Process Improvement: PDSA Cycle (Act)

Why are leaders hesitant to focus on this?

Taking action is what we are called to do as leaders. The final step in the PDSA cycle is action. It is easy to want to jump directly to this step, but the purpose of the PDSA cycle is to facilitate an evaluation and decision making process that produces the best action. As leaders, we can be hesitant to let this process run it’s course. We must be intentional about following the steps to make sure that we make the best decision.

What is the case for doing it anyway?

Some times we will do a PDSA and the outcome will be exactly what we had anticipated. We will have a seamless transition to our new process and everything will be better because of it. However, the PDSA is even more valuable in scenarios where the initial outcome of our study was something other than what we anticipated. In these cases, we must take the proper action of starting the PDSA process over. Doing so will help us drill down into what caused the unexpected outcome and will get us back on the path to improvement.

How can you do it?

  1. Understand what your analysis is telling you. Having conducted the first three steps of your PDSA, you should be able to identify if your plan was successful.
  2. Choose between proceeding or rebooting. In most PDSAs, you’re left with two options for action. Continue with the new process or restart the PDSA to continue to seek a better outcome.
  3. Act. Once you know what you want to do, go for it.

Have you ever used a PDSA cycle?

Process Improvement: PDSA Cycle (Study)

Why are leaders hesitant to focus on this?

We are committed to producing results. We observe. We interpret. We take action. That is what we do as a leader. In some cases, we identify our opportunity, we solicit input from key stakeholders, we develop a plan, and we implement the plan. The temptation might be to think that our work is complete with respect to this specific opportunity. However, when using the PDSA cycle, we have two more steps to consider. The third step is the study step. Study is a hardwired check and balance for our interventions. It forces us to study or observe our change to make sure that it is in fact achieving our desired outcome. Some leaders may have already moved onto the next project before completing this phase.

What is the case for doing it anyway?

The study phase is vital to the success of intervention. It requires us to determine how to measure the success of our plan. If we fail to complete this phase, we will be placing all of our trust in the assumptions we made in developing our plan. This is why taking the time to analyze our outcomes is so important. It allows us to assess the success of our intervention and make an informed decision about whether or not to roll it out to all areas or pull it back and tweak the process again.

How can you do it?

  1. Know your plan. Be sure that you understand what you are trying to address and how your plan will help you achieve success.
  2. Know what you’re going to measure. What does success look like? How can you measure it? Be sure that you have measurable indicators related to your plan so that you can clearly analyze it.
  3. Collect data. Collect the data from your test.
  4. Analyze your data. How does the data stack up to what you expected? Is it evidence of a successful test? Did something happen that you didn’t expect? The answers to these questions will lead you into the final step of the PDSA cycle.

Have you ever used a PDSA cycle?

Process Improvement: PDSA Cycle (Do)

Why are leaders hesitant to focus on this?

Do we have the right plan? What if it could be better? Are you second guessing yourself? We are all prone to this second guessing. Perhaps it’s a fear of failure. Perhaps it’s the perfectionist inside of each of us. As leaders, this paralysis by analysis can cripple us and ultimately submarine our efforts to produce excellent results.

What is the case for doing it anyway?

If time wasn’t working against us, we might have a case against doing something until we have the perfect plan. As we know thought, time is a resource that we can’t make more of and for this reason, doing is our priority as a leader. Once you and your team have developed your plan, proceeding with the plan is the only way you will be able to further evaluate your performance.

How can you do it? 

  1. Choose your plan. Work with your team to determine the best plan to evaluate your process.
  2. Identify who is responsible. Be sure that your plan has a responsible party. Someone who can enact it and be accountable for how things unfold.
  3. Take action. Leadership is defined by the actions we choose in light of our responsibilities. In this case, enact your plan.

Have you ever used a PDSA cycle?

Process Improvement: PDSA Cycle (Plan)

Why are leaders hesitant to focus on this?

Once you have identified an opportunity for improvement using one of the tools we have discussed, you are ready to move onto the next phase. This phase is called the PDSA cycle. PDSA stands for Plan, Do, Study, Act. We are going to talk about the first step: Plan.

We may identify an opportunity so glaring or so obvious that we want to jump right into implementing the change. PDSA allows us to test the change on a small scale.

What is the case for doing it anyway?

Though we may want to dive right into a full scale correction, the test will help us ensure that our proposal is adequate for helping improve the process. The plan phase is the first step in the correction. Here you will craft a strategy for how to improve your process and develop a test for your intervention. This test will serve as a baseline for a broader deployment of your change. Because the scope will be small, it will allow you to identify issues with the plan without having too broad of an impact on your overall processes.

How can you do it? 

