1. General Approach On How To Use The Basic Tools Of Quality Improvement
“AIM”
Issue To
Consider
Brainstorm
& Consolidate
Data
Flow Chart
Existing
Process
Cause & Effect
Diagram –
Greatest Concern
Brainstorming
Force and Effect
“As Is” State
Use 5 Whys To
Drill Down To
Root Causes
Monitor New
Process & Hold
The Gains
Run Charts
Control Charts
Flow Chart
New Process
Analyze
Information and
Develop Solutions
Translate Data
Into Information
Gather Data
On Pain Points
Solution and
Effect Diagram
Pie Charts
Pareto Charts
Histograms
Scatter Plots, etc.
Data Management
Strategy – Ch. 14
“As Is” State to “Should Be” State
Source: The Public Health Quality Improvement Handbook,
R. Bialek, G. Duffy, J. Moran, Editors,
Quality Press, © 2009, p.160

2. The ABC’s of PDCA, G. Gorenflo and J. Moran Plan
Check/
Study
Identify and
Prioritize Opportunities
7. Develop Improvement
Theory
1. Reflect on the Analysis
2. Develop AIM
Statement
8. Develop Action Plan
2. Document Problems,
Observation, and
Lessons learned
3. Describe the Current
Process Do
Implement the
Improvement
4. Collect Data on
Current Process
Act
2. Collect and Document
The data
Adopt
Standardize
5. Identify All Possible
Causes
Adapt Do
3. Document Problems,
Observations, and Lessons
Learned
6. Identify Potential
Improvements
Abandon
Plan

3. Some Tools To Help Create AIM Statements
Current and Future State Model
AIM Work Sheet
Force Field Diagram
Force and Effect Diagram

4. What is the current state? Driving Forces: Future State:
Why is this important?
What is it costing us time/dollars/staff/etc?
What is the impact on our customer/clients?
What is the impact on our division/agency?
Driving Forces:
Future State:
What are the important aspects of the future state?
What is driving us to this future state?
What might be the consequences of not moving to the future state?
What might change?
What is the proposed timeline?
Pathway
Consequences
Benefits

5. (what will it improve and for whom?)
AIM or Opportunity Statement
An opportunity exists to improve the
________________________________________________________________________
(name process, or area to work on)
beginning with ___________________________________________________________
(beginning boundary, starting point)
and ending with __________________________________________________________.
(ending boundary, finish point)
This effort should improve
_______________________________________________________________________
_____
__________________________________________________________________
(key characteristics of area the team is working on)
for the _________________________________________________________________
______________
_________________________________________________________.
(customers, staff or those affected by the process under improvement)
This process is important to work on now because
____
___________________________________________________________________
(what will it improve and for whom?)

6. Desired State Current State Force Field Diagram - Basic
Positive Forces
Negative Forces
Desired State
Current
State

8. High Level S I P O C+CM Collection Form
Constraints:
Ends With:
Begins With:
Process/Activities:
Measures
Outputs:
Inputs:
Suppliers:
Customers: 8

9. SIPOC+CM

10. Flow Chart Symbols Flow Lines Manual Operation Start/End Bookends A
Connector
Data Base
Comment
Collector
Activity:
Operation/Inspection
Wait/Delay
Decision
Display
Storage
Input/
Output
Data
Transport
Manual
Input
These symbols are in Microsoft Power Point
Document
Input
Preparation
Forms
Output
Unfamiliar/
Research 10

11. Flow Chart Summary Matrix
PHF E-News, March 2, 2010,
Actual
Proposed
Flow Chart Step Number
Type of Step
Delta
+/- ∑ ∑
P D P T W P D S
Touch Point (√)
Cost
FTEs/Person Hrs.
Supplies Required
Equipment Required
Space Required
Time
Cost of Quality
Partnerships Needed
Etc.
Value added
Type of Step: P – process, D – decision, T – transport, W – wait, S – storage
Delta = Proposed – Actual – the more negative the subtraction the better – more savings

12. LSS
5S is a visual method of setting the workplace in order. It is a system for workplace organization and standardization.
The five steps that go into this technique:
Seiri – sort – essential items
Seiton – set in order – promote work flow
Seison – shine – clean workplace
Seiketsu – standardize - consistency
shitsuke)- sustain – hold the gains

13. Definition of 8 Types of Waste:
Description
Public Health Example
Overproduction
Items being produced in excess quantity and products being made before the customer needs them
Insurance filing or immunization record opened before all required information is received
Waiting
Periods of inactivity in a downstream process that occurs because an upstream activity does not produce or deliver on time.
Paperwork waiting for management signature or review
Unnecessary
Motion
Extra steps taken by employees and equipment to accommodate inefficient process layouts.
Immunology testing equipment stored in cabinets far from specialist work area.
Transportation
Handling
Unnecessary movement of materials or double handling
Department vehicles stored in central facility, requiring constant movement of vehicles to and from other high traffic locations
Over-processing
Spending more time than necessary to produce the product or service
Combining client survey instruments into one form rather than develop specific instruments for each program
Unnecessary Inventory
Any excess inventory that is not directly required for the current client’s order
Over estimating vaccination support materials requiring additional locked storage cages, inventory counting and reconciliation
Defects
Errors produced during a service transaction or while developing a product.
Ineffective scripts for initial intake applications. Unclear directions for filling out required forms
Duplication
Having to re-enter data or repeat details on forms.
Poorly designed client intake computer screens or services checklists

14. Cause and Effect Diagrams - Construction
Generate ideas as to what are the main causes of the effect
Label these as the main branch headers
Organizes group knowledge about causes of a problem and display the information graphically
Header
Header
Effect
Header
Header

15. Root Cause Analysis Rating Form
Impact on the Problem
Potential
Root
Cause
Improved
Customer
Satisfaction
Improved
Quality
Reduced
Costs
Others
Total
Score
Ranking
Impact Scoring Scale: Low = 1, Medium = 3, High = 5

16. Cause and Effect Diagram

17. Solution and Effect Diagrams - Construction
Generate ideas as to what are the main Solutions of the effect
Label these as the main branch headers
Solution
Solution
Effect
Solution
Solution

18. Root Cause Analysis Solution Impact Analysis
Potential
Solutions
Corrective
Action
Type
Verification
Method
Cost To
Fix
Benefit Of
Fix
Cost
Benefit
Ratio
Selected?
Y/N
Corrective Action Type: Immediate but Interim – II, Short-term Temporary - ST,
Permanent – Short Term – PST, and Permanent – Long Term - PLT

19. Solution and Effect Diagram

20. Intervention and Impact Form AIM Statement Description:1. 2. 3. 4. 5. 6. 7. 8.
Intervention Number
Date
What Was The Change?
How Did It Impact The AIM?
How Did Your Thinking Change?
How Did It Impact Your Procedures?
How Did It Impact Your Customer?
How Do You Know?
Measures

21. The following columns can be added to the Intervention and Impact Form when needed to track the impact of unintended consequences. 9 10 11 12 13 14 15
Unintended Consequence Letter
Unintended
Consequence
Description
Date It Happened
Impact To Aim Statement
Need a Sub AIM Statement?
Impact to Customer
Modifications
Made
Intervention and Impact Form when needed to track the impact of unintended consequences.