Personal Improvement Project Topic
QKhalid
PersonalContinuousImprovementworkBook.pdf
An engaging way to using Quality Improvement
Duncan Neuhauser et al
Personal Continuous Improvement Work
Book
Duncan Neuhauser, PhD Department Of Epidemiology and Biostatistics
School of Medicine Case Western Reserve University 10900 Euclid Avenue, Cleveland,
OH 44106-4945, [email protected]
Silvia Myhre, MBA Santee, California
Farro.kh Alemi, PhD Graduate School of Health Science
Gebrge Mason University Tel 703-993-4226 [email protected]
Foreward to the Seventh Edition
This workbook was first produced in 1997 and since then has been used by health professional students all over the world to learn about quality improvement and what is needed to change some aspect of one’s life. This book is in the public domain and can be reproduced without permission. It is available online at www.mceconnection.org un- der “personal quality improvement 2001”.
It has been translated into Norwegian (Second edition by Jana Kyrkjebo), Swedish (Sec- ond edition by Michael Bergstrom), Chinese (by Jain Wen Cao), Portuguese (Helen Smits), Korean and German.
If you wish to benchmark your project against other projects, this can be done at Dr. Alemi’s website http://improvement.gmu.edu . Also, see Alemi, F. Neuhauser, D. Ardito, S., Headrick, L., Moore, S., Hekelman, F., and Norman, L. “Continuous Self Improvement :Systems thinking in a Personal Context” The Joint Commission Journal on Quality Im- provement, February 2000 Vol 26 No 2 pp 74-86.
Kingsham Press gratefully acknowledges Prof. Duncan Neuhauser’s generous permission to reproduce with changs to the layout and presentation of this work book.
Personal Continuous Quality Improvement Project Work Book1
Contents
SUMMARY
BACKGROUND
LANGLEY, NOLAN & NOLAN MODEL
PDSA CYCLE
TOOLS OF QUALITY
FLOW CHART
CAUSE & EFFECT DIAGRAM
CONTROL CHART
HISTOGRAM
RUN SHEET
PARETO CHART
SCATTER DIAGRAM
PERSONAL IMPROVEMENT PROJECTS
STORYBOARD FORMAT
2
3
5
6
8
9
12
15
17
19
21
23
24
26
i
ii
iii
APPENDIX 1 - RESULTS TO DATE
APPENDIX 2 - CONTROL CHARTS
REFERENCES
Personal Continuous Quality Improvement Project Work Book2
Summary
Thoughts for Improvement:
⁕ Before you try to solve a problem, define it.
⁕ Before you try to control a process, understand it.
⁕ Before trying to control everything, find out what is important.
The purpose of this manual is to assist people in developing a personal quality improvement project utilizing various standard quality improvement “tools”. The second stage and overarching aim is to teach the understanding of quality improvement ideals on a personal level, subsequently applying this knowledge in a professional setting.
Personal Continuous Quality Improvement Project Work Book3
Background The assignment of creating a personal quality improvement plan can be, at first glance, a rather intimidating task. You might ask yourself: What exactly does personal quality improvement mean? How can I improve it? Will it take long? What’s in it for me? How will this help me when I’m at work?
Let’s look at the questions, one by one. First, what is personal quality improvement? This is a term used for identifying areas in our personal lives that create waste or redundancy of effort; in general, a mismanagement of resources. The first task is to identify areas perceived as “oppor- tunities for improvement”. For instance, what do you currently do, that can either be done better, quicker or with less waste? Students have done projects focusing on improvements in areas such as: getting to work on time, better use of time in studying, or improved budgeting on spending money.