  1. Choose a process improvement tool. Using whichever process improvement tool best fits your opportunity, analyze your process.
  2. Identify your opportunity. Where are your gaps? What does your tool tell you needs improved? This will be the focus of your plan.
  3. Consult the experts. Don’t develop your plan in a silo. Invite experts into your process and people who can provide constructive feedback.
  4. Develop a plan. Using all of this information, finalize your plan to test your change. Consider what portion of your process you want to test and how your test can be measured.

Have you ever used a PDSA cycle?  We learn best from each other’s experiences.

Process Improvement: Benchmarking

Why are leaders hesitant to focus on this?

Why do we need to know how other people are doing it? We just need to worry about what we can control. These are some common refrains of isolationist thinking. While not too common, some leaders think it is best to focus all of their energy on what they can control and not to worry about what others are doing.

What is the case for doing it anyway?

When athletes compete, they compete against one another. It may be head to head or against a posted time or distance. Competing in business isn’t any different. We have to be able to measure ourselves against the best in our respective fields in order to move forward. Benchmarking is just that. It is a tool that allows us to use data to measure ourselves against the best in our fields. Data can be found in numerous locations. In some cases, data is publicly reported by each company. In other cases, we have to work harder to mine accurate data.

How can you do it? 

  1. Identify a measure. Identify a key measure of success for your organization. This should be a measurement that will help identify successful performance for your organization.
  2. Find out who does it best. If you want to be the best, you have to measure yourself against the best. Search your industry literature and see who is a high performer in the indicator that you have chosen.
  3. Compare. Once you have your data and the data from other organization, it’s time to see how you stack up.
  4. Evaluate. No tool is effective if we fail to evaluate the data it produces.

Have you ever used benchmarking to evaluate a process? Log on and join the conversation at www.somc.org/blog.  We learn best from each other’s experiences.

Process Improvement: Value Stream Mapping

Why are leaders hesitant to focus on this?

The value stream map is very similar to last week’s tool, the Spaghetti Diagram. Almost all jobs have processes that are considered routine. Most of the time, you might not even think that most of these processes are a candidate for improvement. However, if you do happen to consider one of these routine processes, your familiarity with the process might be your biggest barrier to improvement. It can blind you to gaps and opportunities because you think you already know everything that there is to know about it.

What is the case for doing it anyway?

In this case, the Value Stream Map is best applied to a process that is performed beyond the constraint of a singular location and therefore can’t be easily mapped visually. The tool will help you visually represent a process in a way that aims to help you identify wasteful or unnecessary steps in the process. It will require you to break each individual step down into one of two categories: value added step and non-value added step. This simple step is a powerful one that enables you as a leader to clearly sort through pieces of your process.

How can you do it? 

  1. Select a process. Identify a process that you want to evaluate. The best candidates for this tool are processes that can represented spatially.
  2. Create your flow chart. Almost all process can be represented visually. Create a visual representation of your process by identifying key steps or components into a flow chart style.
  3. Create value. Consider each step and whether or not it is necessary to achieve the desired procedural outcome. If it is, then it adds value. If it isn’t then it doesn’t add value.
  4. Evaluate. No tool is effective if we fail to evaluate the data it produces.

Have you ever used the value added concept to evaluate a process? Log on and join the conversation at www.somc.org/blog.  We learn best from each other’s experiences.

Process Improvement: Spaghetti Diagram

Why are leaders hesitant to focus on this?

Almost all jobs have processes that are considered routine. Most of the time, you might not even think that most of these processes are a candidate for improvement. However, if you do happen to consider one of these routine processes, your familiarity with the process might be your biggest barrier to improvement. It can blind you to gaps and opportunities because you think you already know everything that there is to know about it.

What is the case for doing it anyway?

Routines are necessary. They help us establish consistency in our processes. These consistencies help improve results. However, routines can also be where some of the worst inefficiencies hide. The spaghetti diagram is a tool that can help us find these opportunities. It is a simple visual tool that any team can use to map their processes and see if there are ways to make improvements.

How can you do it? 

  1. Select a process. Identify a process that you want to evaluate. The best candidates for this tool are processes that can represented spatially.
  2. Create your map. Almost all process can be represented visually. Create a visual representation of your process by identifying key steps or components. If a map of the physical space where your process take places is available, this is best for maximizing the effectiveness of this tool.
  3. Make spaghetti.The spaghetti in the diagram are the lines generated by drawing on your map to represent the steps of your process. Draw all possible iterations of the process. It may help to incorporate different colors into your diagram to enhance the visual effectiveness of your diagram.
  4. Evaluate. No tool is effective if we fail to evaluate the data it produces.

Have you ever used a spaghetti diagram to evaluate a process? Log on and join the conversation at www.somc.org/blog.  We learn best from each other’s experiences.

Process Improvement: The Fishbone Diagram

Why are leaders hesitant to focus on this?

