Quality tools and techniques- 7 tools of quality
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Transcript of Quality tools and techniques- 7 tools of quality
7 Tools of Quality
Dr. Lallu JosephQuality Manager, CMC Vellore
&Mr. Rabindranath
Audit Facilitation Officer, CMC Vellore
QUALITY TOOLS AND TECHNIQUES
Recap
• Mean - It is a point of reference and also the central point for measuring variability. The only disadvantage of the arithmetic mean is that it is greatly affected by extreme values.
• Median - It is the middle value in a series of numbers arranged in an increasing order.– Series odd number - (n+1)/2
– Series even- arithmetic mean of the two middle values
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Recap
• Mode - Most frequently occurring value
• Variance
σ2 = 1/n [∑xi2 - (∑ xi)
2 /n]
The Standard Deviation, is a simple square root of the variance.
In a frequency distribution, variance is calculated by
σ2 = 1/n [∑ fi xi2 - (∑ fi xi)
2 /n]
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Example
Daily control measurements of Potassium were made for 25 days during a particular month5.7 5.9 5.7 5.7 5.85.7 5.8 5.7 5.9 5.85.6 5.8 5.8 5.7 5.65.8 5.8 5.5 5.6 5.85.9 5.7 5.8 5.8 5.8
Average x = ∑ xi /25 = 143.7/25 = 5.748 = 5.75Variance = 1/25 [∑ xi
2 - (∑ xi)2 /25]
= 1/25 [826.23 – (143.7)2/25]= 6.06/625 = 0.0097
Standard Deviation = Sq rt of 00.0097 = 0.0985
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Basic tools of Quality for Process Improvement
“The old seven”
“The first seven”
“The basic seven”
– Quality pros have many names for these tools, first emphasized by Kaoru Ishikawa the father of “quality circles.”
– These are diagnostic tools to analyze a process and data from that process
– They make up the fundamental continuous improvement toolkit
QUALITY TOOLS AND TECHNIQUES7 tools of quality
7 Basic Tools of Quality
• Histograms
• Pareto Charts
• Cause and Effect Diagrams
• Scatter Diagrams
• Control Charts
• Flow Charts
• Check sheet
QUALITY TOOLS AND TECHNIQUES7 tools of quality
HISTOGRAM
• It is for illustrating the frequency and the extent for two variables.
• Histogram is a chart with columns which represents the distribution by mean.
• If the distribution is normal, the graph is in the shape of a bell curve.
• If not normal, it may take different shapes based on condition of the distribution.
• Histogram can be used to measure one variable against another. There should be two variables.
• Data should be numerical
QUALITY TOOLS AND TECHNIQUES7 tools of quality
When is it used?
• It is used to communicate the distribution of data quickly and easily to others.
• Help in decision making
• Graphically summarize large data
• Compare performance to expectations or specifications
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Reasons for dissatisfaction at OPD# Reasons Number of patients
1 No mike or display board to know the token number 15
2 Problem mixing with ‘follow-up’ patients 25
3 Insufficient doctors 100
4 Insufficient counter Staff 93
5 Staff not following the Queue 12
6 Too many patients at the same time 21
7 Registration time too long 111
8 No name boards of the doctors 13
9 Others 10
10 Total 400
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Histogram
1525
10093
1221
111
13 10
0
20
40
60
80
100
120
No mike ordisplay
board toknow the
tokennumber
Problem mixing with ‘follow-up’
patients
InsufficientDoctors
InsufficientCounter
Staff
Staff notfollowing
the Queue
Too manypatients atthe same
time
Registrationtime is too
long
No nameboards of
the doctors
Others
Reasons for dissatisfaction of patients N =400
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Pareto Charts
– Pareto charts are used to identify and prioritize problems to be solved.
