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Richard J. Banchs. The Quality Improvement Challenge
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
The Quality Improvement Challenge. A Practical Guide for Physicians
Why This Book?
About the Authors
List of Stories, Examples, Exercises and Case Studies
About the Companion Website
CHAPTER 1 The Problem with Healthcare. SO, WHAT’S THE PROBLEM?
HOW DID WE GET HERE?
THE CHALLENGES TO IMPROVE HEALTHCARE
WHAT IS THE PHYSICIAN’S ROLE IN PROCESS IMPROVEMENT?
REFERENCES
CHAPTER 2 We Need to Improve the Way We Improve. WHAT’S THE GOAL OF A QI PROJECT? First, Define Quality
Then, Define Improvement
A BETTER IMPROVEMENT STRATEGY
GUIDING PRINCIPLES
THE FIVE “RS” OF EVERY QI PROJECT
THE CHANGE SPACE
REFERENCES
CHAPTER 3 The Project Selection Process. WHERE DO I START? Ask the Right Questions
Consider the Three “Voices” for Project Ideas
The Voice of the Customer (VOC)
The Voice of the Stakeholder (VOS)
The Voice of the Process (VOP)
THE PROJECT SELECTION PROCESS. The Goal
Project Selection Criteria
What Does a Good Project Idea Look Like?
Project Selection Steps
THE PROJECT SELECTION MATRIX: A TOOL TO PRIORITIZE QI PROJECTS
A PROJECT TYPE FOR EVERY PROBLEM
PROJECT TYPES FROM THE LENS OF CHANGE
HOW TO ESTABLISH YOUR PROJECT’S TIMELINES
CHAPTER 4 Frame Your Challenge : The Problem Statement and Charter. STORIES FROM THE FRONT LINES OF HEALTHCARE: MARTHA SANCHEZ, THE HEAD OF HOUSEKEEPING
THE PROBLEM STATEMENT. What Is a Problem Statement?
Why Do We Need a Problem Statement?
How to Write a Focused Problem Statement
THE PROBLEM STATEMENT IS YOUR “ELEVATOR SPEECH”
A Problem Statement May Include a “Burning Platform”
Example: First‐case on‐time‐start accuracy at Fond‐du‐Lac Medical Center
THE PROJECT CHARTER. What Is a Project Charter?
The Project Charter “Must‐Haves”
Example: The patient arrival‐to‐departure time at the PCP clinic
EXERCISE: A PROBLEM STATEMENT AND PROJECT CHARTER FOR YOUR QI PROJECT
SUMMARY QUIZ
CHAPTER 5 Don’t Go at It Alone : Find a Primary Sponsor. STORIES FROM THE FRONT LINES OF HEALTHCARE: TURN‐AROUND TIME FOR X‐RAYS IN THE ED
THE PRIMARY SPONSOR. What Is a Primary Sponsor?
The Critical Role of a Primary Sponsor
WHO SHOULD BE YOUR PRIMARY SPONSOR?
REVIEW QUIZ
REFERENCES
CHAPTER 6 Organize Your QI Team and Select the Team Leader. THE QI TEAM. Improvement Is a Team Sport
The Challenge for QI Teams in Healthcare
The Key to Addressing These Challenges
WHO SHOULD BE ON YOUR QI TEAM? Selection Criteria
“Thanks, But No Thanks”
How Many Team Members Do You Need?
THE TEAM LEADER. Who Should Lead Your Improvement Team?
What Is the Role of the Team Leader
THE TRUE ROLE OF THE QI TEAM
THE FIRST TOLLGATE REVIEW
EXERCISE: THE QI TEAM AT HEART MEDICAL CENTER
REVIEW QUIZ
REFERENCES
CHAPTER 7 What Is the Scope of the Project? The SIPOC Diagram. YOU NEED TO KNOW YOUR PROJECT’S SCOPE AND BOUNDARIES
THE TOOL: A SIPOC DIAGRAM. What Is a SIPOC Diagram?
Advantages of the SIPOC Diagram
HOW TO DRAW A SIPOC DIAGRAM
Steps to Creating a SIPOC Diagram
Example: SIPOC Diagram for St. Barnabas’ Preoperative Evaluation Clinic
CHAPTER 8 Who Are the “Customers,” and What Do They Need? IN HEALTHCARE, WE ALSO HAVE “CUSTOMERS” Who Is the “Customer”?
Three Types of Customers
Example: The Customer of a STAT Arterial Blood Gas (ABG)
THE “CUSTOMER CONTINUUM”
Example: Supply Chain Management for Patient Care Units
THE VOICE OF THE CUSTOMER (VOC) What Is the “Voice of the Customer”?
The “What” and “How” of the Voice of the Customer
HOW DO WE COLLECT THE VOC? Interviews
Surveys
CRITICAL‐TO‐QUALITY (CTQ) What are the CTQs?
THE CRITICAL‐TO‐QUALITY TREE
Example: Patient Satisfaction with UI Health Outpatient Care Center
Example: Improving the Organization of Medical Supplies in the EDRR
EXERCISE: CTQS FOR THE NEW WOMEN’S CENTER
REVIEW QUIZ
CHAPTER 9 Who Are the “Stakeholders,” and What Challenges Do They Have? THE FRONTLINE STAKEHOLDERS
THE VOICE OF THE STAKEHOLDERS
THE CRITICAL NEEDS OF THE STAKEHOLDERS. What Are the Critical Needs?
