Presentation on theme: "Making AFSO21 Work in Your Laboratory"— Presentation transcript:
1 Making AFSO21 Work in Your Laboratory TSgt Brent WhitbyNCOIC, Quality Assurance375 Medical Group, Scott AFB, IL
2 Ice Breaker Let’s Draw a Pig Question 1 - How many of you have variance or deviation reporting systemQuestion 2How many of the same variances do you seeIf you are seeing repeated variances you may want to look deeper at the root cause, you will probably find that your process lacks standardizationStandardization is the back bone of AFS021.This exercise hopefully demonstrated that more clear and concise you make a process the more standard or consistent a process will become.Good morning this morning I want to walk you through some of the foundational principles of AFSO21 and help you be more successful in implementing AFSO21 into your workcenters
3 Agenda/Topics To Be Covered AFSO21 ImplementationLinking AFSO21 to Organizational GoalsOODA Loop process of AFSO21We will begin by examining the AFSO21 implementation. Identifying obstaclesShow you how to link it to your OrgThe second hour I will go throught he OODA Loop process of AFSO21Transition: Let’s begin by discussing what brought about the onset of the AFSO21 model of the QMF.
4 AFSO21 Implementation Launched in 2005 Obstacles to deployment Quality Air Force ConundrumSenior Leadership buy-inAFSO21 vs. QAFValue stream mapping vs. process mappingResults- AFSO21 was implemented in 2005 with the thought of the AF being static by 2009 (meaning fully functional) however, it has met many road blocks. The first being theQAF cunnundrum—many commanders were releasing personnel for PAT and never saw there resultsAlthough QAF often ID’d root causes of problems – solutions to those problems were never implementedSenior leadership buy-inHow is AFSO21 different though – why should senior leadership buy-inValue stream mapping vs. process mapping – AFSO21 targets ineffeciencies not just problems as we move forward this morning we are going to discuss how you can get not only senior leadership buy-in but get buy-in up and down the org chart.
5 Linking AFSO21 to Organizational Goals Time: 2 minAssess outlook/future pathCurrent state mapFuture state mapEvaluate current organizational performanceReview system change/improvement capacityImplementing AFSO21 begins with vision. You have to link AFSO21 to your organizational goals. If you don’t you are doomed to fail.The way you link it to your org goals is to simply figure out where you are and where your going. This requires you to assess your path, evaluate your current performance, and review your improvement capacityAssess –Is strategy course clear – does everyone in your organization from top to bottom know where your headed?Can we meet our financial/compliance goalsDo we respond well to new circumstancesEvaluate org performanceInstill a “Go & See” mindset to thoroughly understand problems at their sourceAre we meeting our company needs (look at the SDA report)How effectively are we operatingSystem change /improvementHow well do we manage change controlCross-functional process managementIs our process improvement model clear
6 Key AFSO21 Questions Which process needs the most attention Time: 2 minWhich process needs the most attentionWhere can biggest cost savings occurHow can quality be improved (to what degree?)Look at your metrics – if you are not currently tracking metrics I strongly recommend you do that.What areas seem to fall short ( for us at Scott we recognized a problem with our preanalytical error rates)With the domestic agenda/budget in congress growing daily, the defense budget is going to take hit. We are going to have to find ways to save money. Look around your work center and figure out how you generate savings. This may mean spending money up front to save money in the long run. One thing we are looking at right now is creating a corelab, because we realize how inefficient compartmentalized laboratory medicine is. It will cost some money up front but in the long run we work more effeciently and require less manpower.How many of you are QA coordinators in the room. Ask yourself before you implement AFSO21 will it improve the overall quality of care that we render. LSS in the healthcare industry is gaining a lot of momentum in the civilian sector in fact ASQ is looking into a QA certification for healthcare workers right now.