– Vilfredo Pareto, 1800, Italian economist noted “80% of wealth was held by 20% of population”
– Juran applied the Pareto Principle, stating that 80% variation in process is by 20% of the variables
– “Vital few” as opposed to “Trivial many”
– 80/20 rule
– Need not be 80/20, could be 75/25 or 70/30 or even 65/35 also and even disproportionate like 75/35.
– The concept is to priorities and address the issue.
QUALITY TOOLS AND TECHNIQUES7 tools of quality
When is it used?
• Looking at data on the frequency of problems or causes.
• When there are too many problems or causes and you want to focus on the significant ones.
• When you want to analyze broad causes by looking at their specific components.
• To effectively communicate to others about the problem/ data.
QUALITY TOOLS AND TECHNIQUES7 tools of quality
# Reasons
Number of
patients
1 No mike or display board to know the token number 15
2 Problem mixing with ‘follow-up’ patients 25
3 Insufficient Doctors 100
4 Insufficient Counter Staff 93
5 Staff not following the Queue 12
6 Too many patients at the same time 21
7 Registration Time too long 111
8 No name boards of the doctors 13
9 Others 10
10 Total 400
QUALITY TOOLS AND TECHNIQUES7 tools of quality
# Reasons Number of patients
7 Registration Time too long 111
3 Insufficient Doctors 100
4 Insufficient Counter Staff 93
2 Problem mixing with ‘follow-up’ patients 25
6 Too many patients at the same time 21
1 No mike or display board to know the token number 15
8 No name boards of the doctors 13
5 Staff not following the Queue 12
9 Others 10
10 Total 400
Des
cen
din
g o
rde
r
QUALITY TOOLS AND TECHNIQUES7 tools of quality
# Reasons Number of patientsIn %
(N=400)
7 Registration Time too long 111 28 %
3 Insufficient Doctors 100 25 %
4 Insufficient Counter Staff 93 23 %
2 Problem mixing with ‘follow-up’ patients 25 6 %
6 Too many patients at the same time 21 5 %
1No mike or display board to know the token
number15 4 %
8 No name boards of the doctors 13 3 %
5 Staff not following the Queue 12 3 %
9 Others 10 3 %
10 Total 400
QUALITY TOOLS AND TECHNIQUES7 tools of quality
# ReasonsNumber of
patients
In %
(N=400)
Cumulative
frequency
7 Registration Time too long 111 28 % 28%
3 Insufficient Doctors 100 25 % 53%
4 Insufficient Counter Staff 93 23 % 76%
2 Problem mixing with ‘follow-up’ patients 25 6 % 82%
6 Too many patients at the same time 21 5 % 87%
1No mike or display board to know the
token number15 4 % 91%
8 No name boards of the doctors 13 3 % 94%
5 Staff not following the Queue 12 3 % 97%
9 Others 10 3 % 100%
10 Total 400
QUALITY TOOLS AND TECHNIQUES7 tools of quality
28%
53%
76%
82%87%
91%94% 97% 100%
0%
20%
40%
60%
80%
100%
0
20
40
60
80
100
120
RegistrationTime too
long
InsufficientDoctors
InsufficientCounter
Staff
Problem mixing with ‘follow-up’
patients
Too manypatients atthe same
time
No mike ordisplay
board toknow the
tokennumber
No nameboards of
the doctors
Staff notfollowing
the Queue
Others
Number of patients Cumulative frequency
QUALITY TOOLS AND TECHNIQUES7 tools of quality
28%
53%
76%
82%87%
91%94% 97% 100%
0%
20%
40%
60%
80%
100%
0
20
40
60
80
100
120
RegistrationTime too
long
InsufficientDoctors
InsufficientCounter
Staff
Problem mixing with ‘follow-up’
patients
Too manypatients atthe same
time
No mike ordisplay
board toknow the
tokennumber
No nameboards of
the doctors
Staff notfollowing
the Queue
Others
Number of patients Cumulative frequency
Addressing these 3 issues out of 9, will solve 76% of the problems
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Cause and Effect Diagrams
• Dr. Kaoru Ishikawa• Cause & Effect Diagram (Fishbone or Ishikawa diagram)• It is a schematic way of relating the causes of variation
in a process• A drawing to organize the contributing causes to a
problem in order to prioritize, select, and improve the source of the problem
• Problem (Effect) on the right side and the possible causes on the left side
• Causes are broadly classified into 5M’s and E
Man (People)
Methods (Policies and Procedures)
Materials (Supplies)
Machine (Equipment)
Money
Environment
QUALITY TOOLS AND TECHNIQUES7 tools of quality
When is it used?
