QUALITY TOOLS FOR
PROCESS IMPROVEMENT
PDCA/PDSA
PDCA/PDSA
PDCA
Plan. Do. Check. Act
PDSA
Plan. Do. Study. Act
Cyclic approach
Managing a project
Problem solving process
Increasing your knowledge with each cycle
Recording results
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Emphasizes understanding
results not recording them
PDSA CYCLE FOR LEARNING AND IMPROVEMENT
 Objective, questions and predictions (why)
 Plan to carry out the cycle (who, what, where, when)
Plan
 What changes are
to be made?
 Next cycle?
Act
Continuous
Improvement
Do
 Carry out the plan
 Document problems
and unexpected
observations
 Begin analysis of the
data
Study
 Complete the analysis of the data to
predictions
 Summarize what was learned
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THE MODEL FOR IMPROVEMENT
What are we trying to
accomplish?
When you combine these
three questions with the
PDSA cycle, you get the
Model for Improvement.
How will we know that a
change is an improvement?
What change can we
make the will result in
improvement?
P
A
D
S
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ROOT CAUSE ANALYSIS
ROOT CAUSE ANALYSIS – 5 WHY PROCESS
• The first “Why?”
• This is the top reason
behind the problem
• Answer that question
• The second “Why?”, third “Why?” and so on
• This should follow the same idea
• Continue until you have drilled down to the root of
the problem or root cause of your issue
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WHY IS THE FRENCH TOAST BURNT?
• Why is the French toast burnt?
• The flame on the stove was too hot
• Why was the flame too high?
• Staff didn’t know how to work
the stove
• Why didn’t the staff know
how to work the stove?
• The staff was never instructed in
use of stove
• Why wasn’t the staff instructed in the use of the stove?
• It is not in the job description training
• Why is it not in the job description training?
• French toast is a new item on the menu
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SUPERSTORM SANDY EXAMPLE
• Why were there not enough oxygen concentrators?
• There were not enough working electrical outlets
• Why were there not enough working electrical outlets?
• Some outlets were cracked or did not work
• Why were the outlets cracked or not working?
• The staff did not check/test the outlets
• Why didn’t the staff check the outlets?
• It is not in the preparation checklist
• Why is it not on the preparation checklist?
• We never had a problem before
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FISHBONE DIAGRAM
FISHBONE DIAGRAM (ISHIKAWA DIAGRAM)
• Represents cause and
effect
• Effect forms the head of
the fish
• Potential causes form the
skeleton
• Structured way to
represent contributors to
problems
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FISHBONE DIAGRAM CONTINUED
Environment
System
Facilities
s
Patients
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Materials
Manpower
FISHBONE DIAGRAM
Reasons to use a Fishbone Diagram:
• Organizes causes/potential causes
• Helps the team discuss the issues
• Provides framework to organize issues
• Visual presentation by areas
• Living document
Limitations of the Fishbone Diagram:
• Based on opinion
• Lost energy spent on “potential” causes
• Comes down to a democratic vote
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PROCESS MAPPING
PROCESS MAPPING FOR CONTINUOUS
QUALITY IMPROVEMENT
• Simple method
• Highlights wasteful steps in
your process
• Maps out the actual
processes
• Not processes in procedures
and manuals
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PROCESS MAPPING SYMBOLS
Oval shows input to start process
or output at end of process
There is usually only one arrow out
of an activity box. If there is more
you may need a decision diamond.
Box or rectangle shows task or
activity performed in process
Yes
Diamond
shows places
in process
where yes/no
question is
asked or
decision is
required
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N
o
Oval shows input to start
process or output at end of
process
Process Mapping
Source: wikipedia/commons/9/91/Proposed_Patient_Appointment_Procedure.png.
PROCESS MAPPING CONTINUED
Now What?
• Discuss “reality” with the leadership
• Use recommendations to create a new map
• Change one thing- not everything
• Test the new process map
• Gather key information to support the change
• Saves time, supplies, staff time
• Increased accuracy, consistency
• Better definition of task= improved teamwork
• Discuss updating policies and procedures
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REFERENCES
• Knoth, J., Miller, J. (2014). Quality Tools for Process
Improvement. Healthcare Quality Strategies. Inc.