1. Quality Improvement James Pappas, MD, MBA The speaker does not have any relevant financial relationships with any commercial interests

2. AIMA3

3. What is Root Cause? Injury Poor building design caused by Root Cause is the lowest point in the cause and effect chain that we can affect within our span of control or sphere of influence. SPAN OF CONTROL (Full authority) SPAN OF CONTROL (Full authority) SPHERE OF INFLUENCE (Influence or persuasion only) SPHERE OF INFLUENCE (Influence or persuasion only) OUTSIDE, UNCONTROLLED ENVIRONMENT Electrical cords on floor caused by Fall caused by Lack of electrical outlets caused by AIM Tripping hazard caused by Root Cause

4. Draw the initial process map then walk Flow volumes/rates Cycle (rework/delays) Value (value-add/non-value-add) Costs: COPQ & operating Handoffs Quality (DPMO, Capability) Action Triggers Automated vs. Manual Steps Data (Sources & Uses) whatwhy  Physically follow the process as documented from beginning to end. The purpose is to understand what is being done and why it is being done.  Gather information about existing problems and roadblocks. Include data regarding: MAP

5. Looking at each process step for: Bottlenecks or constraints Sources of delay Extra handling Errors being fixed instead of prevented (rework) Role ambiguity (don’t know who…) Redundancy Duplications Unnecessary steps, waste Cycle time MAP

6. VERSIONS OF A MAP AT LEAST THREE This is what we Need! What You Think It Is... What You Would Like... What It Actually Is... MAP

7. Measurement’s Role 1.You can’t manage what you can’t measure! 2.What gets measured gets done. 3.Measurement impacts behavior. © 2012 The Quality Group - All Rights Reserved v5.0 MEASURE

8. Performance Measurement customer’s problem  Integral to measuring the extent of the “customer’s problem” baseline  Measure how well your process is performing before you start your improvement effort – baseline. goal  Measure your process after your improvement effort – Did you achieve your goal? Measure System Analysis  Measure how good the results are – Measure System Analysis 1.Select what to measure Hint: think Y=f(X) 2.Develop operational definitions 3.Identify data source 4.Prepare collection and sample plan 5.Implement and refine measurement MEASURE

9. P D S A C y c l I n g Plan Objectives, predictions, plan the cycle, plan for data collection Do Test the plan, Document the results and record data; begin analysis of the data Study Complete the analysis of data, compare to predictions, summarize learning's Act What changes are to be made? Adjust the plan for the next cycle PDSA