• When identifying possible causes for a problem.
• Identifies areas for collecting data
• Good process knowledge from multiple stake holders
• Useful for teams: focusing a discussion and organizing large amounts of information coming from a brainstorming session.
• Especially when a team’s thinking tends to fall apart and concentration is lacking
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Schematic
Effect
People /Man
Plant / MachineProcedures / Methods
PoliciesMaterial
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Cause and Effect Diagram
Registration time too
long
People /Man
Plant / MachineProcedures / Methods
PoliciesMaterial
Staff can cut the queue
Registration at any time Irrespective of appointment time
Manual registration- No computers
Inadequate signage / instruction
FIFO not followed
Unnecessary information being collected at the reg.
counter
New staff
Aggrieved StaffInadequate stationeries
Separate line for men and women
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Scatter Plots
• Scatter diagram shows co-relation between two variables
• If correlated – does not necessarily mean a direct cause and effect
• If one variable can be predicted based on the value of the other, then correlated
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Scatter Plots- correlation
• 2 Dimensional X/Y plots (with dots)
• To check if there is correlation b/w two variables
– Used to show relationship between independent(x) and dependent(y) variables
Positive correlation Negative correlation No correlation
QUALITY TOOLS AND TECHNIQUES7 tools of quality
When is it used?
• Trying to determine if the two variables are related, such as…
– to identify potential root causes of problems.
– After brainstorming session and identifying causes and effects using a fishbone diagram, to determine whether a particular cause and effect are related.
– To determine whether two effects that appear to be related both occur with the same cause.
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Time spent by doctor and patient satisfaction
Patient hosp number
Time Spent by doctor (In minutes)
Satisfaction Score
1 24 5
2 8 1
3 9 1
4 22 4
5 10 3
6 19 4
7 10 2
8 16 4
9 13 4
10 15 3
11 23 4
Patient hosp number
Time Spent by doctor (In minutes)
Satisfaction Score
12 12 3
13 12 2
14 14 3
15 11 2
16 16 3
17 20 4
18 18 3
19 14 2
20 14 4
21 17 3
22 17 4
23 13 3
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Scatter plot
0
1
2
3
4
5
0 5 10 15 20 25 30
Sati
sfac
tio
n s
core
-5
be
ing
the
hig
he
st
Time spent by doctors (In minutes)
Satisfaction Score
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Scatter plot
0
1
2
3
4
5
0 5 10 15 20 25 30
Sati
sfac
tio
n s
core
-5
be
ing
the
hig
he
st
Time spent by doctors (In minutes)
Satisfaction Score
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Scatter plot
• A Scatter plot cannot prove that one variable causes another, but it does show how a pair of variables is related and the strength of that relationship.
• Statistical tests quantify the degree of correlation between the variables.
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Control charts• Influence of special causes on process and out of
control situation
• Monitor processes to show how the process is performing over time
• Following needs to be calculated.