Second, how can I improve? Once you have identified an area to be improved, immediately begin to keep data on the process. The more in- formation you are able to gather, the stronger your analysis will be. If you want to improve your finan- cial position - start today, write down all your ex- penditures! Once you have collected adequate data, the analysis can begin. Using the various tools and charts described in this manual, you can evaluate the data for trends, areas of waste, and opportunities for improvement. In many cas- es, getting the information down on paper can
be an eye opening experience. After they have compiled several weeks of data, students are amazed at the amount of money spent on “junk” food, or time wasted because of a “bad” pro- cess. With this information, you are armed with the knowledge of where improvements can be made. Small changes at first are recommended. Test them out, look at your results, draw conclu- sions from what you have learned and continue the process.
This leads into the third question: Will it take long? The bottom line is improvement is an on-going process; it never really ends. The good news is that by working in small cycles, gains or improve- ments are long term and the likelihood of failure is minimized. Most often, an improvement project is explored (perhaps through the prompting of a class project), then implemented. Positive results generate additional improvement projects, typi- cally on a larger scale, utilizing the same prin- ciples and tools to solve professional projects. Before you know it you have several projects run- ning simultaneously, on a personal level and pro- fessional level.
Of course, as a person with minimal free time, it is natural to ask: What is in it for me? With regard to course work completing the project will of course help your grade. But, you are interested in the “big” picture. Learning the tools of quality improve- ment will enable you to understand the areas of waste that plague both professional and personal time. You will have a better understanding of methods used to improve all areas of your life. This translates into a variety of improvements such as more free time, better health, a better work environment, improved customer satisfaction, or improved work flow.
Personal Continuous Quality Improvement Project Work Book4
The final question: How will this help me when I am at work? If your improvement project was to get to work on time, the answer should be fairly clear. But we all know that there is more to the process than just getting to work on time. Understanding the quality improvement process on a personal level makes the lessons learned more salient. It creates a sense of accomplishment and that feeling can be contagious. Once you have mastered the first project, the second one isn’t quite as intimidating. The tools and the approach are the same for a professional project. The players will change and the data to be collected will change, but overall the process remains constant. Start small, make changes, analyze results, realize gains, continue!
Suggestion: Do something you can measure at least everyday. If you can only measure once a week it takes a long time to show you have made a significant difference. Things like exercise, diet, blood pressure, time management, are good because they can be measured frequently.
In addition to this, as a leader in the health care field, personal demonstration of quality improvement techniques reinforces its im- portance. This sends a strong signal to the organization of your commitment to improvement.
Helpful Hints: ⁕ Clearly define your goal for each cycle - Put it in writing!
⁕ Keep a log or diary of your progress.
⁕ Data collection should be on a daily basis - start immediately!
⁕ Assemble data graphically (see the section on tools).
Personal Continuous Quality Improvement Project Work Book5
Langley, Nolan and Nolan Model for Improvement
Langley, Nolan and Nolan have written extensively on improvement processes. Improvement comes from the application of knowl- edge; therefore, improvement must be based on building knowledge and applying it appropriately. Langley, et al believe that there are three basic questions that form the basis for the “Model for Improvement.”
1. What are you trying to accomplish?
⁜ Provides an aim for improvement efforts ⁜ Keeps effort focused
2. How will we know that a change is an improvement?
⁜ Provides criteria for determining if the change resulted in an improvement ⁜ If criteria improve and are sustained over time, then it can be concluded that the change is an improvement
3. What changes can we make that will result in improvement?
⁜ Develop change and test on small scale ⁜ Test done to predict effect of change. Provides flexibility for alterations to the effort (see PDSA cycle).
Personal Continuous Quality Improvement Project Work Book6
After you identify a process needing improvement, develop a Plan that you believe will help you achieve your goal. Write down the plan delineating clear goals. A personal plan might be wake up earlier, more time for exercise, or reduce the amount of money spent on “junk” food.
The next step is to implement the plan (Just Do it!) It is important to rigorously pursue data collection which will measure whether or not the plan has been successful.
After you have pursued the plan for a period of time Study the results. Does the data support change (improvement)? Do you need to modify the plan or make alterations?
