9/20/2012 1 IHI Expedition: Integrating Improvement Approaches Robert Lloyd, PhD Jill Duncan, RN, MS, MPH Tuesday, September 25, 2012 These presenters have nothing to disclose Today’s Host Kayla DeVincentis, Project Coordinator, has worked at IHI since 2009, starting as an intern in the Event Planning department. Since then, Kayla has contributed to the STAAR Initiative, the IHI Summer Immersion Program, and the IHI Expeditions. Kayla obtained her Bachelor’s in Health Science from Northeastern University and brings her interest in health and wellness to IHI’s Health and Fitness team.
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IHI Expedition:Integrating Improvement Approaches
Robert Lloyd, PhD
Jill Duncan, RN, MS, MPH
Tuesday, September 25, 2012
These presenters have nothing to disclose
Today’s Host
Kayla DeVincentis, Project Coordinator, has worked at IHI since 2009, starting as an intern in the Event Planning department. Since then, Kayla has contributed to the STAAR Initiative, the IHI Summer Immersion Program, and the IHI Expeditions. Kayla obtained her Bachelor’s in Health Science from Northeastern University and brings her interest in health and wellness to IHI’s Health and Fitness team.
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WebEx Quick Reference
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What is YOUR goal
for participating in this Expedition?
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Join Passport to:
• Get unlimited access to Expeditions, two- to four-month, interactive, web-based programs designed to help front-line teams make rapid improvements.
• Train your middle managers to effectively lead quality improvement initiatives.
Jill Duncan, RN, MS, MPH, Director, Institute for Healthcare Improvement (IHI), is responsible for leading the strategic planning and daily operations for IHI’s Impacting Cost + Quality initiative as well as serving as faculty for IHI’s Leading Quality Improvement: Essentials for Managers. Jill is also the Director for a variety of new IHI Expedition programs in 2012-13. With nearly 20 years of clinical nursing experience, Jill draws from her learning as a Clinical Nurse Specialist, pediatric nurse educator and front line nurse. Her clinical interests have developed through experiences in a variety of settings including Neonatal ICU, pediatric ER, clinical research and Early Head Start health programming. Ms. Duncan has contributed to a variety of collaborative publications in The Journal of Pediatrics and she is co-author of Pediatric High-Alert Medications: Evidence-Based Safe Practices for Nursing Professionalsand Stressed Out About Your Nursing Career.
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Agenda
• Welcome
• Expedition overview
• Building an Integrated Approach to Improvement with Lean, Six Sigma and the Model for Improvement
─ Robert Lloyd, PhD, Executive Director , IHI
• Resources
• Next steps
Ground Rules
We learn from one another – “All teach, all learn”
Why reinvent the wheel? - Steal shamelessly
This is a transparent learning environment
All ideas/feedback are welcome and encouraged!
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Expedition Aim
Introduce participants to various improvement methodologies and guide
participants in building an integrated quality improvement strategy for their unit,
department or organization
Expedition ObjectivesParticipants will be able to . . .
• Describe the similarities and differences among Lean, Six Sigma (which includes DMAIC) and the Model for Improvement.
• Determine which approach(es) are most appropriate for their organization.
• Initiate a plan to build an integrated quality improvement strategy.
• Define a customized approach for crafting projects and hardwiring discipline into improvement processes across participant’s organization.
• Plan small tests of change they can test throughout the Expedition.
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Today’s Faculty
Robert Lloyd, Executive Director of Performance Improvement, Institute for Healthcare Improvement, provides leadership in the areas of performance improvement strategies, statistical process control methods, development of strategic dashboards, and quality improvement training. He also serves as faculty for various IHI initiatives and demonstration projects in the US and abroad. Before joining IHI, Dr. Lloyd served as the Corporate Director of Quality Resource Services for Advocate Health Care, Director of Quality Measurement for Lutheran General Health System, and spent ten years with the Hospital Association of Pennsylvania in various leadership roles. He is author of numerous articles, reports, and books.
Source: Moen, R. and Norman, C. “Circling Back: Clearing up myths about the Deming cycle and seeing how it keeps evolving,” Quality Progress November, 2010:22-28.
Charles S. Peirce (1839–1914) The founder of American pragmatism. He wrote on a wide range of topics, from mathematics, to logic, semiotics and psychology.
William James (1842–1910) An influential psychologist and theorist of religion, as well as philosopher and a physician. First to be widely associated with the term "pragmatism" due mainly to Charles Peirce’s difficult personality.
“As a rule we disbelieve all the facts and theories for which we have no use.”
C. I. Lewis (1883-1964)Perhaps the most important American academic philosopher active in the 1930s and 1940s. He was the founder of conceptual pragmatism and made major contributions in epistemology and logic, and, to a lesser degree, ethics. Lewis was also a key figure in the rise of analytic philosophy in the US. He also had a profound impact on Walter Shewhart and subsequently Edwards Deming. His classic book, Mind and the
World Order, served as a foundation for the work of Walter Shewhart and Edwards Deming.
John Dewey (1859–1952)Prominent philosopher of education, referred to his brand of pragmatism as “instrumentalism. “
Source: Moen, R. and Norman, C. “Circling Back: Clearing up myths about the Deming cycle and seeing how it keeps evolving,” Quality Progress November, 2010:22-28.
The Deming Wheel1. Design the product (with appropriate tests).2. Make it; test it in the production line and in the laboratory.3. Sell the product.4. Test the product in service, through market research. Find out
what user think about it and why the nonusers have not bought it.
1950
Development of the Shewhart Cycle
1986
Source: Moen, R. and Norman, C. “Circling Back” Quality progress, November 2010: 22-28.