– Mean variable
– Upper control limit (UCL)
– Lower Control limit (LCL)
• UCL and LCL can be calculated based on • data from scientific literature
• Historical data
• Statistical data like Standard deviation
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Time between glucose measurements(in Hours)
Day Hours
1/1/2017 5
1/2/2017 5.5
1/3/2017 5.5
1/4/2017 5
1/5/2017 7
1/6/2017 5
1/7/2017 5
1/8/2017 6
1/9/2017 6
1/10/2017 10
1/11/2017 11
Day Hours
1/12/2017 5
1/13/2017 6
1/14/2017 6
1/15/2017 5
1/16/2017 4.5
1/17/2017 5
1/18/2017 6
1/19/2017 5.5
1/20/2017 6
1/21/2017 5
1/22/2017 5
1/23/2017 5
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Time between glucose measurements(in Hours)
Day Hours
1/1/2017 5
1/2/2017 5.5
1/3/2017 5.5
1/4/2017 5
1/5/2017 7
1/6/2017 5
1/7/2017 5
1/8/2017 6
1/9/2017 6
1/10/2017 10
1/11/2017 11
Day Hours
1/12/2017 5
1/13/2017 6
1/14/2017 6
1/15/2017 5
1/16/2017 4.5
1/17/2017 5
1/18/2017 6
1/19/2017 5.5
1/20/2017 6
1/21/2017 5
1/22/2017 5
1/23/2017 5
Calculate Mean and Standard deviation
Mean= 5.869565 SD = 1.575
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Time between glucose measurements(in Hours)
Day Hours
1/1/2017 5
1/2/2017 5.5
1/3/2017 5.5
1/4/2017 5
1/5/2017 7
1/6/2017 5
1/7/2017 5
1/8/2017 6
1/9/2017 6
1/10/2017 10
1/11/2017 11
Day Hours
1/12/2017 5
1/13/2017 6
1/14/2017 6
1/15/2017 5
1/16/2017 4.5
1/17/2017 5
1/18/2017 6
1/19/2017 5.5
1/20/2017 6
1/21/2017 5
1/22/2017 5
1/23/2017 5
Calculate UCL (upper control limit) and LCL (Lower control limit)
Mean= 5.869565
UCL = Mean + 3 *(Standard Deviation) = 10.59
LCL = Mean -3 *(Standard Deviation) = 1.14
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Time between glucose measurements(in Hours)
Day Hours Mean UCL LCL
1/1/2017 5 5.869565 10.59 1.14
1/2/2017 5.5 5.869565 10.59 1.14
1/3/2017 5.5 5.869565 10.59 1.14
1/4/2017 5 5.869565 10.59 1.14
1/5/2017 7 5.869565 10.59 1.14
1/6/2017 5 5.869565 10.59 1.14
1/7/2017 5 5.869565 10.59 1.14
1/8/2017 6 5.869565 10.59 1.14
1/9/2017 6 5.869565 10.59 1.14
1/10/2017 10 5.869565 10.59 1.14
1/11/2017 11 5.869565 10.59 1.14
Day Hours Mean UCL LCL
1/12/2017 5 5.869565 10.59 1.14
1/13/2017 6 5.869565 10.59 1.14
1/14/2017 6 5.869565 10.59 1.14
1/15/2017 5 5.869565 10.59 1.14
1/16/2017 4.5 5.869565 10.59 1.14
1/17/2017 5 5.869565 10.59 1.14
1/18/2017 6 5.869565 10.59 1.14
1/19/2017 5.5 5.869565 10.59 1.14
1/20/2017 6 5.869565 10.59 1.14
1/21/2017 5 5.869565 10.59 1.14
1/22/2017 5 5.869565 10.59 1.14
1/23/2017 5 5.869565 10.59 1.14
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Control Chart
0
2
4
6
8
10
12
1-J
an-1
7
2-J
an-1
7
3-J
an-1
7
4-J
an-1
7
5-J
an-1
7
6-J
an-1
7
7-J
an-1
7
8-J
an-1
7
9-J
an-1
7
10
-Jan
-17
11
-Jan
-17
12
-Jan
-17
13
-Jan
-17
14
-Jan
-17
15
-Jan
-17
16
-Jan
-17
17
-Jan
-17
18
-Jan
-17
19
-Jan
-17
20
-Jan
-17
21
-Jan
-17
22
-Jan
-17
23
-Jan
-17
Tim
e b
etw
een
glu
cose
mea
sure
me
nts
(in
Ho
urs
)
Date
Hours Mean UCL LCL
In this case, the variation was detected on January 11 because the corresponding data point was above the upper control limit. Root cause for the variations needs to be investigated.