If modifications are necessary, then make them and Act. Also important in the “act” phase is positive action to consolidate, strength- en and support the change achieved. This requires explicit energy - without it, things tend to slide back to the status quo. The cycle starts all over again. As changes are made to the initial plan, it is similar to developing a new plan and therefore, the process con- tinues: Plan, Do, Study and Act once again.
Outside: Scientific Method Inside: Shewart’s Plan-Do-Study-Act cycle
PDSA Cycle Plan-Do-Study-Act (PDSA) Cycle:
Description: The PDSA cycle is a method by which improvements can be made on small scales and examined for success, prior to continuing further changes. The exercise should have built into the procedure clear measures to check progress. This is also referred to as the PDCA cycle: Plan-Do-Check-Act.
Method: To begin a PDSA cycle, start by clearly identifying an area that you would like to improve. For example; decrease fre- quency of snacking, increase number of sessions at the gym, improve budget control. Be sure that your improvement allows adequate data collection (i.e. something that you can monitor on a daily basis). Start your data collection immediately! The more information you are able to gather and process the better analysis you can perform.
Personal Continuous Quality Improvement Project Work Book7
A Practical Example Example: Mary has decided to improve her health. One way to achieve this goal is by reducing her weight 15 pounds. She knows she can do this through a variety of methods, including exercise and diet control. The first method she would like to try is to follow a low fat/low calorie diet. Mary’s PDSA cycle might look something like this:
Plan: Go to the library and check-out several books on nu- trition. Plan a menu for one week that has a reduced c a l o - rie/fat intake. Mary’s aim for the first cycle is to lose 3 pounds in one week.
Do: At the beginning of the experiment, Mary weighs her- self in the morning, noting her weight. She maintains the diet for one week. Everyday she weighs herself and records the number
Study: At the end of the week if she has lost the weight as intended, the diet (plan) is working. If not, she needs to re-evaluate her plan.
Act: If the diet is working, she will continue the process every week to lose the desired 15 pounds. Everyone who has tried to lose weight knows that the work doesn’t stop when the goal weight is reached. Further effort is needed to keep the weight off (hold the gain)!
Personal Continuous Quality Improvement Project Work Book8
Seven Tools of Quality The following section outlines various charts and instruments utilized in improvement efforts. These tools can be used to better understand a process in order to improve it. Not all the tools will be applicable to the data you are collecting. Be sure to first look at the information and understand what it is you want the information to tell you, then pick an appropriate tool. More than one can be useful to measure different aspects of your study.
Seven Quality Control Tools Cause & Effect Flow Chart
Pareto Chart
N um
be r
Type
Run Chart
Time
M ea
su re
Histogram
N um
be r
Measurement
Control Chart
N um
be r
Reading Over Time
Scatter Diagram
Variable 1
Va ria
bl e
2
⁜ ⁜⁜ ⁜ ⁜ ⁜⁜ ⁜ ⁜
⁜⁜⁜ ⁜ ⁜⁜
⁜ ⁜⁜ ⁜ ⁜ ⁜⁜⁜
⁜ ⁜ ⁜
⁜ ⁜
⁜ ⁜
⁜ ⁜ ⁜
Personal Continuous Quality Improvement Project Work Book9
Flow Chart1
Definition: A system used to understand and make a picture of an entire process. For complicated processes it is important to have all members participate in the design of the flow chart, to have all operations properly represented.
Method: If possible, gather all participants connected to the process. Start at the beginning and put down on paper the steps that are required to complete the process. It may be helpful to draw a map of the physical locationof equip- ment or departments to facilitate the movement of goods/paper. Be sure to include all steps.
Student Project: A recent improvement project submitted by a student focused on incorporating exercise into an already hectic work schedule. She prepared a flow chart to demonstrate the various steps required to integraed it into her daily schedule. A copy of the flow chart title “Will I walk today?” is on page 11.
Advantages: People working within the process understand their own area best, which can be fit into the overall p r o c e s s . Once the entire process is laid out improvements can be easily identified.
