Grant/Riverside Methodist Hospital
I.
Brainstorming
II.
Multivoting
III. Storyboarding
IV. Flowchart
V.
Force-Field Analysis
VI. Cause and Effect (Fishbone) Diagram
VII. Pie Chart/ Bar Chart/ Run Chart
VIII. Pareto Chart
IX. Scatter Diagram
X.
Histogram
XI. Control Chart
XII. Gantt Chart
XIII. Contingency Diagram
XIV. Team Charter
XV. Why Technique
XVI. Impact Analyzer
XVII. Visual Management Sheet
XVIII.
Quad Sheet / Continuous Improvement
XIX. Decision Matrix
XX. Seven Step Process
3
3
4
5
6
7
8
9
9
10
11
12
13
14
15
16
17
19
20
21
2
What it is
A technique for generating a list of ideas
What to use it for
Generating lists of processes, topics for data collection, potential solutions
How to use it
1. Decide on a topic
2. Have each member in turn offer an idea about the topic. Other members should refrain from any comment,
listen and build on each other’s ideas
3. Have one person record all the ideas on a flipchart
4. Continue the process until the team feels it has exhausted its ideas on the topic
5. Discuss and clarify the ideas on the list
Example
A “wish list” for new office lunchroom
Running water and sink
Soft drink machine
Tables and chairs
Fruit-juice fountain
Microwave oven
Free bagels and cream cheese
Food delivery service
Toaster
Massage lounge chairs
Refrigerator
What it is
A technique to narrowing down a list of ideas or options. It is used in conjunction with brainstorming
What to use it for
Selecting a process, topic for data collection, solution, or item to monitor
How to use it
1. After a list of topics is generated, have one person record the ideas on a flipchart
2. Review and clarify each idea. Combine any similar ideas
3. Have each member assign ten points to the ideas (no more than 7 points in one category), and record their
points for each idea on the flipchart
4. Tally the votes for each idea. Narrow down the list to the four to six ideas that received the most votes
Example
A “wish list” for new office lunchroom
Running water and sink (4)
Soft drink machine (8)
Tables and chairs (11)
Fruit-juice fountain
Microwave oven (7)
Free bagels and cream cheese
Food delivery service
Toaster (4)
Massage lounge chairs
Refrigerator (15)
3
What it is
A systematic process for creative thinking that combines idea-generating (brainstorming) and analysis of ideas.
What to use it for
1. Identify creative alternatives for problem solving and decisions
2. To go beyond brainstorming and identify a recommended alternative solution
How to use it
1. Define the topics on a 5 x 8 card and tack to the wall.
2. Define and agree on the “leaders” on major areas that need consideration on this topic and place them on a
4 x 6 card.
3. Present the guidelines:
 Evaluation and judgement are forbidden
 The quantity of ideas is important
 Wild, far fetched and “illogical” ideas are encouraged
 Ideas may be combined, modified, or “piggybacked”
4. Give each participant some 3 x 5 note cards. When they have an idea for one topic, they write it on a card,
say it out loud, and hand it to the facilitator
5. When there is silences, move on.
6. Participants begin objection-counter where any individual can raise questions, or ask for removal of an ideaanyone can counter the objection. Cards are removed and rewritten.
7. Decision about final board are made by consensus
8. Ideas are ordered into proper sequence to be written into hard copy.
Example
BEFORE A WOMAN HAS AN MRI SHE NEED TO:











