Listening to Voices
The voice of the process
What are the voices?
Media Attention
Customer/Citizen Surveys
Complaints
Work Areas
The Staff
Staff Surveys
Waste
Efficiency
Outcome & Process Measures
Wasting valuable
management time
How much time do you spend trying to
achieve targets?
• Trying to achieve everything
• Writing reports
• Holding meetings to sort perceived
performance issues
Performance Reports?
How often do you report?
• Month on month
• This quarter compared to last
quarter
• This quarter compared to this
quarter last year
• The average for the:
• Month
• Quarter
• Year
Average Late Starts
Late start rates
14
13
12
%
11
10
9
8
7
6
Urology
T&O
Gen Surg
Why collect data?
How can we compare, quantify or record
changes if we cannot capture our data in some
numerical form?
Without measurable data we are at the mercy
of anecdote. If you make an assumption based
on anecdote rather than data, it will nearly
always be wrong because we remember the
unusual, not the mundane.
What are we measuring ?
• What data is currently being
collected?
• How do you interpret/use these?
• Is this info fed back to those who
collect the data?
Chasing Tails!!!
Chasing Tails–
learning points
• Any process contains variation
• Reacting incorrectly to variation
is futile
What is variation?
Nick Tyson
Nick Tyson
Nick Tyson
Nick Tyson
Nick Tyson
What is variation?
“I drive to work every day.
When asked, I say it takes 55
minutes. In fact, it takes about
55 minutes, but every day it is
slightly different”
Histogram
Time to drive to work
10
Number of days
8
6
4
2
0
50
.0
.5
.0
.5
.0
.5
.0
.5
.0
.5
.0
.5
.0
.5
.0
.5
.0
.5
.0
.5
2
5
7
0
2
5
7
0
2
5
7
0
2
5
7
0
2
5
7
5
5
5
6
6
6
6
7
7
7
7
8
8
8
8
9
9
9
9
Journey Time
The importance of time
• Time is often the most
important variable, but it is
often lost in the aggregation of
data
Average Late Starts
Late start rates
14
13
12
%
11
10
9
8
7
6
Urology
T&O
Gen Surg
Run charts
• How to draw a run chart
Y axis
The value
(measure)
X axis
Time period (e.g.
days, weeks)
Run Chart Exercise
• The raw data for the three
departments are attached
• Roughly plot each directorate
separately on the graph paper
provided
Three graphs
Future gazing
• Can you predict how your
process is likely to perform?
• How can you measure the
context of YOUR variation?
SPC Chart
Upper control limit
Journey Time in Minutes
100
90
80
70
60
50
1
4
7
Lower control limit
10
13
16
Day
19
22
25
28
31
Range of the process
What is variation?
• All processes contain variation
• The key in managing variation is
to distinguish between
- variation caused by the process
(common cause)
- variation that is caused by
special events (special cause)
Special cause leading
to new process
One-off special cause
Journey Time in Minutes
100
90
80
70
60
50
1
4
Common cause
7
10
13
16
Day
19
22
25
28
31
Match action to type of
variation
TYPE OF VARIATION
TYPE OF ACTION
Common Cause
Common
Cause
Special
Cause
Understand the
process so that
changes
introduced will
change the process


Investigating and
correcting each
incidence of common
cause variation will be
time consuming & won’t
address the system
factors causing variation
Special Cause

Changing the process
to deal with one-off
events is only likely
to increase variation
and make things
worse
Investigate the
occurrence and
determine what factor
external to the process
has caused the variation

Dealing with common cause
variation
Reduce the variation e.g.
by avoiding rush hour
Move the centre line
e.g. by changing route
Trends
• What is a change?
• What is a trend?
• “Last month our waiting
list was 453. This month
it is 441. We’re getting
better!”
Point Outside Control
Limits
Indicates there is something different about this point
UCL
Average
LCL
A change in the process
8+ points in a row above or below the
centreline indicates a process change
Centreline
Process average
Trends
6+ points in a row increasing or decreasing
indicates a trend in the process
Upward Trend
Downward Trend
Example
Example
Dealing with rare events
PARETO CHART: EXAMPLE
Focus on the most
important
(Pareto Principle)
20
100
18
90
16
80
14
70
12
60
10
50
8
40
6
30
4
20
Reasons
2
10
0
C
E
B
D
A
Other
Cumulative Percentage
Action taken on the key causes