Pitfalls: Can be time consuming. Difficulty in coordinating all the proper participants. Too many “why” questions when first preparing diagram. Get all the information down - as it currently occurs - then analyze.
Personal Continuous Quality Improvement Project Work Book10
One Intern’s Experience with an Admission
Yes
Yes
Yes
No
No
Call from unit clerk: “Mr H is here!”
08:09
Is he a 10 B firm patient?
end
end Is his admit
time long call?
Finish rounds with SAR
08:19 Stop rounds
Night Float signs out
08:45 RN from floor calls:
“Can Mr H have breakfast?”
08:58 Look at ED Sheets (can’t read), labs (none) call for medical rec-
ommendations (no answer)
Find the chest X-ray and look at it
Go see patient
Start history and physical (H & P)
Decide patient is sick now!
Look for blood culture supplies
Find supplies on neighbouring floor
Draw labs and blood culture
Find imprint card and lab slips, find chart paper, make
out and sign the slips
Call for more pneumatic tubes to send labs (none there)
Tube labs (each in its own tube) - microbiology, hema-
tology and chemistry
09:50 Find patient ID card, find pa-
per, and write orders
Answer a call from another intern: “Where are you?”
Finish orders; write orders a second time on
antibiotic sheet: tax to pharmacy
Find Mr H’s RN
Go over orders with the RN
Answer call from hematology lab: “Why two tubes?”
“Because I had the blood”
10:13 Give my pager number to
unit clerk (patient is a board- er on different floor)
10:26 Answer page for stat work
on another patient
11:00 Continue to round on other patients
11:36 Finish rounds
11:43 Finish H&P on Mr H
12:17 Work-up finished
12:22 Call again for medical records
15:30 Mr H gets antibiotics
Personal Continuous Quality Improvement Project Work Book11
Flow Chart -“Will I Walk Today?”
Wake up
Go to work no
no
no
no
no
It’s the weekend
yes
yes
yes
yes
yes
Bought tennis shoes
Is partner at work?
Time for a full lunch?
Anyone else want to walk?
Can’t walk w/o comfortable shoes
Can’t walk w/o a partner
Eat on the run No walk
Accomplished Goal
Walk the basement for half an hour
Meet walking partner in office
Personal Continuous Quality Improvement Project Work Book12
Cause-and-Effect Diagram (Ishikawa
or Fishbone diagram) Definition: A method for analyzing process dispersion. The purpose is to relate causes and effects.
Method: Determine the area you want to improve. A good idea is to write this statement on a piece of paper to remind you of the aim (the effect). List all the items that promote this effect. These become the main “causes”. Pull out your magnifying glass and examine what leads to these main causes. A good suggestion is to look at the issues in their broadest sense. Many items may be brought to the table that are beyond your control, but having them out in the open facilitates the understanding of their impact.
Student Project: Another project was completed by a student who wanted to begin an exercise routine. After monitoring her activities for one month, she created a fishbone diagram to identify underlying components. As you will see in her Fishbone diagram labeled “Exercise” on page 14 she cited four main functions that contributed to the exercise routine.
Advantages: Provides an excellent means to facilitate brainstorming by focusing on issues at hand.
Pitfalls: Might become very complex, requiring time to work out. Also may be difficult in some areas to sort out relationships and get them down on paper.
2
If we look at the example of Mary wanting to lose weight, she realizes that she is not getting enough exercise. Therefore, the “Effect” is “lack of exercise”, but what really causes Mary not to exercise? Some ideas she came up with include: lack of time, the gym is closed, bad weather, or not in the mood. These are her main “causes”, but if she digs a little deeper the lack of time issue can be attributed to her wanting to sleep in late because she was up late watching TV.