Know she will need to lie still for 1-½ hours.
Know the procedure will be done at the hospital.
Know there is load noise during the procedure.
Let her doctor know if she is claustrophobic.
Know she may have tapes of music with her.
Know what the size limit is for the equipment.
Know to remove her valuables.
Know to use the bathroom before the procedure.
Know to check with her insurance to see if she needs pre-authorization.
Know to tell someone if she has any history of metals in her body.
Know to ask her doctor for a sedative before the procedure.
4
What it is
An illustration of the sequence of activities that make up a process
What to use it for
1. Understanding the activities that constitute a process and the relationship among those activities
2. Providing a framework for further process analysis by ensuring that the list of activities is complete
3. Identifying opportunities to eliminate problems, add missing steps, and streamline work
How to use it
Begin, end
Activity, task
Decision
point
Delay
1. Set boundaries for the process
 Decide where the process begins and ends
2. List all the activities in the process
3. Arrange the activities in sequence, make sure to include all decision points
4. Draw arrows to clearly show the sequence of activities
5. Review the flowchart and answer these questions:
 Where are the bottlenecks in your work flow?
 Where can rework or redundant steps be eliminated?
 Where can time be saved?
Example
Serving customers in a restaurant process flow
No
Customer
Enters
Take Order
Take money
and give
change
Food
Ready
?
Wait until
food is
ready
Yes
Give food to
customer
Say “Thank
You!”
Customer
leaves
restaurant
5
What it is
A method to identify forces that make possible or obstruct a change. These forces are driving forces (help you
achieve a change) and restraining forces (work against a change).
What to use it for
1. Determining if a solution can get needed support
2. Identifying obstacles to execution
3. Suggesting actions for reducing the strength of the obstacles
How to use it
1.
2.
3.
4.
5.
Draw a force-field chart (a large “T”)
Write the current situation at the top center of the chart
Write the desired situation at the top right of the chart
Brainstorm for driving forces (pushing toward what you want) and enter them on the left side of the chart
Brainstorm for restraining forces (preventing you from getting what you want) and enter them on the right
side of the chart
6. Discuss the chart and determine which factors could be altered to increase the chances of success
7. Decide whether your solution is doable. If it is, make a list of action items to alter the forces. If it isn’t,
develop another solution.
Current Situation
Example
Present Delivery
System
Driving Forces
What you Want
Proposed Delivery
System
Restraining Forces
Dissatisfaction of “regular order” customers
Grocer hollers at “Emergency” driver
Shipping department backup
Unhappiness from “emergency“ grocers who get
orders late
Dispatcher errors
Phone calls to shipping from irate customers
Low morale
Resistance from scheduling office
Lost business
Resistance from management over drivers making
their own schedules
6
What it is
A diagram showing the possible causes for a problem, with detailed causes attached to the main causes
What to use it for
1. Getting the big picture of a problem
2. Facilitating team members’ use of their personal knowledge to identify causes of the problem
3. Providing ideas for data collection and/or solutions
How to use it
1.
2.
3.
4.
Write the problem on the right side of a flipchart and draw a large arrow that points toward the problem
Draw arrows indication the main types of causes (or contributing factors) and points toward the central error
Brainstorm for specific causes and attach each specific cause to an appropriate main cause
Break down the causes further by brainstorming for sub-causes
Example
This is the
“effect”, or
major error
Machines
People
This is
major
cause
Height
Carelessness
Fatigue
Poor eyesight
Assembly line
Physical Problems
Drill Press
Poor hearing
Ignorance of correct procedure
Lack of guard
Poor coordination
Hand and
Wrist Injuries
Speed
Ceramics
Lighting
Sharp objects
Assembly line
Monitoring
Maintenance
Poor machine
maintenance
Work movements
Heavy Objects
Bases
Methods
This is a
sub-cause
Metals
Tools
Materials
This is a category
of causes
7
What they are
A way to describe what is happening by summarizing quantities of data in simple visual displays
What to use them for
1. Seeing results yourself
2. Presenting results to others
Examples
Sharpshooters
Pie Chart
The pie chart divides the whole into parts,
showing each part as a slice of the pie.
Cooks
Infantry
Calvary
Medical
Officers
16000
13620
Number of Troops
14000
12000
Sharpshooters
10000
Cooks
6841
8000
4000
Infantry
Calvary
6000
Medical
3090
3153
2428
2428
Bar Chart
The bar chart displays comparisons, with each bar
indicating the number or volume of the items measured.
Officers
2000
0
Number of Troops
19
17
15
13
11
9
7
5
3
The trend chart, or run chart is widely used for monitoring and tracking
changes is processes over time.
16
14
12
10
8
6
4
2
0
1
Run Chart
Number of New Recruits
Trend Chart of New Recruits
Week
8
What it is
A technique for determining the most significant causes of problems.
What to use it for
Identifying the one or two situation categories in which most of your problems occur.
How to use it
1. Define the categories to be used in
your diagram
2. Sort the data into categories and
arrange the categories in descending
orders as defined by the data
3. Make a bar graph based on the data,
with the highest category on the left
4. You can also include a cumulative
run chart on the bar graph that shows
the percentage of the entire data set
each category contains
Example
What it is
A graphical representation of data points
What to use it for
To illustrate the relationship between two variables
How to use it
1.
2.
3.
4.
5.




