Assignment

4633 Continuous Quality Improvement

Module VI

Terminal Performance Objective:

Upon completion of this unit, the student should be able to recognize and utilize tools for quality management.

Enabling Objectives: 

Upon completion of this unit, the student should be able to:

• Expand the abbreviated flowchart developed in Unit III, or expand a new idea into a SIPOC Chart.
• Construct a flowchart from the information gathered in the SIPOC.
• Conduct a brainstorming session.
• Construct the following: affinity chart, relationship diagram, cause and effect diagram, force-field analysis, decision matrix, tree diagram, and action plan.
• Analyze gathered information through the use of tools 

The Manager's Tool Kit - Part Two Tools for Targeting Improvement

This unit will focus on the second set of tools: tools for making improvements. These tools allow you to not only see a graphic representation of the problem, but also to illuminate barriers and stumbling blocks. These are the tools to specifically find solutions to the problem and narrow the solutions down to those that are feasible. Remember as you work through these to be serious about mapping out the problem and taking into account all barriers. 

The tools for targeting improvement may be as simple as discussion or as complex as months of study, but the success in continuous quality improvement lies in the understanding you gain through the knowledge and use of the appropriate tools.

Tool 8 - Flowchart

A simple flowchart is a crude picture of process steps in sequence, each contained in a box and connected with arrows to the steps that come before and after. More complex flowcharts include symbols for activities such as decisions, waits, stops, starts, arrows, and documentation.

Construction

List the steps involved in a process using direct observation, brainstorming, or consultation with the people involved in the steps. Arrange the activities and decisions in chronological order, depicting each with the appropriate symbol. Ask questions about inputs, throughputs, and outputs.

Questions about input:

• Who provides the input?
• Who receives the input?

Questions about throughput:

• What is done with the input?
• What checks or tests are performed at each step?
• What happens if the step does not pass the test?

Questions about outputs

• Who receives the output?
• Where does the service go?
• What happens to it?

Flowchart Activites

	Stop and Start	This circle shows the start or end of a process.
	Activity	The rectangle reflects a single process step.  Briefly describe the step inside the box.
	Decision	The diamond signifies that a decision is made here.  It indicates a branch point.  The nature of the decision is written inside the diamond in the form of a question.  Each alternative path or branch is labeled with a possible answer.  The answer determines the path or branch taken to the next step.
	Wait	This symbol signifies a delay or waiting period.
	Arrows	These point out the direction of flow from one activity or decision to the next.
	Document	This symbol signifies the need to document an activity.
Start                Activity              Wait          Decision        Document          Stop

Flowchart Video

You are finished if:

1. You have connected all inputs to outputs.
2. The flowchart shows both the parallel activities and the sequence of events.
3. The chart includes all decisions that affect the flow of the process.
4. The chart shows all possible paths that things, work, and/or people take, even the unexpected.
5. You have listed all responsible parties across the top of your chart.  Without losing chronological sequence, place each activity and decision in the process under the people responsible.
6. If possible, do a walk-through or observation of the actual process to verify the flowchart.

Tips for developing flowcharts

• Make sure you involve the right people in making the flowchart, including those who actually do the work, suppliers to the process, customers, and managers and supervisors involved in its control.
• Use many sheets of flip chart paper, Post-itTM notes, etc., so that you can move steps around flexibly until you think you have positioned all of them correctly.
• With complicated processes, do a crude flowchart with only the major steps and then break them down into sub-steps.
• Remind yourself that the time is worth the effort because your data collection and problem-solving rely on your flowchart's accuracy and thoroughness.
• Use a SIPOC to identify suppliers (S), inputs (I), processes (P), outputs (O), and chart (C).
SIPOC Chart

Suppliers	Inputs	Processes	Outputs	Customer
Physician	Patient orders	Request for exam	Request is written	Front desk
Front Desk	Request	Notifies U/S tech	Notify patient	U/S tech
U/S tech	Notified of patient	Retrieves request	Scans patient	Radiologist
Radiologist	Patient films	Reviews	Rescans or not	Patient

From here the information can be expanded into a flow chart. The flow chart may look like a series of boxes and arrows, but each box is unique in its relation to each step and its shape indicative of its symbolism.

Example Flowchart

full flowchart

 

Uses of Flowcharts

The most beneficial result of using flowcharts is that you will be able to see a process and follow it without running behind people all over your institution. As you map out each step, you will be able to not only discover problems with flow, but you discover unnecessary steps that can be eliminated. Everyone can be involved and the finished product will give you visible justification to make changes. Isn't that a great deal better than just saying, "This process doesn't work."?  Some excellent uses are:

• To get a clear picture of the process you already follow to see its logic or lack of logic
• To understand and walk through even a complex process without leaving the room.
• To more easily figure out what kind of information is needed to move forward.
• To identify problems.
• To make conscious decisions about the scope or focus of improvement efforts.
• To create a new flowchart of the improved process.

Tool 9: Brainstorming

Brainstorming is not only powerful and exciting, but it can be lots of fun. Through the use of brainstorming, people involved get a chance to contribute and respond in a non-threatening atmosphere. Ideas will surface which otherwise may never have been discovered.

How to Conduct Brainstorming

Generation Phase

This phase can be either structured or unstructured.  The leader reviews the rules with group members, clearly state the question or purpose, writes it as the header on a flip chart, and then invites and records responses.

• Quantity, not quality.  The more, the better.
• Discussion, judgment, and criticism are all suspended.
• Build on others' ideas.
• Practicality is unimportant
• Three-word minimum per idea; otherwise, it's difficult to know what is being suggested.
• Six or sever word maximum; otherwise, you will hear speeches.
• Record every idea.
• Do not let anyone break the rules.
• Move quickly.  The session should last only 5 or 10 minutes.

Clarification Phase

The group reviews the list to ensure that everyone is clear about what all the items mean.  This clarification is important before ideas are judged so that in later discussion, unclear ideas are not dismissed along with unworkable ideas.

Evaluation Phase

The group considers the list and rules out duplications, irrelevant ideas, or ideas considered beyond its scope or power.  Screen and sort the list to narrow down the list of ideas to a select few.

Uses of Brainstorming

• Generate a list of problems to tackle
• Find alternative solutions to a problem.
• Find factors that contribute to a problem.
• Generate alternative problem statements.
• List obstacles that might interfere with successful implementation of a plan.
• Many, many others.

Tool 10 - Affinity Charts

Affinity charting is a process for generating an abundance of ideas, opinions, perceptions, issues, or activities and then organizing them into natural groups of the related item.  The resulting clusters are easier to discuss, manage, and manipulate than the large number of individual elements originally generated.  Patterns may begin to emerge that help make sense of different ideas.  Affinity charts come from brainstorming sessions.

Affinity Chart From a Brainstorming Activity

A.  Initial Brainstorm
Solutions to problems Results that will satisfy administrators Good feelings among us Happier patients Fewer fires to put out Harmony among staff Faith in possibility of solving problems Teamwork among staff Teamwork between departments More physician cooperation Happier physicians No more cynicism Better relationships between departments Less frustration when things go wrong More efficient operations Better problem-solving skills among us
B.  Resulting Two-Part Affinity Chart
Our Team's Objectives
Concrete Improvements Solutions to problems Fewer fires to put out Results that satisfy administrators	Heightened Customer Satisfaction Happier patients More physician cooperation Happier physicians
The Values We Want to Guide Us
Better Interdepartmental collaboration	Growth/Gratification for Team Members
Better relationships between departments	Better problem-solving skill among us
Less frustration when things go wrong	Faith in prospect of solving problems
More efficient operations	No more cynicism
Teamwork; less turf	Harmony among us