Personal Continuous Quality Improvement Project Work Book13
Causes of Cost Variation For Asthma Care
PATIENT
PHYSICIAN
SITE OF CARE
SERVICES
Severity of symptoms
Severity of disease
Compliance
Costs of Asthma Care
Success of Treatment
Complications
Accessibility
Knowledge of prices of possible
tests and treatments
Patient education
Compliance
Cost to patient
Other illnesses
Use of emergency
room
Time of day
Day of week
Office
Phone
Primary Care provider available
Hospitalisation
Treatment
Admission
Pt. desire for tests
Diagnostic tests
Relapsing symptoms
Visits
Personal Continuous Quality Improvement Project Work Book14
Fishbone diagram: Reasons for Exercising
Exercise
Motivation Equipment/ Gymnastics
Find the time
Comfort
Too much stress
Too much time to unwind
Exercise vs. Diet
Benefits of Diet
Benefits of Exercise
Mood
Good Equipment
Stationary Bike
Treadmill
Studying
Family Activites
Cooking
Laundry
Errands
School Days (commuting)
Kids Sick
Personal Continuous Quality Improvement Project Work Book15
Control Chart
Definition: A control chart is a method that looks at data collected in a process, understanding that variation will occur. Built into this system is the tolerance for variation (upper and lower control limits). Identifying the items that fall outside the control limits will assist in lo- cating the issues that are causing this tremendous fluctuation. The aim is not to redesign an entire process, but to locate the factor that is causing the disruption.
Method: Collect data on the process you are evaluating over several days, batches or lots. Figure the average(xl and the average range of the data (R). To calculate the upper and lower control limits use the mean ±2 sigma. Please refer to Appendix 2 for an additional example of calculating a control chart.
Advantages: Creates a method in which it is easy to chart information and quickly detect if a process is out of control (outside tolerable limits).
Pitfalls: The chart can show items that are not within tolerable limits, but does not offer suggestions at their cause or how to eliminate (con- trol) them. Also, depending on the information being gathered, the process may not remain stable. For example, if you are charting your speed at jogging, over time your speed may change (quicker) and a re-evaluation of the chart is necessary.
3
If we use Mary’s decision to lose weight as an example, she may want to chart her caloric intact. She would start by keeping track of the calories consumed on a daily basis for two weeks. Figuring the averages, then calculate the upper and lower control limits. Having done all this, what do the numbers tell Mary? If she continues to monitor her calories, by plotting them on the chart she can determine if she is within the area that she has deemed appropriate for weight loss. However, if she notices days that are not within the limits, she can determine if they are a result of a change in her eating habits or special cause (i.e. Uncle Filbert’s birthday party!). A general change in eating habits can then be addressed and corrected, Uncle Filbert’s birthday, fortunately occurs only once a year and should not cause too much concern.
Upper Control Limit = data average + 2 (range average divided by 1.13) Lower Control Limit = data average - 2 (range average divided by 1.13)
Personal Continuous Quality Improvement Project Work Book16
Control Chart Mary’s Monthly Caloric Intake
Days of the Month
N um
be r o
f C al
or ie
s
3,000
2,500
2,000
1,500
1,000
500
0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29
Lower Control Limit
Upper Control Limit
Uncle Filbert’s Birthday
Personal Continuous Quality Improvement Project Work Book17
Histograms4
Definition: A pictorial summary of variation in a data set.
Method: After data has been collected over a period of time, it is plotted on a bar chart to represent the variation in performance. If Mary wants to look at her jogging performance, a histogram may be a good tool to determine which days she is running the best. By keeping track of her distance on a daily basis she can track her progress and strongest day for running. Label the “x” axis “Days of the Week” and the “y” axis “Distance Run”.
Student Project: Page 18 is an example of a histogram prepared by a student wanting to increase her level of exercise through walking. The results were posted on a histogram, clearly showing an increase in mileage walked during a 30 minutes session. Note: Sundays she did not walk February 4, 11, 18 and 25. This is “special cause variation”. She could have shown the histogram for 6 days a week dropping Sunday if that is part of her plan. This data could also be presented as a run chart.
