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LeveragingDMAIC&ActiveManagementforSustainableQualityImprovements:

KristineKoontz,PhD,SSGBAmyDianeShort,MHSA,CSSBB

KristineKoontz,Ph.D.• ClinicalPsychology—SciencePractitioner• SixSigmaGreenBelt• VicePresidentofQualityandCorporateIntegrity• OversightofBehavioralHealthOrganization

• ResidentialandCommunitySettings• IntellectualDisabilities,MentalHealth,AutismSpectrumDisorders

• Lifespanservices• USA:PA,DE&CT• International:Moldova,India

AmyShort,MHSA• BSPsychology• MHSA(Master’sHealthServicesAdministration)• CertifiedSixSigmaBlackBelt• OperationalOversightofHospitalFunctions• QILeadershipofImplementationResearchatAcademicHealthCenter

• PatientAdvisoryCouncilMentor• UniversityofCincinnatiIRBMember• AdministrativeDirectorofCenterofImprovementScience,CincinnatiCCTST

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PresentationOverview

• ANewApproach• GettingtoKnowYou• DMAIC• StakeholderEngagement• ControlRevisited• ManagingtheGameofHotPotato• AuditingandActiveManagement

Active Learning

ChangesfromYOURFeedback

• Broad,ProvenConceptswithaDeeperDiveon1‐2Ideas

• TraceaSuccessfulProject• BalanceBetweenDidacticsandActivities

Icebreaker:WhoAreYou?• AnswerPrivatelyinSocrative.com,• TypeinRoomNumber:

AMYSHORT• LoginasStudent• EnteratLeastOneLetterasaName

Click Here for Menu

Click Here to Login

Or Use the App

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HowExperiencedAreYouinQI?• AnswerPrivatelyinSocrative.com,• TypeinRoomNumber:

AMYSHORT• LoginasStudent• EnteratLeastOneLetterasaName

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Click Here to Login

SuccessfulOrganizations

• Understandwhattheircustomerswant

• Understandhowtheyaremeasuringup

• Candescribe,monitorandadjustprocesses

• Canexamineandsupportemployeeperformance

andfunctions

• Canquicklyidentifyandrespondtointernaland

externaldemands

SuccessfulOrganizationsUseDMAIC

DefineMeasureAnalyzeImproveControl

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DMAICDefineMeasureAnalyzeImproveControl

What Compliance IssueKeeps You Up at Night?

DMAICDefineMeasureAnalyzeImproveControl

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Findawaytomaketheimportantmeasurableinsteadofmakingthemeasurableimportant

WheretheJourneyBegins:Data

WhyData?• YouCannotManagewhatYouCannotMeasure

• DataInformation KnowledgeWisdom

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“InGodwetrust.Allothers,bringdata.”‐W.E.Deming

Measurement101:“Eyeballyourdata”

• TheImportanceofVisualInspection

• FirstStepinAnalyzingandUnderstandingYourData

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StronglyDisagree

Disagree Neutral Agree Strongly Agree

Number of Responses

Shhhhh….It’saSecret

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MeasureThe Process Map

ProcessMappingina Nutshell

“Everysystemisperfectlydesignedtogettheresultsit

gets.”

Theonlywaytogetdifferentresultsistochangethesystem

WhyProcessMap?

• YouCan’tFixaProblemUntilYouUnderstandthePresentState• …HowItREALLYWorks• ….EveryoneSharestheSameUnderstanding

• ProcessMapsRevealWhereImprovementIsNeededMost

• ProcessMappingHelpsKeepaProjectinScope

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ProcessMapErrors

• OnlyWorkingwithThoseDistaltotheProcess• MappingtheImprovedProcessFirst• MappingtheWayaProcessis“SupposedtoWork”• IncorrectLevelofAbstraction• NotVerifyingAccuracy

DMAICDefineMeasureAnalyzeImproveControl

Analyze• WalktheProcessMapandRefineIt

• SpendTimewiththePeopleWhoDotheWork• Re‐scopeifNeeded• CaptureCycleTimes• BrainstormIdeasforImprovement

• FishboneDiagrams• AffinityDiagrams

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DMAICDefineMeasureAnalyzeImproveControl

PilotingImprovement andChange

Wemustremember…

AllImprovementsstemfromchange,butnotallchangesareimprovements

&

Hopeisnotanimprovementstrategy

TheEngineforInnovation&Change:PDSACycleSTARTHERE

Plan

• Objective• Predictions• Plan to carry out the cycle (who, what, where, when)

• Plan for data collection (who, what, where, when)Do

• Carry out the plan

• Document observations

• Record data

Study

• Analyze data

• Compare results to predictions

• Summarize what was learned

Act

•What changes need to be made?