7 Key Themes of AFSO21 Customers are important Speed, quality, low cost are linkedVariation/defects minimizedTime trap eliminationData driven improvementsTeamworkOne variable that never changes is that our patients are important. We have all been to customer services classes that tell us the customer is always right. Just because we are in the military doesn’t mean that our patients don’t pay our wages.Therefore if we can find ways to process patients faster, better, and cheaper then we will keep these patients coming back…if can’t do that then dependents and retirees will seek care elsewhere.There was a big push about 5 years ago to incorporate 6 Sigma into our daily operations, problem they ran into was that 6 Sigma in the lab field was virtually impossible to achieve due to the amount of variation. At best most labs could run at 4 Sigma simply due to non-automated processes associated with our jobs. Therefore, there is a push to minimize variations.
8 Benefit/Effort Matrix Time: 3 minQ1 - Immediate attentionQ2 - Hardest decisionQ3 - Sometimes beneficialQ4 - AvoidHigh12Benefit34LowEffortLowHigh- As we continue looking at implementing AFSO21 into our work processes, it is advantageous for you to perform benefit/effort matrix.
9 Project Selection Process elements Stakeholder analysis Customer data Quality function deploymentBenchmarking
10 Process Elements (SIPOC) Supplier (provide inputs)Input (services provided)Process (value added steps)Output (final product)Customer (internal/external)SuppliersInputsProcessOutputCustomerMLTsPerform TestVerify PatientAcceptable Specimen to analyzePatientPatientsProvide SpecimensAccession TestAccurate ResultsPhysicianPhlebotomistCollect specimensCollect SampleTimely treatmentTechnical SupervisorReport ResultsProcess SamplePut on AnalyzerSIPOC model creates, monitors and improves process management, process improvement, and process design/redesignDisplays cross-functional activities (flow charts)Framework for all processesBig picture perspectiveAlthough we focus on the SIPOC the order in which we address these issues is critical.1. Name the process (keep it simple but direct)2. Start/stop points this will control the scopeOutput. The largest problem here is often qualifying/quantifyingID Customers both primary/secondaryID Suppliers of the of the processID inputs of the process (Data)ID 5-7 highest level as they exist today – what is the culture (Ready Fire Aim???)
11 Stakeholder Analysis Control resistance (reduce or remove) Provide alternativesRemove pitfallsEnsure buy-inPerceived value drives feedbackPositiveNegative
12 Customer DataUse Service Delivery Assessment data (customers define quality/expectation)Listen to external/internal customersWoW FormsInternal customer surveysCQFACostQualityFeaturesAvailability
13 Quality Function Deployment Often referred as “Voice of Customer”House of QualityCustomer needsDesign features/technical requirementsCustomer prioritiesBenchmarking (targeted values)Inter-relationship between design featuresCreates customer driven environmentReduces cycle timesUses concurrent engineering methodsReduces design costs (fewer changes)Increases communicationCreates dataEstablishes priority requirements
14 Benchmarking Types Sequence Process Performance Project Strategic Determine current practicesID best practicesAnalyze best practicesModel best practicesRepeatProcess – Find the most effective operating practices from other orgs who have similar work functionsPerformance – Price, technical quality, speed reliabilityProject – Planning, scheduling, and controlling specific projectsStrategic – examines how companies compete (not industry focued)Determine current practiceFind problem areasID key performance factorsUnderstand your own/other processesAnalyze performance vs. needs/prioritiesID best practicesCompare performance w/I orgDetermine leaders w/I criteria areasFind internal/external org to modelAnalyze best practicesVisit w/partnerCollect dataEvaluateNote improvement areasModelFocus on improved performanceExtend breakthroughs w/I orgShare
17 OODA Loop Originated by Col John Boyd (USAF) Also known as Decision CycleFour Overlapping and Interacting ProcessesObserveUnfolding Circumstances and InformationOrientAnalysis and SynthesisDecideAct (and Test)Decision making occurs in an OODA cycleProcessing OODA quickly gets inside opponent’s decision cycleMilitary or Business Competitive AdvantageOrient Phase most importantObserved information must be processed to orientData must be Filtered via various factorsComplexity grows as OODA processed by teamMany teams therefore stutter “OO-OO-OO”Winning requires team to Orient faster than opponentsOften compared to Toyota’s PDCA Cycle
18 Problem Solving Process PlanActCheckDo1. Clarify The ProblemObserve2. Break Down The Problem/Identify Performance Gaps3. Set Improvement TargetOrient4. Determine Root Causes5. Develop CountermeasuresDecide6. See Countermeasures Through7. Confirm Results & ProcessAct8.Standardize Successful Processes
19 Elements of the 8 Step Problem Solving and A3 Approach Time: 1 minLogical Thinking ProcessObjectivityFocus on Results and ProcessesSynthesis, distillation, and visualizationAlignmentCoherence & ConsistencySystems ViewpointThinking generated by using the A3 is more important than the report itselfThe mind-set behind the A3 system is distilled into these seven elementsThese interact and reinforce each other.Ask them to think about the way their units work—do they exhibit any of these characteristics?