$800
$600
$400
$200
$0
100%
80%
60%
40%
20%
0%
Percentage
Cost per
Category
Causes of Heat Loss
f
er
lls
Roo
Wa
Oth
Category of Heat Loss
Gather data and determine high and low value for each factor
Decide which factor will be plotted on the horizontal axis
Draw and provide clear labels on axes
Plot the paired data
Identify and classify the pattern of correlation
Strong correlation – suggests that control of one results in control of other
Weak correlation – suggests control of one does not necessarily result in control of other
No correlation – suggests no relationship
Complex correlation – suggests non-linear relationship
9
What it is
A graphic summary of variation in a set of data
What to use it for
To identify patterns in a set of data
How to use it
1. Collect at least 40 data values
2. Determine the range of the data by subtracting the lowest data value form the highest
Highest Value – Lowest Value = Range
3. Determine how many bars you will use to display your data on the histogram (6 to 12 bars is good – use
more for large collections of data)
4. Divide the range by the number of bars to determine the range of values that will be represented by each bar
5. Create a chart with the horizontal axis labeled with the bar ranges and the vertical axis labeled with the
corresponding number scale
6. Draw the bars on the chart
7. Use the chart to identify and classify patterns of variation and to develop a plausible and relevant
explanation for the pattern
Example
Height of 10-year old boys
35
# of boys in range
30
25
20
15
10
5
0
0 to 3 to 5 to 7 to 9 to 11 to 13 to 15 to 17 to 19 to 21 to 23 to
2
4
6
8
10 12 14 16 18 20 22 24
Ranges (range = 24 inches)
10
What it is
A tool used to analyze and understand the variation in a process over time
What to use it for
1. To observe and predict the performance of a process
2. To determine if a process is “in control”
How to use it
1.
2.
3.
4.
5.
Points in control?
Plot data in time order
Calculate the average
Determine the median of the ranges
Multiply the median of the ranges by 3.14
Add the result to the average to get the Upper Control Limit (UCL). Subtract the result from the average to
get the Lower Control Limit (LCL).
6. Draw the centerline (average) and control limits on the chart with the data points




Points out of control?


Only common causes of variation
Points fall within control limits
Greater uniformity cannot be attained with the process as it currently exists
Improvement can only be achieved by changing the process
Points outside the control limit (investigate cause, eliminate special cause if identifiable negative,
incorporate special cause if positive)
Runs: a group of points collected one after another ( six points in a row above or below centerline, 14 points
in a row alternating up or down)
Example
1:26
1:12
UCL
Values (minutes)
0:57
0:43
0:28
0:14
0:00
LCL
Days of the Week
11
What it is
A graph of a project schedule
What to use it for
1. To help make scheduling easier
2. To help monitor time
How to use it
1. List elements of your project plan where work is done down the left edge
2. Draw a timeline across the bottom
3. Draw a bar between the start and finish dates for each element
Example
ID
1
Task Name
Plant garden
Duration
1.81 days
2
Draw garden layout
2 hrs
3
Buy seeds and supplies
3 hrs
4
Plow dirt
2 hrs
5
Make holes
1 hr
6
Plant seeds
2 hrs
7
Cover seeds
8
Spread hay or mulch betw een row1 shr
9
Water garden
8
9
10 11 12
1
2
3
4
5
6
7
8
9
Thu Aug 17
10 11 12 1 2 3
4
5
6
7
8
9
10 11 12
0.5 hrs
3 hrs
Gantt Chart for planting a garden
12
1
2
What it is
A way to find good solutions to persistent problems using reverse logic.
What to use it for
To plan actions that will prevent a problem from recurring
How to use it
1. Select a situation where change is needed and possible
2. Draw a diagram like the one below and write the situation in the oval.
3. Work with others to brainstorm actions that would make the problem continue or worsen and write those
actions on the lines to the left of the oval. Follow these guidelines:
 Assign one person to record all ideas on a flipchart
 Have group offer ideas in turn (If a person does not have an idea, they can pass)
 Never criticize, praise, or question ideas
 Continue until the group has no more ideas
 Discuss and clarify the list
4. Think of actions that would prevent the problem from continuing or worsening and create a prevention
checklist that describes these actions as specifically as possible
Example
Problem: losing information between day and night shifts
Don’t provide a place to record information
Losing Information
Prevent shifts from seeing each other
Blame the other shift
Assume everyone knows that
information is important
Prevention Checklist