The fishbone is a form of cause and effect analysis. It is different than the 5 Why approach that we discussed last week. However, the objective is the same. It seeks to help us identify the cause of an undesirable outcome. As leaders, we may be tempted to settle for what appears to be the obvious answer. The fishbone diagram helps stimulate a dialogue that is more thorough and often helps drill down into a deeper under standing of the root cause.

What is the case for doing it anyway?

The fishbone is a tool for mildly complex problem solving that doesn’t require a lot of data analysis. It also allows for a team to discuss multiple potential root causes and document all of the information in one location so that is can be visually analyzed. This is a great tool to use at a leadership retreat or planning session where multiple ideas can be discussed in a medium to large sized group setting.

How can you do it? 

  1. Identify an opportunity. In order to arrive at answer, we must first have a clearly defined problem. Write out the problem or opportunity statement on a large board or flip chart.
  2. Makes the bones. The initial statement should be written to the far right and each possible cause should be written to the left. Each topic will make one bone of the fishbone diagram.
  3. Drill down.There may be sub-topics under a specific cause. Discuss them in detail until the idea has been exhausted. This should be documented with the corresponding bone on the diagram.
  4. Identify the cause (or causes). This process may lead to multiple root causes. Once you and your team feel that you’ve exhausted the potential causes, assess your information and decide which causes require action.

What are some examples of how you have used this process to stimulate a problem solving discussion? Log on and join the conversation at www.somc.org/blog.  We learn best from each other’s experiences.

Process Improvement: Why Why Why Why Why (5 Whys)

Why are leaders hesitant to focus on this?

The first tool we are going to take a look at is called the Five Why Analysis or 5 Whys. You may be tempted to overlook this tool because it seems too simple. The truth is, it is simple. Its simplicity is part of the key to its effectiveness. Don’t be fooled, this tool can help you get to the root cause of a problem or opportunity in no time.

What is the case for doing it anyway?

5 Whys is a process improvement tool that doesn’t require any special training or statistical analysis. It focuses on a basic step by step approach to uncovering the root cause of a problem. By continuingly asking why something happens, you are able to drill down to the root cause of a problem quickly and directly. The number five is just a reference to a rule of thumb for iterations of the question why. You may find that a successful analysis takes a few more or a few less steps depending on its complexity. To learn more about the 5 Why tool to problem solving click here.

How can you do it? 

  1. Define the problem. In order to arrive at an answer, you must first have a clearly defined problem. Write out the problem or opportunity statement to initiate the process.
  2. Ask why. The first step is to ask why your problem statement is true. The answer to this question will launch into your root cause analysis.
  3. Repeat. Continue the process of asking why until you and your team are confident that you have arrived at a root cause for your problem that is actionable.
  4. Make a plan. Once you have your root cause, take action. Create a plan that is actionable and measurable.

What are some examples of the 5 Why technique that you have used to improve a process?  Log on and join the conversation at www.somc.org/blog.  We learn best from each other’s experiences.

Process Improvement: Having the Right Tools

Why are leaders hesitant to focus on this?

Have you ever heard anyone describe themselves as a creature of habit? I have! If I am being honest, that statement might have been made for me. As a matter of fact, most of us are guilty of being such a creature from time to time. Even if you’ve successfully avoided that rut, I can assure that you work with people who haven’t. Don’t believe me…I’ll prove it to you. Have you ever tried to change a process at work? Has anyone ever told you that the new way “isn’t how they do it around there” or some variation of that? If so, you have creatures of habit within your circle of influence.

What is the case for doing it anyway?

I am not trying to convince you that all habits are bad. Of course they aren’t. However, all opportunities aren’t the same either. Knowing this, we must seek to equip ourselves with the right problem solving tools for the job. Our habits will naturally draw us towards using tools that we are familiar with and that have helped us achieve success in the past. These tools should be considered in evaluating an opportunity, but we must be certain that we have the right tool for the job. I’m particularly fond of the expression “you can’t fit a square peg in a round hole.” I think it applies to this discussion quite nicely.

How can you do it? 

  1. Seek advice from other leaders. Consult with your colleagues when faced with an opportunity that you aren’t sure how to solve. Leveraging your collective experience for the good of the organization will help produce the best results.
  2. Seek advice from your professional organization. I am a member of the American Society for Healthcare Engineering. We have multiple resources, including a listserv and publications, that allow people in my field to share opportunities and solutions. I am sure that most of you have such resources as well. I would encourage you not to underestimate how helpful they might be.
  3. Put tools in your tool belt. Over the next few weeks, I am going to focus on some of the most basic process improvement tools. It is my hope that by introducing you to some simple tools, you will be better prepared to handle opportunities as they arise.

 

What are some of your favorite tools to use for process improvement?  Log on and join the conversation at www.somc.org/blog.  We learn best from each other’s experiences.