20 Logical Thinking Process Time: 2 minStrong emphasis on cause and effectFocuses organization to maximize resources by focusing on the “critical few”Minimizes wasted time by management by using a robust problem solving processToyota wants its people to be able to think and then act rationally in decision making and problem solvingGreat emphasis in factually discerning the difference between “cause” and “effect”Infinite number of problems but finite amount of resourcesToyota develops people to recognize the most important problems and instill in the employee the obligation and capability to solve the problems expeditiouslyCreates consistent, socially constructed approaches to key classes of problemsLogical thought processes are thorough, address important details, consider numerous potential avenues, take into account the effects of implementation, anticipate possible stumbling blocks, and incorporate contingenciesThe process applies to goal setting, policymaking, and daily decision making just as much as business, organizational, and engineering problem solvingEmphasize here getting to the “critical few” problems—prioritization is critical.
21 ObjectivityTime: 2 minProcess drives employees to think with quantitative data as opposed to emotion and opinionsFosters a collaborative process as opposed to a “silo mentality”THIS IS EXTREMELY HARD --- Setting aside your biases and preconceived notions, but it is ESSENTIALHuman observation is inherently subjective; every person sees the world a little bit differentlyHis or her representation is the “right” oneOps maintenance down time as example: ops blames mx, mx blames supply, etcNatural reaction, if one feels their representation is “right”, is to view other’s as “wrong”Quickly devolve into the blame gameA3 thinking attempts to resolve those multiple viewpointsObjectivity is a central component to A3 thinkingEffective problem solvers continually test their understanding of a situation for assumptions, biases, and misconceptionsBegins by framing the problem with relevant facts and details, as objectively as possiblePromotes organizational good rather than personal agendasVery little room for qualitative opinion or wishful thinkingAsk them if we are all inherently subjective due to our experiences, training, world view etc: of course we areHere is a good place for personal example, i.e. When I was a commander, I did the “Ready, Fire, Aim” approach based on “I have seen this before, etc” where I don’t think I truly understood the REAL problem, and the better approach would have been start with a clean slate, get out of the office and go and see and reset or adjust your perception of the problem.
22 Focus on Results and Processes Time: 2 minExample:Insurance company is losing business due to 5 day turnaround on quotes.Possible Solutions:Hire more people to reduce timeIncentivize employees to work harderFind the root cause for lengthy turnaround and implement permanent corrective actionResults and process are important, neither favored over the other. Both are necessary and critical to effective organizational improvement and personnel development.As much about personal development as it is about achieving results, so the process used becomes paramount.The ultimate goal is not just a problem resolved in the immediate term, but also that:the problem is less likely to occur in the future because the overall system is improvedthe problem-solver has enhanced his or her problem-solving skills and is prepared to tackle even more challenging tasksThe results truly are the result of one’s understanding of the problem or opportunityInsurance problem example:Toyota would want to know the REASON for the 5 day turn time.Missing information? Poor flow in processing the quote? Approval process too lengthy? Employees properly trained?A process that quickly jumps to a solution (hiring more) without good grasp of the root causes may achieve desired results but not viewed as successful, must go through the process
23 Synthesis, Distillation, and Visualization Time: 2 minMinimizes “Death by PowerPoint”Forces brevity and clarityOnly most vital points used for proper understandingUtilizes graphs, pictures, and sketches to promote understanding (visualization)A3 is brief by design, hits main point directlyBrevity for brevity’s sake is not the point (but attractive side benefit)Brevity Forces synthesis of the learning acquired and interaction with others during the processNot all info is equally salient, therefore must distill the synthesized picture to only the most vital points neededA picture is worth a thousand wordsEmphasize here that once alignment is achieved and inputs are considered, you will have a very broad picture of the situation, but the key is to distill down to most critical info. THIS IS HARD.This is where visualization is invaluable. Takes out subjectivity when data is used, and visual representation through graphs, pictures, etc helps you do that.
