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					     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




                                                                                    30
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.




                                                                                     32
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.

				
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