Richard J. Banchs - The Quality Improvement Challenge

10 Chapter 12FIGURE 12‐1 From concept to decision: concepts, measurements, data, and metr...FIGURE 12‐2 The Voice of the Customer (VOC) defines what to measure.FIGURE 12‐3 The Critical Needs (CN) of the front line can also define what w...FIGURE 12‐4 The decisions of what to measure may need to be driven by stakeh...FIGURE 12‐5 Project metrics to improve STAT chest X‐rays in the ICU are deri...FIGURE 12‐6 Metrics of effectiveness assess our performance in meeting the s...FIGURE 12‐7 Three types of data.

11 Chapter 14FIGURE 14‐1 Different types of data require different types of summary stati...FIGURE 14‐2 The Anscombe’s Quartet data set has a different interpretation w...FIGURE 14‐3 The Graphic Analysis for different types of data.FIGURE 14‐4 Types of histograms.FIGURE 14‐5 The “box” and “whiskers” of a box plot.FIGURE 14‐6 The individual value plot of patient falls in inpatient units pe...FIGURE 14‐7 A Bar chart of “Critical care patients needing hemodialysis.”FIGURE 14‐8 Time series plot of “Request To Administration (RTA) time at St....FIGURE 14‐9 Relationships for Common Cause Variation.FIGURE 14‐10 Relationships for Special Cause Variation.FIGURE 14‐11 The improvement strategy.

12 Chapter 15FIGURE 15‐1 Run chart of “Waiting time for mammography results” showing viol...FIGURE 15‐2 Run chart of “Number of wasted prefilled syringes per day” showi...FIGURE 15‐3 Run chart of “OTR times for STAT ABGs at Mercy Hospital’s MICU” ...FIGURE 15‐4 Run chart of “Narcotic discrepancies at Chicago Med” showing the...FIGURE 15‐5 Run chart of “C‐section rate at London Memorial” showing the num...

13 Chapter 16FIGURE 16‐1 The Individuals and moving range (I‐mR) chart. Chart created wit...FIGURE 16‐2 The three lines of an Individuals chart. Chart created with Mini...FIGURE 16‐3 Individuals chart for “Catheter angioplasty balloon diameter” sh...FIGURE 16‐4 The upper and lower control limits of the Individuals chart. Cha...FIGURE 16‐5 Individuals chart showing violation of rule 1. Chart created wit...FIGURE 16‐6 Zone A, B, and C on the Individuals chart can be used to detect ...FIGURE 16‐7 Improvement in systolic blood pressure management appears as spe...FIGURE 16‐8 Improvement in systolic blood pressure management is clearer whe...FIGURE 16‐9 Types of Control charts for continuous and discrete data.FIGURE 16‐10 Individuals chart of “door‐to‐infusion time” for all “stroke co...

14 Chapter 17FIGURE 17‐1 There are four possible scenarios when evaluating a process’s pe...FIGURE 17‐2 The relationship between specifications (VOC) and control limits...FIGURE 17‐3 Data outside the upper and lower specification limits are consid...FIGURE 17‐4 Capability analysis of “Catheter angioplasty balloon diameter” s...FIGURE 17‐5 Assessing a process’s performance. Stability and capability guid...

15 Chapter 18FIGURE 18‐1 Problems come from the interaction of actions and conditions.FIGURE 18‐2 Path to analysis of y .FIGURE 18‐3 Tools to identify potential causes of a problem.FIGURE 18‐4 Fishbone diagram.FIGURE 18‐5 Fishbone diagram showing the possible causes of Amenorrhea.FIGURE 18‐6 An example of a The 5 whys diagram.FIGURE 18‐7 Pie chart.FIGURE 18‐8 Conditions for the Pareto principle to apply. Chart created with...FIGURE 18‐9 This Pareto bar chart that does not hold the Pareto Principle. C...FIGURE 18‐10 Pareto bar chart strategy.

16 Chapter 19FIGURE 19‐1 Options for the analysis of the cause and effect.FIGURE 19‐2 Tools used in the quantitative analysis of the cause and effect....FIGURE 19‐3 The scatterplot.FIGURE 19‐4 The scatterplot scatter tightness reflects the strength of the r...FIGURE 19‐5 Positive and negative values for the Pearson coefficient.FIGURE 19‐6 Analysis of residuals.FIGURE 19‐7 Hypothesis testing for continuous data.FIGURE 19‐8 Hypothesis testing for proportions.