24 Alignment 3D Communication Heavy emphasis on consensus decision making Time: 2 min3D CommunicationUp and down the hierarchyHorizontally across the organizationBack and forth in timeHeavy emphasis on consensus decision makingDevelop agreement around decisions3D communication: horizontally across the organization, up and down the hierarchy, and back and forth in timeConsensus is actually Practical consensus: 100% buy in not always possible, so when someone’s concern is not incorporated, the problem solver returns to that person to explain (a courtesy and tangible act to show the concerns were taken seriously). This is also an implicit request of the individual to sacrifice some of his or her interests for the greater goodAsk them what consensus it? (May not agree with the point, but I can live with it).Inform them this is proper buy-in or coordination as they may know it.
25 Coherence & Consistency Time: 2 minAvoids:Tackling problems that are not important to organizational goalsSolutions that do not address root cause(s)Incomplete implementation plansOmission of follow up plans and standard workCoherence within & Consistency Across the organizationWhat it does do:Establishes a logical flow from one section of the A3 to the next—flows like a storylinePromotes coherency within the problem solving approachA3 makes the coherency of one’s approach (or lack of it) visibleTheme or issue should be consistent with the organization’s goals and valuesPromotes consistency across organizational unitsHere point out that some folks a few days or weeks into a major problem could stray and for example, have countermeasures that don’t address any of the root causes. The A3 approach helps prevent that.
26 Systems ViewpointTime: 2 minThe impact of the proposed solution must not adversely impact other parts of the organization (i.e. transferring a problem from one department to another)The good of the whole organization takes clear precedence over the individual departmentsSimply saying “Let’s take a systems viewpoint” is insufficientActivities and conversations that occur are paramount importanceToyota individuals mentored to develop deep understanding of:The purpose of the course of actionHow the course of action further the organizations goals, needs or prioritiesHow it fits into the larger picture and affects other parts of the organizationThe good of the overall organization takes full precedence over any individual or unit.Ask what behavior is generated at the end of FY money wise? Spend or lose correct. Whose money is it really (Taxpayers, and the AF is trusted with those resources for mission performance). Should we not give that back to big AF for the overall good? Or to DoD?The problem is the process generates behavior that gets rewarded that is very counter to a systems viewpoint.
