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Often, the DMAIC or the PDCA framework is seen as THE framework for quality improvement. While it is good for an organization to have a framework that they typically employ, there should also be a recognition of other frameworks and tools that should be used, depending on the problem to be addressed. The difficulty of process improvement efforts is not the lack of improvement or analysis approaches but matching the right approach to the problem under study. Figure 1.2 provides a matrix for consideration when deciding how to approach a particular type of problem. Typically, process improvement objectives fall into three main categories: (i) reduce process errors, (ii) reduce processing time or waiting times, and (iii) increase utilization of resources. Likewise, there can be three difficulty levels of problems: (i) too easy, problems with known root cause/solutions, (ii) just right, focused problems with nonobvious solutions, and (iii) too difficult, complex, and large problems with unknown root causes most likely coming from different sources. Projects that attempt to solve category three problems are typically known for trying to solve “world hunger.” This type of project should be narrow‐scoped before attempting any improvement effort. Nevertheless, the improvement methodology should match the problem difficulty level and improvement objective. For example, as shown in Figure 1.2, less difficult projects can be approached with Kaizen. Kaizen is a continuous improvement approach that utilizes short, intensive “events” where dedicated teams work to develop and implement incremental improvements. Lean is the term coined by MIT researchers to describe the way Toyota improved their processes by focusing on value‐added activities to identify waste and thus streamline processes (Roos et al. 1991). Thereby, lean works well for projects with less complex problems and when the primary interest is in minimizing time and reducing wasteful activities. For nonobvious solution projects, more analysis is often required; in particular, Six Sigma/DMAIC is well suited for minimizing errors. Lean Six Sigma lies at the intersection of these two process improvement objectives, and for more complex problems, process methodologies that look into the redesign of products, processes, and sustainability of resources are better suited for systemic problems such as design for Six Sigma (DFSS).

Figure 1.2 Framework‐type of problem matrix.

There are other methodologies used when designing new products such as TRIZ, which is a Russian acronym from “Theory of Inventive Problem Solving,” which is based on universal principles of creativity and invention for the design of innovative solutions to design problems (Altshuller 1999). Last, the concept of robustness is also used when solving complex design problems where the objective is to reduce variability in the performance of a product by making improvements in the product design. While these latter approaches originated in the manufacturing sector, these can also be applied to healthcare by focusing on the process or products used necessary for providing patient care. These quality improvement approaches, however, are beyond the scope of this casebook.