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(Title)
Name(s) of presenter(s)Organizational Affiliation
Welcome BackFee-for-Service, Level II
January 2012Project Funded by CSAT
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(Title)
Name(s) of presenter(s)Organizational Affiliation
NIATx Model
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"Never invest in any idea you can't illustrate with a crayon." –
Peter Lynch
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Executive Executive
SponsorSponsor
Change Change
LeaderLeader
Change Change
TeamTeam
People
Walk-throughWalk-through
FlowchartingFlowcharting
Nominal Group Nominal Group
TechniqueTechnique
PDSA CyclePDSA Cycle
ToolsTools
RulesRulesUse existing Use existing
resourcesresourcesMeasure Measure
changechange
ImproveImprove
mentment
ProcessProcessModelModel
ChangeChange
ProjectProject
aimaim
Sustain the gainsSustain the gains
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(Title)
Name(s) of presenter(s)Organizational Affiliation
Who’s Who in Process Improvement?
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Executive Sponsor
Authority to Allocates resources
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Executive SponsorResponsible for Communicating the Vision
Martin Luther King
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Executive SponsorSees change as a priority
Barack Obama, President
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Executive Sponsor Empowers the change
leader
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Change Leader
Reggie White
Someone who is comfortable providing day-to-day leadership, energy and enthusiasm
Has the power and prestige to influence people at all levels of the organization
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Change Leader
Oprah Winfrey
Michelle Obama
Focuses the team on the change team objective
Uses mandates
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Change Leader
Queen Rania of Jordan
Challenges the status quoReports directly to the Executive SponsorGets results mandated by data
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Change Team Members
Samaritan Village, Inc.Jamaica Outpatient Program
Staff and supervisors in the work area where changes will be made
Customers, family, caregivers
People with special knowledge
Others who are affected by the change
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Change Team Responsibilities
• Identify possible changes that could meet the objective
• Decide how to implement the change• Create and conduct rapid-cycle pilot tests until
goal is achieved• Collect data• Study results to see if the change should be
adopted, adapted or abandoned
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Key Roles:Change Team
AIM
LOCATION
POPULATION
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What makes this approach to change different?
• Change is a big experiment
• No mistakes, no right or wrong
• Data tells you if the change was an improvement
• Customer guides change ideas
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To often we design processes to meet the organization’s needs and not the needs of the customer.
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PlanDoStudyAct
Using Rapid Cycle Testing
Why?Evaluate the impact of potential changes on a given aim
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Model for ImprovementModel for Improvement
3. What changes can we make that will result in an improvement?
1. What are we trying to accomplish?
2. How will we know that a change is an improvement?
Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide
P
DS
A
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Learning Objectives
Participants will:• Understand the basic concepts of a rapid
cycle change using the Plan-Do-Study-Act approach to process improvements.
• Practice entering information on the Change Project Form.
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1. CHANGE PROJECT TITLE
Going the Distance
2. What AIM will the Change Project address?
Choose one aim and indicate baseline measure and target.
Increase flight distance of our plane
Increase the distance the paper airplane flies by 25% over the baseline distance of _10_ feet.
4. START DATE and expected completion date
7. EXECUTIVE SPONSOR
Mary Adams
8. CHANGE LEADER Jane Smith
9. CHANGE TEAM MEMBERS
Carla, Sam, Terri, John (Jerry is our data coordinator)
Name of Organization: Wing and a Prayer Airlines, Inc.
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RapidCycle
#
Cycle Begin Date2010
CycleEnd Date2010
PlanWhat is the
idea/change to be tested?
DoWhat steps are you
specifically making to test this idea/change? Who is responsible?
Study What were the
results? How do they compare
with baseline measure?
ActWhat is your next
step? Adopt? Adapt?
Abandon?
B 11/2
11/2
The team will design/build one paper airplane. Fly the plane to see how far it will go.
Two pilots (Clara & John) will fly the airplane. Jerry will document the distance traveled for each flight and record it on the template.
Distance traveled:flight #1 = 11 ft.flight #2 = 9 ft.Plane took an immediate nose dive so it was decided that more weight was needed in the back of the plane.
Baseline data was established. Average distance =10 ft. We will now select a change to test.
1 11/2
11/2
Add masking tape to the wings.
A 1” piece of masking tape was placed on both wings near the tail of the plane. Carla and John will test fly. Jerry will document data.
Distance traveled:Carla’s flight = 4 ft.John’s flight = 6 ft.The wings sagged from the weight of the tape making the plane fall quickly.
AbandonThe tail of the plane seems too heavy and reduced the distance traveled. We will remove the tape.
PDSA CYCLES
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PDSA Cycle for Improvement• Form Teams (4-6 members)• Count off by _______________• Assign the following roles
– Team Lead (NIATx = change leader)– Pilot 1– Pilot 2– Data collection/scribe– Designers
• Design and build a paper airplane for distance and accuracy• Flight One - Pilot 1 and Pilot 2 will fly the plane, record the data
this will be your baseline (the number you want to improve)Repeat• Rapid Cycle: More cycles means more data means more chances
to improve, means a better score
Flight
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PDSA Cycle for Improvement
RulesRules•Only one design change per PDSA cycle•Each team designs and commits to flying only one plane•All planes must have wings and be able to fly•Each design is flown by each of the pilots•In order to fly you must get clearance from the air traffic controller
Flight
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Have Fun &
Fly Safe!!!