Walter A. Shewhart(1891 – 1967)
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The Shewhart Cycle for Learning and Improvement
Act Plan
Study Do
Act – Adopt the change, abandon it or run through the cycle again.
Plan – plan a change or test aimed at improvement.
Study – Examine the results. What did we learn? What went wrong?
Do – Carry out the change or test (preferably on a small scale).
BMJ Quality & SafetyApril 2011 Vol. 20, No Suppl. 1
Epistemology (from Greek epistēmē), meaning "knowledge, science", and (logos), meaning "study of" is the branch of philosophy concerned with the nature and scope (limitations) of knowledge.
It addresses the questions:
• What is knowledge?
• How is knowledge acquired?
• How do we know what we know?
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History of Six Sigma & Lean
History of Six Sigma & Lean
Bill Smith (1986)Motorola
Mikel Harry (1988)Motorola- MAIC
Forrest Breyfogle 111(1992)- Integration
Michael George (1991)- Integration
F.Taylor-The Principles of Scientific Method (1911)
Toyoda Family Taiichi Ohno 1950-1980Toyota Production System
• Process performance/savings measurable & directly tied to project
• 3-6 months or more to project completion
Reduce Never EventsReduce Inventory
ObsolescenceReduce Billing Errors
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What are our first steps?
• Assessment: problem statement, identification of root causes or flow charts and levers for improvement with drivers, prioritization of projects, scoping and resourcing using a charter
• Select/plan: defining what the focus will be – flow, defect reduction, redesign?
• Test: changes and application in real time before implementation
• Implement/control: Apply to processes locally to make part of core work and macro process standardization (ie. training, procedures)
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Performance Improvement Project Checklist
� Org/Team Charter� Problem Statement
� Goal Statement
� Scope
� Team roles and time commitments
� Timeline/Milestones
� Project Prioritization
� Driver Diagram
Assess Develop/ ID Changes Test Implement/Control
� 6 S
� Identify Waste
� Cause and Effect (Fishbone)
� OPI (Output –Process – Input)
� FMEA (Failure Modes & Effects Analysis)
� Evidence-based Practice
� PDSA Action plan
� Test using PDSA Action Plan
� Annotated Run Charts
� PI Leadership Report
� Solutions Tested
� Work Instructions
� Visual Display
� Control Charts/ SPC
� Sustainability Plan with annotated run and control charts
� ROI Template
� Storyboard
� Project Closure Form
� Stakeholder Analysis
� Value Stream (with metrics)
� Process Flow Map
� Voice of the Customer
� Baseline measures
What are we trying to accomplish?How will we know the change is an improvement?What change can we make that will result in improvement?
Name:Medical Center/Region:Project Title:
Signed by:
<insert name>
(HP Sponsor)
<insert name>
(Labor Sponsor)
<insert name>
(Finance Sponsor)
<insert name>
(Med Group Sponsor if applicable)
<insert name>
(IA)
� These subjects are taught in the Regular Institute (our version of
“It should be fairly obvious that no single quality system, set of quality criteria or even quality philosophy is ever going to be the solution by itself to a firm’s
quality problems.”
H. Scott Tonk. “Integrating ISO 9001:2000 and Baldrige Criteria”Quality Progress August, 2000.
“The greatest thing in the “The greatest thing in the “The greatest thing in the “The greatest thing in the world is not so much where world is not so much where world is not so much where world is not so much where
you stand, as in what you stand, as in what you stand, as in what you stand, as in what direction we are moving.”direction we are moving.”direction we are moving.”direction we are moving.”
~Oliver Wendell Holmes
Where are you headed?
Questions?
Raise your hand
Use the Chat
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Resources & Suggested Reading
• BMJ Quality & Safety. Papers from the Vin McLaughlin Symposium on the Epistemology of Improving health Care. April 12-16, 2010. BMJ Quality &
Safety, April 2011, Vol. 20, No. Supplement 1.
• Edmonds, D. and Eidinow. Wittgenstein’s Poker: The Story of a Ten-Minute
Argument between Two Great Philosophers. Harper Collins Publishers, 2001.
• Lastrucci, C. The Scientific Approach: Basic principles of the Scientific Method. Schenkman Publishing Company, Inc., 3rd printing 1967.
• Lewis, C. I. Mind and World Order. Reprinted by Dover Press, 1929.
• Moen, R. and Norman, C. “Circling Back: Clearing up myths about the Deming cycle and seeing how it keeps evolving,” Quality Progress November, 2010:22-28.
• Shewhart, W. A. Statistical Method from the Viewpoint of Quality Control. US Department of Agriculture. Dover Publications, 1939 (reprinted 1986).
• Wallace, W. The Logic of Science in Sociology. Aldine Publishing Company, 1971.
Homework for Next Call
• Complete the IHI Improvement Capability Self-Assessment Tool─ Does your assessment suggest one or more actions you can take
now to increase your hospital’s capabilities?
─ Does your assessment suggest a need for more information to help you determine specific actions to help you increase your improvement capabilities?
Send ‘Tweet-like’ summary of 140 characters or less to Jill at [email protected] by Friday, October 5th
─ Helen Zak, President and COO, Healthcare Value Leaders Network
• Session 4 – Tuesday, November 6th 1:00 – 2:00 ET─ Six Sigma
─ Dennis Deas, Senior Director Clinical and Operational Improvement Implementation Team, The Center for Health System Performance, Care Management Institute, Kaiser Permanente
• Session 5 – Tuesday, November 20th 1:00 – 2:00 ET─ Sustaining an Effective Quality Improvement Strategy
─ Robert Lloyd, Executive Director of Performance Improvement, IHI
Thank You
Please let us know if you have any questions or feedback following today’s Expedition webinar