Advantages: Data can sometimes be overwhelming, a picture may be easier and quicker to interpret. Through visual representation, a pattern can be easier to discern.
Pitfalls: Conclusions should not be drawn on too small a sample, with a larger sample more confidence can be built into the expla- nation of peaks and valleys.
Personal Continuous Quality Improvement Project Work Book18
Walking Distance
Miles walked in 30 minutes
Days in February Walked
2.6 2.5 2.4 2.3 2.2 2.1 2
1.9 1.8 1.7 1.6 1.5 1.4 1.3 1.2 1.1 1
0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0
28th27th26th25th24th21st20th19th18th17th14th13th12th10th7th6th5th4th3rd
Personal Continuous Quality Improvement Project Work Book19
Run Sheets
Definition: A simple data recording form that has been designed to not only collect data, but readily interpret the results from the form itself.
Method: Create a data collection sheet that will enable the operator to not only plot the information, but see the results in trend format immediately.
Student Project: Based on data collected during a one week period, a student decided to reduce her caffeine consumption. The implementation process substituted coffee, tea or cocoa with decwaffeinated beverages. To chart her progress she prepared a check sheet. As you can see on page 20 the chart shows caffeine consumption (in milligrams) for a 28 day period. After the initial week of observation then implementing a plan, her caffeine consumption showed a marked decrease.
Advantages: Quick way to chart progress.
Pitfalls: The method does not offer any interpretation, only hard facts. When any type of data is collected, it is important to be accurate and know exactly what it is that needs to be measured/analyzed.
5
Mary could use this type of chart to look at her jogging times on a daily basis. The “x” axis can represent the “Days of the Week” and the “y” axis can represent “The number of minutes to run 3 miles”. Everyday after she runs she checks her time and puts a “dot” on that day/time intersection. As her times improve (hopefully), the line should slowly move down towards the “x” axis.
Personal Continuous Quality Improvement Project Work Book20
Run Chart Caffeine Consumption Over Time (28 Days)
C af
fe in
e (m
gs )
Day
600
500
400
300
200
100
0 0 5 10 15 20 25 30
Personal Continuous Quality Improvement Project Work Book21
Pareto Charts
Definition: A Pareto chart depicts a “maldistribution”, or a lot of problems that come from a small number. Typically, we use the breakdown of 80% of the problems come from 20% of the group.
Method: Data is gathered on a specific function or operation. The information is plotted on a chart and organized with the most frequent cause placed on the left with subsequent stacks continuing to the right in decreasing rates.
Student Project: Faced with many options, opportunities and excuses, a student was frustrated with her lack of exercise. Part of her personal im- provement project included recording the number of occurances that inhibited her from exercising. After 28 days she tallied these tick marks and prepared a Pareto Chart (see page 23). Based on her chart, she realized that studying was the chief culprit.
Advantages: Helps identify the “nasty” few that really need attention, helps focus change efforts.
Pitfalls: Too much data might not produce a clear-cut “nasty few”, so data will need to be refined for proper identification.
6
Mary may want to keep track of reasons why she is not exercising (look at your Fishbone diagram for ideas!). With all the reasons, which is really the one that is the biggest factor? She has cited on the Fishbone four main hurdles for not exercis- ing: (1) lack of time, (2) bad weather (3) gym closed and (4) not in the mood. Everyday she has not exercised, she puts a “tick” mark next to the reason. After several weeks of gathering information she prepares her Pareto chart. She notices that although she cited four reasons, the single most items that has caused her lack of exercise is “lack of time”. Armed with this knowledge, she can now make changes in her schedule.
Personal Continuous Quality Improvement Project Work Book22
Pareto Chart Top Reasons for Not Exercising
12 10
8 6
4 2
0
Stu dy
ing
Co mm
uti ng
(s ch
oo l)
Co ok
ing
Er ran
ds
Fa mi
ly Ac
tiv itie
s
La un
dr y
Kid (s)
Si ck
Personal Continuous Quality Improvement Project Work Book23
Scatter Diagrams
Definition: A non-mathematical method to show (visually) the relationship between two characteristics.