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Discussion
What did you learn about rapid cycle change projects?
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Designing Change Projects
Unfocused improvement efforts are a waste of time and resources
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Designing Change Projects
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(Title)
Name(s) of presenter(s)Organizational Affiliation
Flowcharting
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Why Flowchart?
Flowcharts force an organizational
focus on process.
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Why Flowchart?
Flowcharting is useful for:
1. Providing a starting point to understand the process as it is today.
2. Identifying key problems/bottlenecks
3. Showing where to test ideas for most impact
4. Adding interactivity & fun - gets the team together
5. Creating a simple & succinct visual process overview
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Setting up a flowchart
Where does the
process begin?
Where does the
process end?
START
END
Verifying Coverage.
Intakeappt.
Is scheduled
Customercalls
office
Title the process
you are
flowcharting.
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Key Symbols for Flowcharts
?
No
Yes
A square identifies a step in the process
A diamond is a decision point in the process and asks a “yes or no” question or offers a choice of direction in the process.
Action
Post-It Notes are great for flowcharting.
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Sample FlowchartProcess name: Customer 1st Contact (phone call) to Agency Response
Customerphones agency
START
END
Customer routed to voicemail
Receptionistanswersphone?
Receptionistable to helpcustomer?
Transfer customer to
qualified staff person
Receptionist books the
appointment “thanks” customer
Hang up phone
Yes Yes
No NoWebsite
Walk-in
Referral
Other 1st Contact Options
Checke
d 1x
per d
ay
Staff
not ava
ilable
1 person to answer phone
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Before You Start
1. Identify a Change Leader to lead the flowchart
discussion.
2. Choose one person’s organization and
complete the flowchart exercise.
Change Team Assignment
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Change Team Assignment
Flowchart the billing process.
Remember the steps to follow:
1. Define where the process begins and ends2. Give your flowchart a title: e.g., “First Contact to
Scheduling First Appointment”3. Define process steps4. Review/refine flowchart5. Identify problems and bottlenecks6. Customer barriers
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Large Group Discussion
1.Useful?
2. How could you use your flowchart to
help engage your organization in the
change process?
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Learning Objectives
• The importance of data in a change project.
• A six-step process for the effective measurement of the impact of change.
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Data answers three common change project questions…..
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DataData directs the action steps toward directs the action steps toward a change project improvement goal.a change project improvement goal.
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Keep data collection and reporting as simple as possible, but be specific.
Keep data collection and reporting as simple as possible, but be specific.
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A Step Process
for Measuring the
Impact of Change
66
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6 Steps for Measuring the Impact of Change
Always ask why.
1DEFINE YOUR
AIM & MEASURES
1DEFINE YOUR
AIM & MEASURES
2COLLECT
BASELINE DATA
2COLLECT
BASELINE DATA
3ESTABLISH A CLEAR GOAL
3ESTABLISH A CLEAR GOAL
4CONSISTENTLY COLLECT DATA
4CONSISTENTLY COLLECT DATA
5CHART YOUR PROGRESS
5CHART YOUR PROGRESS
6ASK
QUESTIONS
6ASK
QUESTIONS
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1. Define your measures.
This ensures that the results are interpretable and accepted within the organization.
Clear definitions of your measures should:- Clarify project objectives- Be agreed upon by stakeholders
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2. Collect baseline data.
QUESTIONS TO ASK:A.Was the data defined to ensure that we collect exactly the information needed?B.How accurate is the data? Does accuracy matter?C.Does the process ensure that the measures will be collected consistently?D.Do trade-offs exist? Is quality more important than the time required to collect data?
Never start a change project without it.
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3. Establish a clear goal.
This ensures that the results are interpretable and accepted within the organization.This ensures that the results are interpretable and accepted within the organization.
A goal should:- Be realistic yet ambitious- Be linked to project objectives- Avoid confusion
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4. Consistently collect data.
Regular data collection is a crucial part of the change process.
Regular data collection is a crucial part of the change process.
As a team, decide:Who will collect the data?How will they collect it?Where will the data be stored?
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5. Chart your progress.
Use visual aids forsharing the data.Use visual aids forsharing the data.
Share pre-change (baseline)and post-change data with:
- Change Team- Executive Sponsor- Others in the organization
Line graphLine graph
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A simple line graph example
Remember: One graph, one message.
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6. Ask questions.What is the information telling me about change in my organization?
Why was one change successful and another unsuccessful?
Always ask why.
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Begin to fill out the measurement worksheet
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(Title)
Name(s) of presenter(s)Organizational Affiliation
CollaborationWhy?
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"If you have an apple and I have an apple and we exchange these apples then you and I will still each have one apple.
But if you have an idea and I have an idea and we exchange these ideas, then each of us will have two ideas.“
George Bernard Shaw
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Coach/NIATx/Convener Design this slide
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Call to ActionWhat will you do next?
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Thank you!
Celebrate