27 Cell Design / Variation Reduction Error Proofing Quick Changeover TPM Time: 5 minSA&DSWOTVoice of CustomerVSMGo & SeeBrainstormingParetoAffinityFishboneControl Charts6S & Visual MgtStandard WorkCell Design / Variation ReductionError ProofingQuick ChangeoverTPMRIEKPIs/MetricsPerformance MgtSA&DStandard Work AuditKPI/MetricsPerformance Gap AnalysisBottleneck AnalysisA3Action PlansTimelinesFinancial Reporting TemplateSo here is how an AF A3 would flow using OODA (PDCA) methodology and some of the tools available to the problem solver at each stepWe will go into each of these steps in great detail throughout the rest of the courseEmphasize here that the tools are not exclusive to the steps where they are listed. They can and are used wherever needed.Also a good place to emphasize that this is not a cookbook, so use the tools where they help you.Ideal StateFuture State MappingB-SMARTCheckpoints / Standardization TblReport Out Theme StoryBroad ImplementationCPI Mgt Tool2727
28 Observe Phase Clarify the Problem Strategic Alignment and Deployment OODAClarify the ProblemStrategic Alignment and DeploymentVoice of CustomerValue Stream MappingGo & SeeBreak Down the Problem and Identify Performance GapsKey Process Indicators / MetricsSWOTPerformance Gap AnalysisBottleneck Analysis
29 Step 1 – Clarify the Problem OODAStrategic Alignment & Deployment (SA&D)Ensuring that activities are linked to the key strategies and directives of the organizationStrengths, Weaknesses, Opportunities & Threats (SWOT) AnalysisAssessing the organization from a SWOT perspective to identify areas of needNeeds to be rolled into SA&D at appropriate levelsVoice of Customer (VOC)Understanding who the customer is and what they need from the process or problem areaValue Stream Mapping (VSM)Overview of Process to determine areas of needed focusGo & SeeDetermine issues by actually walking the process or problem area (Gemba or Genchi Genbutsu)
30 Step 1 – Key QuestionsDoes this problem, when solved, help meet needs identified by the organization?Is it linked to the SA&D of organization?Does it help satisfy customer needs (VOC)?Does this problem, when solved, address key issues identified during SWOT analysis?Has this problem been identified and directed by a Value Stream Map at the appropriate level?What does the “Future State” need?What resources have been identified to address this issue?What opportunities were identified or observed by the process or problem area “walk”?Will addressing or improving these issues deliver results that relate to #1 or #2?Will addressing or improving this problem deliver the desired future state from #3?16OODA
31 Step 2 – Break Down Problem & I.D. Performance Gaps OODAGather and Review Key Process Indicators and MetricsProblem Solving and Process Improvement begin with DataUnderstanding what data is necessary and what the data means is critical to true “root cause” problem solvingPerformance Gap AnalysisOnce data has been gathered, analyzing the gap between the current state and the desired state directs effortsBottleneck AnalysisBottlenecks are inhibitors to the flow of the processUnderstanding bottlenecks (TOC) is critical to flow
32 Step 2 – Key Questions Is this simply a leadership directive? Does the problem require more analysis or does leadership have enough information to execute a solution?Is this simply a leadership directive?If more data is needed, how do we measure performance now?What are the Key Performance Indicators (KPI)?What is the performance gap?Does other “non-existent” data need to be gathered?What does the data indicate are the potential root causes?Does the data review indicate a bottleneck or constraint?OODA
33 Step 3 - Set Improvement Target OODAIdeal State MapBrainstorming “Could-Be” without constraintsFuture State Mapping“Vision” of Future for ProcessB - SMART Action PlanBalancedSpecificMeasurableAction OrientedResults OrientedTime-based
34 Step 3 - Set Improvement Target Target characteristicsMust be measurable, concrete, challenging and achievableStatement of a TargetDo what: (examples include “decrease ____?”, “increase ____?”, eliminate ____?, reduce ____?)By how much: (measured in the same terms as the standard)By when: (specific date)Must be output orientedThings to be achieved, not things to doOODA
35 Step 3 – Key Questions Is the Improvement Target measurable? Is it Concrete?Is it Challenging?Is the Target “Output Oriented”?What is the desired output?Should be “things to achieve”Should avoid “things to do”Will be addressed by Action Plans in “Develop Countermeasure”The desired target should:Do What?By How Much?By When?If it is a Process Problem, what is the future state?How will it be realized?OODA