Method: The data is plotted on a graph, usually with the “y” axis for the characteristic we would like to predict and the “x” axis for the variable used for making the prediction.
Advantages: A method to determine quickly if there is a relationship between to characteristics.
Pitfalls: Just because two variables seem to be related, they may not necessarily be so. There may be other factors influencing the apparent relationship.
Scatter Diagram Mary’s Minutes of Exercise/Calories Burned
Week 1
Week 2
Week 3
Number of Minutes in Workout
N um
be r o
f C al
or ie
s B
ur ne
d
200
150
100
50
0 10 12 14 16 18 20 22 24 26 28 30
⁜
⁜ ⁜
⁜
⁜ ⁜
⁜
⁜ ⁜ ⁜
⁜ ⁜ ⸋
†
⸋ ⸋ ⸋
† ⸋
⸋ ⸋
⸋
⸋ ⸋ ⸋
⸋
† †
†
† †
†
†
† † †
7
Personal Continuous Quality Improvement Project Work Book24
Personal Improvement Projects
As you can see in this workbook, a variety of projects have been explored including:
Time Management - Improve travel time to work or school
- Study habits (less TV watching, fewer breaks)
- Sleep habits
Nutrition - Reduce snacking, coffee drinking
- Reduce calorie/fat intake
- Increase water intake
General Health Issues - Exercise (walking, jogging, weight-lifting)
- Hypertension
- Reduce blood sugar levels
- Improve peak flow for asthmatics
- Reduce weight
Others that you may consider - Personal budgeting, saving money
- Getting a job - Reading more
- Reducing interruptions
- Creating more personal time
- Spend less on soft drinks
- More prepared meals rather take outs
- Personal stress level
- Reduce smoking Fatigue reduction
- Medication compliance
Personal Continuous Quality Improvement Project Work Book25
While working on your project be sure to remember key points in constructing the experiment.
1 Clearly state the improvement effort
2 Begin data collection immediately
3 Try several small PDSA cycles
4 Plot your results using one or several of the charts
5 State whether an improvement was realized
6 Create a “next-step” process
Personal Continuous Quality Improvement Project Work Book26
Storyboard Format Storyboards are a communication vehicle to display your project to the public They general present the information in a standard- ized format facilitating understanding. There is not one “right” answer, but typically the following information should be displayed (this is the information that should be included for this project):
Your name
The Title (Area of Improvement)
What was chosen and possibly why Indicate your PDSA cycles Data and diagrams
Results (was an improvement realized and how was it measured?)
Next steps
Listed below are additional ideas on how to construct a storyboard:
Project Title
Your name or team members
Address
Phone numbers/e-mail
Publicly post your story board in the organization which will alert other employees that changes are being carried out. It facilitates future implementation of suggestions.
Statement of Problem
⁕ How do you know this is a problem?
⁕ Give bench-marking data.
⁕ Be brief.
⁕ Describe only one problem.
Personal Continuous Quality Improvement Project Work Book27
Define your problem without suggesting a solution. An example of a bad problem definition: “Information system is down too often.” A better statement might read: “Some patients wait more than 45 minutes for admission to be completed.”
In creating a process chart try to solicit every group members ideas separately before presenting the group with an integrated view. Get an understanding of the process but be ready to put in an entirely new process Start with an overview chart and add details later.
Description of the process
Pilot Study
⁕ Describe when the study was done.
⁕ What was the intervention?
⁕ How was data collected and by whom?
⁕ How was the data analyzed?
⁕ Who was involved?
Personal Continuous Quality Improvement Project Work Book28
Proposed Plan & Conclusion
⁕ Describe in detail the next steps.
⁕ Describe the timing of the next improvement.
⁕ Be specific. Be brief.