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Control Chart
• Control charts are made with the existing data. Suggestions, if necessary, are implemented based on the chart.
• Post Implementation, the mean and the control limits of the control charts will vary depending on the effectiveness of the implementation
• They are helpful for analyzing a process before and after an improvement as well
• Helps to see how process mean and variability change as a result of the improvement.
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Tim
e ta
ken
fo
r ad
mit
tin
g th
e p
atie
nt
(in
Min
ute
s)
Days
Tim
e ta
ken
fo
r ad
mit
tin
g th
e p
atie
nt
(in
Min
ute
s)
Days
Time taken for ICU admission
Time taken for ICU admission
QUALITY TOOLS AND TECHNIQUES7 tools of quality
160
180
200
220
240
260
280
300
320
2/9 3/9 4/6 5/4 6/1 6/29
Week
ED
Sta
y (
min
ute
s)
Reducing Delays for Patients Admitted to the Emergency Department
Goal
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Work
Days
ACA
Initiative
begun
Optimize
the Team
0
10
20
30
40
50
60
70
80
90
100'O
ct
01
'Jan
02
'Ap
r 02
'Ju
l 02
'Oct
02
'Jan
03
'Ap
r 03
'Ju
l 03
'Oct
03
'Jan
04
'Ap
r 04
'Ju
l 04
'Oct
04
'Jan
05
'Ap
r05
'Ju
ly05
'Oct
05
'Jan
06
'Ap
ril0
6
'Ju
ly06
SI
Initiative Optimize
the Team
Imaging – MRI Backlog
7 tools of quality
Flow Chart• Process flow chart of flow diagram• A powerful improvement tool to define, describe, and
communicate clinical, administrative and operational processes.
• A flowchart represents an algorithm or process with the help of pictorial symbols.
• They trace the steps the “object” of the process goes through from start to finish. (a lab test, a clinic visit, a specialty visit, an imaging study, etc. )
• Boxes of pictorial symbols connecting with arrows to represent sequence of activities.
• Flowcharts help in identifying points or bottle necks where problems might occur.
QUALITY TOOLS AND TECHNIQUES7 tools of quality
• Develop understanding of how a process is done.
• Study a process for improvement.
• Communicate to others how a process is done.
• When better communication is needed between people involved with the same process.
• In order to document a process.
• While planning a project.
When is it used?
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Flow chart- Symbols
One step in the process
Direction of flow
Link to another page or
flowchart
Input or output Document Start and end points
Decision based on a question
Delay or wait
7 tools of quality
The Process Flow Diagram (Flow Chart)
Used to understand the current process and identify opportunities for improvement. It shows the work flow through the process including all activities, decisions, delays, and measurement points.
DELAY
DELAY
ACTIVITY
ACTIVITYDECISION
ACTIVITY
DECISION
ACTIVITY
BEGIN
END
YES
ACTIVITYNO
NO
YES
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Flow chart
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Check Sheet
• Defect concentration diagram
• A check sheet is a structured, prepared form for collecting and analyzing data. This is a generic tool that can be adapted for a wide variety of purposes
• A simple document used for collecting data in real time and at the location where the data is generated.
QUALITY TOOLS AND TECHNIQUES7 tools of quality
When is it used?
• When data can be observed and collected repeatedly by the same person or at the same location.
• When collecting data on the frequency or patterns of events, problems, defects, defect location, defect causes, etc.
• When collecting data from a production process.
QUALITY TOOLS AND TECHNIQUES7 tools of quality
Check sheet
Wrong admission
Wrong diet
Late Discharges
Staff not punctual for duty
Missing CSSD item
Problems identified in the Wards
7 tools of quality
7 tools of quality