36 Step 4 – Determine Root Cause OODARoot Cause CharacteristicsThe root cause is the most likely source of the discrepancy or greatest possible improvement targetThe root cause can be dealt with directly and a countermeasure can be planned to address itIf root cause is addressed, it will address the performance gapThe root cause must be verified by “go and see”Determining the Root Cause is easier with Data
37 Step 4 – Determine Root Cause Tools for Step 45 WhysBrainstormingPareto AnalysisAffinity DiagramsFishbone Diagrams (also called Cause & Effect)Control ChartsAdditional Data Gathering ToolsCheck Sheets, Chonbo Charts, Scatter DiagramsOODA
38 Step 4 – Key Questions 10 heads are better than one What root cause analysis tools are necessary?Why are these tools necessary?What benefit will be gained by using them?Who will need to be involved in the root cause analysis?10 heads are better than oneRemember “cultural” issues related to problemWhat is (are) the root cause(s) according to the tools?How will the root cause be addressed?Will addressing these address the performance gap?Can the problem be turned on or off by addressing the root cause?Does the root cause make sense if the problem solving 5 Whys are worked in reverse?Working in reverse, say “therefore” between each of the “whys”OODA
39 Step 5 – Develop Countermeasure Decide Stage – Develop CountermeasuresA3 Problem Solving and Reporting FormatCommon Structure and Concise ReportingAction PlansSMART Action ItemsTimelines & Project ManagementManaging complex Problem Solving in a project fashionFM ToolUnderstanding the impact of the improvementsOODA
40 Step 5 – Key ActionsDevelop potential countermeasuresTools and philosophies from Lean, TOC, 6 Sigma and BPR as appropriateSelect the most practical and effective countermeasuresBuild consensus with others by involving all stakeholders appropriatelyCommunicate, communicate, communicateCreate clear and detailed action planSMART ActionsReference Facilitation Techniques as appropriateOODA
41 Step 6 – See Countermeasures Through Process Improvement PhilosophiesLean, TOC, 6 Sigma, BPRLean and Process Improvement Tools6-S & Visual ManagementStandard WorkCell DesignVariation ReductionError ProofingQuick ChangeoverTotal Productive Maintenance (TPM)Rapid Improvement Events (RIE)OODA
42 Step 6 – Key QuestionsWhich philosophy best prescribes tools that address root cause(s)?Which tools best address root cause(s)?Which method for implementation fits the tool and improvement need?Rapid Improvement Event?Improvement Project?Point Improvement or “Just Do It”?If RIE or Project, create “Charter” and communicateWhat training or education is needed? By Whom?OODA
43 Step 7 – Key QuestionsHow are we performing relative to the Observe phase (Steps 1 & 2)?How are we performing relative to Step 3?How are we performing relative to FM Tool projections?If we are not meeting targets, do we need to return to OODA Step #4?Most problem solving “breakdowns” occur relative to improper root cause identificationOODA
44 Step 8 – Standardize Successful Processes Checkpoints and Standardization TablesReport-out StoryboardsBoard ImplementationCapture Results in PowersteeringSharing of ResultsCommunication of Best PracticesRestart OODA LoopOODA
45 Step 8 – Key Questions What is needed to Standardize Improvements? Tech Order changes?Air Force Instruction changes?Official Instruction changes?How should improvements and lessons learned be communicated?PowersteeringKey meetings?Were other opportunities or problems identified by the Problem Solving Process?Restart OODA LoopOODA
46 Step 8 – Standardize Successful Processes Checkpoints and Standardization TablesReport-out StoryboardsBoard ImplementationCapture Results in PowersteeringSharing of ResultsCommunication of Best PracticesRestart OODA LoopOODA
47 Step 8 – Key Questions What is needed to Standardize Improvements? Tech Order changes?Air Force Instruction changes?Official Instruction changes?How should improvements and lessons learned be communicated?PowersteeringKey meetings?Were other opportunities or problems identified by the Problem Solving Process?Restart OODA LoopOODA
48 Clarify the Problem Problem Solving Process & Related Toolsets SA&D SWOTVoice of CustomerValue Stream MappingGo & See
49 Break Down the Problem/Identify Performance Gaps KPI/MetricsPerformance Gap AnalysisBottleneck Analysis
50 Set Improvement Target Ideal StateFuture State MappingB-SMART
51 Determine Root Cause 5 Whys Brainstorming Pareto Affinity Fishbone Control Charts
55 OODA Loop SummaryEffective Problem Solving must follow the Observe, Orient, Decide and Act processFollowing OODA ensures actions will result in desired resultsFollowing OODA ensures results will meet the needs of the organizationMeeting the needs of the organization will lead to a stronger Air Force (Culturally as well)A stronger Air Force leads to a Safer Country!