Did it work?
⁕ Display charts that are most appropriate for your data.
Personal Continuous Quality Improvement Project Work Booki
Appendix 1 Results to Date
Student Personal lmprovement Projects have been monitored with regard to improvement tools use, improvement realized and out- comes measured. In the fall 1996 semester students completed their personal improvement projects with only general directions. In later semesters students were given the project workbook with step-by-step directions and examples. Below are the results we collected:
Fall1996 (n=17) no workbook Spring 1997 to 1998 (n=66) with workbook
Number of Outcomes:
Measures Taken No Workbook With Workbooks 0 25% 0%
1 - 5 0% 15% 6 - 10 25% 9% 11 - 20 35% 15% > 20 15% 61%
100% 100%
Percentage of Students Using Improvement Tools:
Tool No Workbook With Workbooks Flow Chart 0% 45%
Cause & Effect 0% 50% Control Chart 0% 23%
Histogram 24% 62% Check Sheet 47% 32% Pareto Chart 0% 33%
Scatter Diagram 0% 17%
Students were surveyed if they felt an improvement was made: (Percentage of students)
Response No Workbook With Workbook (n=65) Not Yet 65% 9%
Not Sure 0% 2% Unmeasured 5% 6%
Measured 30% 48% Significant 0% 35%
100% 100%
Students were surveyed if they would continue working on their improvement:
Yes No Workbook (n=17) 41%
With Workbook (n=65) 86%
Personal Continuous Quality Improvement Project Work Bookii
Appendix 2
Control Charts
George measured the number of hours he studied each day for a week.
Day Hours of Studying Range 1 3.0 x 2 2.3 0.7 3 2.0 0.3 4 1.0 1.0 5 3.0 2.0 6 2.5 0.5 7 2.2 0.3
Number of Observations = 7 Mean number of hours studying, data average = (3+2.3+2+1+3+2.5+2.2) divided by 7 = 2.28057
Range = the difference between observations. There is no range value for the first observation. For the second day the range is the absolute difference between the observation on day one and day two. Thus 3 - 2.3 = 0.7. The range for day 2.
Range average = (0.7+0.3+1+2+0.5+0.3) divided by 6 = 0.8
Sigma is calculated by dividing the range average R (in this case 0.8) by a constant 1.13.
The two sigma upper control limit equals The mean value plus two times the range average divided by 1.13 2.28 + 2 (0.8/1.13) = 1.146 The two sigma upper control limit
The two sigma lower control limit equals The mean value minus two times the range average divided by 1.13 2.28 - 2 (0.8/1.13) = 0.864 The two sigma lower control limit
The upper control limit for the range = the range average multiplied by the constant 3.27 In this case (0.8)(3.27) equals 2.616 Three rules for “out of control’’ are:
• One point above or below the two sigma control limits • Three points in a row above or below the one sigma control limit • Seven points in a row above or below the average.
Note: Sometimes standard deviations are used to calculate control limits. The interested student might see Grant and Leavenworth cited in the references.
Personal Continuous Quality Improvement Project Work Bookiii
References
• The Foundation of Improvement. Quality Progress. (Langley GJ, Nolan KM, Nolan TM), June 1994:81-86.
• The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (Langley GJ, Nolan KM, Nolan TW, Norman CL, Provost LP), San Francisco: Jossey-Bass Publishers, 1996.
• Clinical COl: A Book of Readings. Joint Commission on Accreditation of Healthcare Organizations Press (Neuhauser 0, McEachern JE, Headrick LA), Oakbrook Terrace, IL, 1995.
• Applying Quality Improvements to Model Patient Care Outcome: Hypertension and Diabetes, Medical Care Supplement (Solodky C, Chen H, Jones P, et al), Aug. 1998, Vol. 36, No. 8, pp. AS13-20.
• Statistical Quality Control (Grant Eugene, Leavenworth R) Seventh Edition, McGraw Hill, 1996.