17 Chapter 20FIGURE 20‐1 The Double Diamond model.FIGURE 20‐2 Tools for the divergent phase to generate a list of ideas.FIGURE 20‐3 Tools for the convergent phase to filter and prioritize the best...FIGURE 20‐4 The Impact Effort matrix.FIGURE 20‐5 The How‐Now‐Wow matrix.FIGURE 20‐6 The FMEA tool.FIGURE 20‐7 Calculating the FMEA’s Risk Priority Index.

18 Chapter 21FIGURE 21‐1 The PDSA is an acronym for Plan‐Do‐Study‐Act.FIGURE 21‐2 The PDSA cycle steps and actions.FIGURE 21‐3 The PDSA cycle is a systematic series of steps to gain valuable ...

19 Chapter 22FIGURE 22‐1 The three types of process steps.FIGURE 22‐2 Causes of time delay between value‐added (VA) steps.FIGURE 22‐3 Strategy to create and improve process flow.FIGURE 22‐4 Sequence to creating and improving flow.FIGURE 22‐5 Approach to improving a queue.FIGURE 22‐6 The red tag technique used for Sort in 5S.

20 Chapter 23FIGURE 23‐1 The four zones of a Power & Influence (PxI) diagram.FIGURE 23‐2 Stakeholder analysis using a Power & Influence diagram for stake...FIGURE 23‐3 Stakeholder Analysis using a Stakeholder Bar Graph.FIGURE 23‐4 Sponsor Analysis using an organizational chart.

21 Chapter 26FIGURE 26‐1 Anatomy of a great meeting: what to do before the meeting.FIGURE 26‐2 Anatomy of a great meeting: what to do during the meeting.FIGURE 26‐3 The four stages of team development by Bruce Tuckman.

22 Chapter 27FIGURE 27‐1 The four dimensions of team performance.FIGURE 27‐2 The six drivers of team performance.FIGURE 27‐3 The team cycle drives the team to a successful work product.FIGURE 27‐4 The Johari Window.FIGURE 27‐5 The Thomas‐Kilmann Conflict Mode Instrument.

23 Chapter 28FIGURE 28‐1 The six‐step decision‐making process.

24 Chapter 29FIGURE 29‐1 Success of change initiatives in healthcare.FIGURE 29‐2 The brain’s Central Organizing Principle.FIGURE 29‐3 Change affects our behavior through the Central Organizing Princ...FIGURE 29‐4 The effects of change on our social needs.FIGURE 29‐5 The Change Strategy.

25 Chapter 30FIGURE 30‐1 The project scope and boundaries: the SIPOC diagram.FIGURE 30‐2 The Critical Needs tree for the MRI staff.FIGURE 30‐3 A Basic Process Flow map for an MRI study.FIGURE 30‐4 Current state Value Stream map for an MRI study.FIGURE 30‐5 Bar chart comparing the percentage of inpatients to outpatients....FIGURE 30‐6 Bar chart showing the most common MRI scan protocol used.FIGURE 30‐7 Pareto Bar chart showing the duration of the most common scan. C...FIGURE 30‐8 Histogram showing “Scanner idle time” at baseline (before improv...FIGURE 30‐9 Run chart of “Scanner idle time” before improvement. Chart creat...FIGURE 30‐10 I‐mR chart of “Scanner idle time” before improvement. Chart cre...FIGURE 30‐11 A Time Series plot (Run chart) of “Scanner idle time” shows the...FIGURE 30‐12 Capability analysis of “Scanner idle time” shows a 50% defect r...FIGURE 30‐13 Pareto Bar chart showing the most common causes of turn‐over ti...FIGURE 30‐14 Fishbone diagram of possible causes of “Waiting for the next pa...FIGURE 30‐15 Pareto Bar chart showing the most common cause of “Waiting for ...FIGURE 30‐16 Histogram of “Scanner idle time” (turn‐over time) after improve...FIGURE 30‐17 Histograms comparing “Scanner idle time” before and after impro...FIGURE 30‐18 An I‐mR chart of “Scanner idle time” after improvement shows Co...FIGURE 30‐19 Before and after Individuals chart of “Scanner idle time.” Char...FIGURE 30‐20 A Process Capability report of “Scanner idle time” after improv...FIGURE 30‐21 Capability Analysis of “Scanner idle time” before and after imp...

1 Cover Page

2 Title Page The Quality Improvement Challenge A Practical Guide for Physicians Richard J. Banchs, MD Associate Professor of Anesthesiology Associate Head, Department of Anesthesiology Director, Quality and Safety University of Illinois Hospital and Health Sciences System USA Michael R. Pop, SSMBB, MBA Director of Business Process Improvement Omron Automation Americas USA