• Next cycle?

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HoorahforPDSA!• Action‐orientedLearning

• ScientificProcess• Hypothesize• Experiment• Evaluate• Synthesize

• Avoid“AnalysisParalysis”

• LessonsinSTUDYandACTBecomePublicKnowledgeandSpeedsGeneralization

• MinimalExpenditures$$

• VerticalTeamFacilitatesBuy‐in

TesttheChange

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PDSA:Processchange

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DMAICDefineMeasureAnalyzeImproveControl

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NowWhat?

CONTROL

• “Surface” Key Process and Outcome Measures

• Timely Data Entry =“Knowable” Individual and Group Performance

• Embed Use of Data into Management Repertoire

C

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CONTROL

CONTROL• ThisistheMostDifficultPhaseinDMAIC

• MaintainingtheGains

• Safeguards:WhatWillBeDonetoKeepthisonTrack?

• ResponsibilityRestsontheProcessOwner(RoleofKPI)

• WhatHappensinthisPhase?

• PicktheRightControlMethod(Checklists,Monitoring,Reporting)

• WhatisAcceptableVariance?

• DocumenttheResponsePlan

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MissionImpossible

ItTakesaTeam!

But…I’mAllAloneSustainable,transformative,changerequiresanengaged,interdisciplinary,team

• Letyourleadershipknowwhatyouneed

• Worktheseprinciplesasbestyoucaninyouownsphere• Ittakestime• Ittakesconstanteffort• It’sworthit!

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SuccessfulOrganizations

• Understandwhattheircustomerswant

• Understandhowtheyaremeasuringup

• Candescribe,monitorandadjustprocesses

• Canexamineandsupportemployee

performanceandfunctions

• Canquicklyidentifyandrespondtointernaland

externaldemands

…Ismultifactorialandcomplicated!

• Today’sfocusison:• Stakeholderengagement

• Communication(bitesized!)

StakeholderEngagement

Stakeholder:Anybodywhocanaffectorisaffectedbyanorganization,strategyorproject

FromOGCSuccessfulDeliveryToolkit2005

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StakeholderEngagement

Whatyougetfromstakeholderengagement:• Agreementonpurposeanddirection(i.e.buy‐in)ofaprojectorprogram

• Earlyidentificationofpotentialissues,conflictsandbenefits

• Generationofnewideas• Defusionofconflictsituationsbeforetheseimpedeprogress

• Increasedcommunitycohesionandstrengthenedsharedidentity

REVITStakeholderEngagement:AToolKithttp://www.revit‐nweurope.org/selfguidingtrail/27_Stakeholder_engagement_a_toolkit‐2.pdf

StakeholderEngagementKeyelementsforstakeholderidentification:• Whoisdirectlyresponsibleforthedecisionsontheissues?• Whoisinfluentialinthearea,communityand/ororganization?• Whowillbeaffectedbyanydecisionsontheissue(individualsandorganizations)?

• Whorunsorganizationswithrelevantinterests?• Whoisinfluentialonthisissue?• Whocanobstructadecisionifnotinvolved?• Whohasbeeninvolvedinthisissueinthepast?• Whohasnotbeeninvolved,butshouldhavebeen?

REVITStakeholderEngagement:AToolKithttp://www.revit‐nweurope.org/selfguidingtrail/27_Stakeholder_engagement_a_toolkit‐2.pdf

WhoAreYourStakeholders?

NameandRoleStrategicObjective

ScopeofInfluenceCoherencewith

ObjectiveYes*No*Indifferent

KeyAlliances

Jane Doe, Clinic Manager Care Delivery Clinical site/staff Indifferent Corporation VP HR

Adaptedfrom“MainstreamingParticipation”http://www.fsnnetwork.org/sites/default/files/en‐svmp‐instrumente‐akteuersanalyse.pdf

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PrioritizeYourStakeholders

KeepSatisfied ManageClosely

Monitor(MinimumEffort) KeepInformed

www.mindtools.com

PowerVs.InterestGrid

StakeholderActions

Someone'spositiononthegridshowsyoutheactionsyouhavetotakewiththem:

• Highpower,interestedpeople:thesearethepeopleyoumustfullyengageandmakethegreatesteffortstosatisfy

