how processes work, and how understanding the variation
in those processes can lead to wise management action.
Process Improvement
Leader A person designated to lead a Quality Improvement
Team. An individual who has team leadership skills,
basic quality improvement skills and is a major
stakeholder in reaching a project result.
Process Variation The spread of process output over time. There is
variation in every process, and all variation is caused.
The causes are of two types – special or common. A
process can have both types of variation at the same time
or only common cause variation. The management action
necessary to improve the process is very different in each
situation.
Quality Characteristics Characteristics of the output of a process that are
important to the customer. The identification of quality
characteristics requires knowledge of the customer needs
and expectations.
Quality Improvement
Team Typically a team of five to eight people from within a local
functional ara or a number of areas addressing an issue.
Run Chart A display of data in the order that they occur. A run chart
is used to indicate the presence of special causes of
process variation in the form of trends, shifts, or other non
random patterns in a Key Process variable or Key Quality
Characteristic.
Special Cause Variation Variation in the process that does not affect every
occurrence but arises because of special circumstances.
Can usually be traced to a special event (faulty machine,
one untrained worker etc).
Storyboards/Storybooks Promotional and self-monitoring tools. They follow the
steps in the FOCUS-PDCA strategy and help teams
organise their work and their presentations so the Team
and others can readily learn from them. Storybooks form
a permanent record of a team‟s actions and achievements
and all the data generated.
Survey A written or verbal questionnaire primarily used to
understand customer or staff needs and views. The
introduction to the survey, the working of questions and
the size and composition of the “sample” need careful
consideration if the information collected is to be
meaningful.
System A group of related processes. Eg: recruitment of new
staff would be a system containing processes such as
recruiting candidates for entry level clerical positions,
recruiting nursing staff, recruiting medical staff, etc.
Tools A group of problem solving, team building and data
gathering techniques used to collect, organise, display,
and evaluate knowledge about a process. Specifically –
Brainstorming, Surveys, Flow charts, Cause and Effect
Charts, Check Sheets, Pareto Charts, Run Charts and
Control Charts are examples of these tools.
Tracking Sheet A form for tracking team progress. The update of these
forms is the responsibility of the Team Leader.
Variation See Process Variation.
REFERENCES/READINGS & RESOURCES
Total Quality Management
Crosby P.B Quality if Free, McGraw Hill, NY, 1979.
Deming, W.E. Out of the Crisis, MIT, MA., USA, 1986
Deming, W.E. Quality, Productivity and Competition Position, MIT, MA., USA, 1982
Juran J.M. Juran‟s Quality Control Handbook, MIT, MA., USA, 1988.
Juran J.M. Juran on Leadership for Quality, MIT, MA., USA, 1989.
McConnell, J. Analysis and control of Variation, Delaware Books, Dee Why, NSW,
Aust. 198?.
Scholtes, P.R. The Team Handbook, How to Improve Quality with Teams, Joiner
Associates Inc., WI, USA 1988.
Standards Association of Australia
AS3900-1987 Quality Systems Guide to Selection and Use
AS3904-1987 Quality Systems Guide to Quality Management and Qual. Systems
Elements
Tools
Brassard, M. The Memory Jogger+, Goal/QPC, 1994
Gitlow, H.S, Shelly, J. and Oppenheim, A.R. Tools and method for the Improvement
of Quality, Irwin, Homewood, II., USA, 1989.
McConnell, J. The Seven Tools of TQC, Delaware Books, Dee Why, NSW, Australia,
1986.
McConnell, J. Analysis and Control of Variation, Delaware Books, Dee Why, NSW,
Australia, 1986.
Nayatani, D.J The Seven New TQC Tools, Quality Resources, NY, USA, 1994.
Scholtes, P.R. The Team Handbook: How to Improve Quality with Teams, Joiner
Associates Inc., WI, USA 1988.
Questionnaire Design
de Vaus, D.A. Surveys in Social Research, Allen Unwin, Ma., USA 1990.
Teambuilding/Facilitation
Adair, J Effective Teambuilding, Pan, USA.
Aubrey, C.A. and Felkins, P.K. Teamwork, ASQC Quality Press, 1988.
De Bono, E. Lateral Thinking, Pelican. 1977.
Bianchi, S. Butler, J. and Richey, D. Warmups for Meeting Leaders, University
Assoc., Inc., 1990.
Hart, L Faultless Facilitation, Kogan Page, London, 1992.
Jacobs, M: Swift to Hear: Facilitating Skills in Listening and Responding, SPCK,
1985.
Scholtes, P.R. The Team Handbook, How to Improve Quality with Teams, Joiner
Associates Inc. WI, USA 1988.
University Associates Inc., The Encyclopaedia of Icebreakers, 1993.
Ward, P. and Preziosi, R. Fostering the Effectiveness of Groups at Work; 1994
Annual for Developing Human Resources, Pfeiffer and Co, 1994.
Change
Bennis, W. The Planning of Change, CBS College Publishing, NY USA, 1985.