Keep a detailed logbook
Have change-of-shift meetings
Designate someone on each shift to be responsible
Explain why information is important
13
What it is
A written document describing the
purpose of a team’s process
improvement effort and how it is to be
accomplished
Example
License Renewal Team Charter
Name of process to be managed or improved
What to use it for
How to use it
1. Focusing the activities of the team
2. Showing others what the team is
doing
3. Providing a record of past
improvement activities
4. Providing a framework for ongoing
discussion between the team
sponsor, leader, and members about
the process improvement effort
1. Draft a team charter, including the
following :
 Name of the process to be managed
or improved
 Organizational goals and strategies
to be addressed
 Boundaries of the process
 Improvement targets and measures
 Resources available
 Constraints
 Time frame for completion
 Team strategies: expectations about
how the work will be done
2. Review the team charter with
members of the improvement team
and modify it as needed
License renewal (for applicants who come to a Registry office; mail applications are not included).
Organizational goal and strategies to be addressed
Delighting the public through excellent customer service
Name of process to be managed or improved
Boundaries of the process
Beginning and end points
Beginning: Applicant enters registry office.
End: Applicant leaves with new license or other disposition of application.
What is not included?
Not included: Applicants who come in for multiple purposes; mail applications
Improvement targets and measures
A.
B.
Significantly decrease turn-around time- Measure = cycle time
Significantly increase applicants’ satisfaction- Measure = customer satisfaction ratings
Resources available
A.
B.
Team members can meet for three hours per week, counted as regular work time.
Team can spend up to $1 million for new equipment, training, facilities, etc.
Constraints
None other than above
Time frame for completion
Begin March. Expect new system to be implemented by October.
Team Strategies
A.
B.
C.
The project will focus primarily on customer satisfaction, although reductions in cycle time
should also result in eventual cost savings
Large-scale redesign of processes can be considered. Benchmarking against other state agencies
is expected.
The team will include representatives of all major functions involved in the process
14
What it is
A way to move through layers of causes to get at the preventable root cause of a recurring problem
What to use it for
To find the root cause of a problem that may be masked by other symptoms
How to use it
1. Select a recurring problem
2. Ask “Why did the problem occur?” to uncover the first-layer causes
3. Take the causes that you uncovered in step 2 and ask “Why did they happen?” to uncover the second-layer
causes
4. Continue asking why the previous causes happened until you believe you have uncovered the most
important, root cause
Example
Problem
Recently, a number of projects have been delivered late.
Why did that problem occur? (first-layer cause)
Despite our best efforts, we were not able to complete those projects on time.
We’re spread too thin. It seems as though we’ve got way too many projects for
the number of people in the department.
Why did that occur? (second-layer cause)
Productivity is down, and employees are calling in sick every day.
Why did that occur? (third-layer cause)
Our employees have been doing way too much overtime in the last six months – they’re getting burned out.
Why did that occur? (fourth-layer cause)
One big reason is that the computer network is always going down. This causes repeated work stoppages and
even lost files, which must then be recreated from scratch. Also, file transfers are very slow over the network,
which causes work delays. Basically, it’s taking our employees longer to do less work.
Why did that occur? (fifth-layer cause)
The company has outgrown its network. MIS tells us that we are now running 132 terminals over a network
designed to handle 100 workstations, maximum.
15
What it is
A way to identify the effects that a change will have throughout an organization
What to use it for
1. Visualizing the impact of process changes before they change happens
2. Planning to manage changes in an organization
How to use it
1. Identify the proposed change and write it in the center of a flipchart
2. Brainstorm the primary effects of that change and write them on the flipcharts, connecting them to the
proposed change with a single line
3. Review the primary effects and determine whether there are any expected secondary effects. Link those to
the primary effects with a double line
4. Repeat step 3 for the secondary effects, connecting tertiary effects to secondary with triple lines
5. Determine action steps for successful implementation
Example
Develop
new
procedures
Change
reporting
relations
Consolidate
functions
Enlarge
training
budget
Gear up
HR for
counseling
Train meter
readers on
new
technology
Redesign
billing
process

Redeploy
staff in
data entry
Supervisors
more
involved in
training
Plan to use
more people
in other
areas
Align MIS
function
with new
process
Create
new
software
The team realized that the changes
it was visualizing would require
additional training for supervisors
and revisions in the reporting
relationships and structures.
Members decided on the following
action steps:


Schedule an executive
meeting off-site to
review the
organizational
structure
Inform HR of its
expanded role in
redeployment activities
Provide training skills
to the supervisors
Install
new
hardware
16
What it is
A method of communicating project goals, roles and responsibilities, resource requirements, progress, and
outcomes
What to use it for
To have a clear, concise document of a project to show to others in the organization
Reason for the project
Why we are doing this project, or what is wrong with the status quo
Process Owner/
Executive Sponsor
Physician Sponsor
Which Senior Staff-person is ultimately accountable for the project’s success
Project Team Leader
Who is responsible for providing day-to-day project management
Advisors
Who is responsible for providing project management and other types of technical support
State the Project
A concise statement of what the project will achieve, by when and at what cost
Objectives
A list of specific outcomes the project will achieve
Measures of Success
How we will track progress and know we have achieved the desired outcomes
Work Breakdown
Structure (WBS)
Resource Requirements
A summary of the main steps of the project and the timeline for completing those steps
Requirements for
Success
Protect the Plan
A list of internal factors that might endanger the success of the project (things the
organization can control)
A list of external factors that might endanger the success of the project (beyond the
organization’s control)
Which Physician is responsible for gathering physician input and buy-in for the project
What resources are needed to make the project succeed
17
18
What it is
A document that helps to identify
problem areas and develop action plans to solve the problems
What to use it for
process
7. Develop an improvement plan to
close the gap. The improvement
plan involves determining actions,
the person responsible for the
actions, the date the action should be
complete, and the measure that will
determine whether the action was
effective or not
1. To identify problem areas in a
2. To document these problems as well
as the improvement plan
How to use it
1. Fill out the top portion of the Quad
Sheet with the Management Model
Section the problem corresponds to,
the process name or approach, the
process owner, and the date the sheet is
initially filled out
2. In the concern box, write your reason
for filling out the sheet (the problem
that caused your concern about the
process)
3. Determine the gap you are trying to
close (the measures dealing with the
problem) and put that in the
Performance box
4. Brainstorm causes leading to the gap
and place them on the fishbone in the
Contributing Factors box
5. Be positive by identifying the
strengths in the process and place
these in the strengths box
6. Determine areas in the process that
need improvement and place them
the Improvement Areas box
Example: Continuous Improvement Plan Worksheet
Management Model Section: 2.2 Selecting, Attracting, Matching
Process name (Approach):
Applicant Tracking
Process Owner:
Jon Joffe
Date:
2/23/2000
Concern: The current Applicant Tracking database does not meet internal or external
customer needs.






PERFORMANCE
Current system is a stand-alone
database- does not connect to other
databases
The same data must be entered into
multiple databases
STRENGTHS
HR senior management support
Passionate process owner
HR project manager
Strong end user desire for new system
CONTRIBUTING FACTORS
Causes:
Limitations & design of Access database
Staff who try to make system work
Processes not documented or communicated
Lack of funding for more robust system



IMPROVEMENT AREAS
Enable staff to track job fulfillment
process throughout
Enable staff to create a useful set of
reports
Interface with current Lotus Notes
IMPROVEMENT PLAN & SUPPORT REQUIREMENTS
Action
Begin project to
install PS
Applicant
Tracking Module
Responsibility
Joffe, White
End Date
7/15/2000
Measure
Project
meets all
structure,
process and
outcome
measures
id’d in
project plan
Review Date: 8/14
19
20
What it is
A methodology and set of tools for process improvement
What to use it for
It is used for improving an existing process, redesigning a process, or creating a process where none existed
How to use it
Doing Things Right
Doing Right Things
Tools







Tools







Measurement matrix
Basic descriptive
charts
1. Identify
improvement
opportunity
7. Measure and
monitor
2. Identify key
customers and
suppliers


Contingency diagram
Benchmarking
Innovation transfer
Force-field analysis
Building individual
support
Action plan
Presentation





Input-output diagram
Flowchart
Fishbone diagram
Pareto analysis
Why Technique


Brainstorming
Multivoting
Impact analysis
Selection grid
Opportunity Statement
Team Charter
Team member
checklist
Roles and
responsibilities chart
Customer-supplier
network map
6. Develop and
execute solutions
3. Establish agreedupon requirements
5. Describe and
analyze current
process
4. Identify the gaps

Customer requirement
chart



Impact analyzer
Survey
Checksheet
21