• Highpower,lessinterestedpeople:putenoughworkinwiththesepeopletokeepthemsatisfied,butnotsomuchthattheybecomeboredwithyourmessage

www.mindtools.com

StakeholderActionsSomeone'spositiononthegridshowsyoutheactionsyouhavetotakewiththem:

• Lowpower,interestedpeople:keepthesepeopleadequatelyinformed,andtalktothemtoensurethatnomajorissuesarearising.Thesepeoplecanoftenbeveryhelpfulwiththedetailofyourproject

• Lowpower,lessinterestedpeople:again,monitorthesepeople,butdonotborethemwithexcessivecommunication

www.mindtools.com

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UnderstandYourStakeholders• Whatfinancialoremotionalinterestdotheyhaveintheoutcomeofyourwork?Isitpositiveornegative?

• Whatmotivatesthemmostofall?

• Whatinformationdotheywantfromyou?

• Howdotheywanttoreceiveinformationfromyou?Whatisthebestwayofcommunicatingyourmessagetothem?

• Whatistheircurrentopinionofyourwork?Isitbasedongoodinformation?

• Whoinfluencestheiropinionsgenerally,andwhoinfluencestheiropinionofyou?

www.mindtools.com

UnderstandYourStakeholders• Dosomeoftheseinfluencersthereforebecomeimportantstakeholdersintheirownright?

• Iftheyarenotlikelytobepositive,whatwillwinthemaroundtosupportyourproject?

• Ifyoudon'tthinkyouwillbeabletowinthemaround,howwillyoumanagetheiropposition?

• Whoelsemightbeinfluencedbytheiropinions?Dothesepeoplebecomestakeholdersintheirownright?

www.mindtools.com

StrategicTip:BeCompellingDon't"pushitthrough"– it'smuchbettertoconvincepeoplethatit'simportantandurgent–onlythatwaycanyougetaclearcommitmentfromothers• Whatconditionscreatetheneedforchange?

• Whataretheunderlyingcauses?

• Haveyouidentifiedandmadeacaseforthechange?

• Haveyouidentifiedtheonecrucialreasonforchange?

• “WIIIFM”?www.mindtools.com

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StrategicTip:GettheWordOut

One size does not fit all forcommunication

• Whichstakeholderswillneedregularoneononechats?

• Doyouneedtodoorganizationwide“townhalls”?

• Dopeopleatyourorganizationreademailsreliably?

• Canyouputarticlesinthecompanynewsletter?

• Whichregularoperationalorstaffmeetingsshouldyouattend?

• Isaspecialactivityrequiredtogainattention?www.mindtools.com

But…I’mAllAloneSustainable,transformative,changerequiresanengaged,interdisciplinary,team

• Letyourleadershipknowwhatyouneed

• Worktheseprinciplesasbestyoucaninyouownsphere• Ittakestime• Ittakesconstanteffort• It’sworthit!

SuccessfulOrganizations

• Understandwhattheircustomerswant

• Understandhowtheyaremeasuringup

• Candescribe,monitorandadjustprocesses

• Canexamineandsupportemployeeperformance

andfunctions

• Canquicklyidentifyandrespondtointernal

andexternaldemands

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Focus andStreamline

Typical Desired

Data Collection/Measure

Data Analysis

Data Utilization/Improve

Plan/Define

Follow-up/Control

Changing the Approach is Key to Success

Quality Services

Quality Assurance

Ongoing measurementof “Vital Signs”

Data

Quality Improvement

Targeted and SystematicChange and

measurement of impact

QualityAssuranceorImprovement?

KeyPerformanceIndicators(KPIs)

• Howdoyoumeasuresuccess

• Typeofperformancemeasurement

• Helpanorganizationdefineandmeasureprogress

• Linkedtoanorganization’smissionandvision

• Shouldincluderegularexaminationsofgoals/expectations

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WhyAreKPIsImportant?

• Sustainabilityinanewera

• Performanceinformationisfrontandcenter

• Increasethepaceofeffectivedecision‐making

• Decisionsneedtobetargetedandinformed

• UseofKPIsembeddedintomanagementwillenabletheseabilities

Scorecard

ActiveManagementvs.Auditing

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ActiveManagementvs.Auditing

Component ActiveManagementwith

Data

Auditing

Scale Population Sample

Time Closetorealtime Retrospective

Opportunitiestoexamine

Performance Status

Frequent Dependentonauditschedule

Focus CurrentandFuture RetrospectiveandFuture

Organizational Risk Catchissues quickly Depends onAudittimeframe

WhoeverOwnstheProcess,ShoulderstheResponsibility

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Questions?