Example: Improving MRI Patient Throughput
THE SECOND TOLLGATE REVIEW
REVIEW QUIZ
CHAPTER 10 To Understand a Process, You Need to “Go See” and Create a Map. STORIES FROM THE FRONT LINES OF HEALTHCARE: ANDREA, THE QI PROJECT MANAGER
THE FIRST STEP IS TO “GO SEE”
The “gemba”
AT THE GEMBA YOU SEE THE SYSTEM. What Is a System?
System Components
“Systems Thinking”
IT’S ALL ABOUT THE PROCESS
THE PROCESS MAP
General Recommendations When Creating a Map
Steps to Completing Your Map
The Three Most Common Types of Mapping Techniques
BASIC PROCESS FLOW MAP
THE SWIM LANE CHART
THE VALUE STREAM MAP. What Is a Value Stream?
The Value Stream Map
Steps to Create a Value Stream Map
PROCESS DATA FOR THE VSM
EXERCISE: MAPPING “ORDERING BLOOD FROM THE BLOOD BANK”
REVIEW QUIZ
CHAPTER 11 Get a Quick Win: Identify and Eliminate “Waste” WASTE IS THE OPPOSITE OF VALUE
What Is Waste?
How Do We Define Value?
Who Defines Value and Waste?
WHY TARGET WASTE?
WHO IS TIM WOOD?
Waste of Transportation
Waste of Inventory
Waste of Motion
Waste of Waiting
Waste of Overproduction
Waste of Overprocessing
Defects
How to Use TIM WOOD
TOOLS TO IDENTIFY AND ELIMINATE WASTE. Stand in the Circle
“Waste Rounds”
MAPPING TECHNIQUES TO IDENTIFY WASTE. The “Spaghetti” Diagram
The Opportunity Flowchart
EXERCISE: IDENTIFYING WASTE IN THE PEDIATRIC UNIT
REVIEW QUIZ
CHAPTER 12 Measure What Matters : Choose the Right Project Metrics. MEASUREMENTS. Measurements Are Everywhere
What Are Measurements, and Why Do We Need Them?
METRICS. What Is a Metric?
Data and Metrics
WHO DECIDES WHAT WE NEED TO MEASURE?
Example: Improving STAT Chest X‐rays in the ICU
THE TWO TYPES OF METRICS USED IN QI PROJECTS
WHAT DOES A “GOOD” PROJECT METRIC LOOK LIKE?
How Many Metrics Do We Need in Our QI projects?
METRICS ARE EXPRESSED AS TWO TYPES OF DATA
COMMON METRICS USED IN QI PROJECTS. Defects and the Defect Rate (Metrics of Effectiveness)
Time (Metrics of Efficiency)
Cost (Metrics of Efficiency)
Additional Terms
REFERENCE
CHAPTER 13 Practicalities for Planning and Collecting Baseline Data. WHY DO WE NEED TO COLLECT DATA?
WHERE CAN I FIND THE DATA THAT I NEED?
WHAT MAKES DATA SO HARD TO GET?
THE KEY TO DATA COLLECTION IS TO START WITH A GOOD DATA COLLECTION PROCESS
THREE RULES OF DATA COLLECTION
Rule # 1: Collect Data Using an Operational Definition
Example: Temperature Management on Arrival to the ED
Rule # 2: Use the Principle of Stratification (Rational Subgrouping)
Example: Stratification Factors for “Time from Order to Arrival of TPN Bag”
Rule # 3: Collect Data in a Time‐Ordered Fashion
MAKE YOUR DATA COLLECTION MORE EFFECTIVE WITH A DATA COLLECTION PLANNER
REVIEW QUIZ
CHAPTER 14 Define Baseline Performance : Is the Process “Stable”? HOW DO I ASSESS A PROCESS’S BASELINE PERFORMANCE?
WHY DO WE NEED A COMBINATION OF NUMBERS AND PICTURES?
GRAPHS ARE THE BEST TOOLS TO INTERPRET DATA. The Anscombe’s Quartet
What Can We Learn from the Anscombe’s Quartet?
DO I NEED TO HAVE DATA NORMALLY DISTRIBUTED?
THE GRAPHICAL ANALYSIS
THE HISTOGRAM: A TOOL TO GET A SNAPSHOT WITH CONTINUOUS DATA
Types of Histograms
How to Create a Histogram
ADDITIONAL GRAPHS YOU CAN USE WITH CONTINUOUS DATA. The Box Plot
The Individual Value Plot
THE BAR CHART: A TOOL TO GET A SNAPSHOT WITH DISCRETE DATA
ADDITIONAL CHARTS YOU CAN USE WITH DISCRETE DATA. The Pie Chart
The Pareto Bar Chart
CASE STUDY: IMPROVING RTA TIME AT ST. MICHAEL’S HOSPITAL
What Can We Learn from the RTA Time at St. Michael’s Hospital?
THE ANSWER TO THE PROBLEM OF VARIATION IS A GRAPH OF TIME‐ORDERED DATA
Understanding the Types of Variation
What Is Common Cause Variation?
What Is Special Cause Variation?
VARIATION GUIDES THE IMPROVEMENT STRATEGY
With Common Cause Variation and a Stable Process
With Special Cause Variation and an Unstable Process
The Bottom Line
Getting Back to the RTA Time at St. Michaels
TIPS WHEN PRESENTING DATA
REVIEW QUIZ
REFERENCES
CHAPTER 15 Tools to Characterize the Type of Variation : The Run Chart. WHAT IS A RUN CHART?
MAKING A RUN CHART
INTERPRETING THE RUN CHART
Example: Order‐to‐Result (OTR) Time at Mercy Hospital
Example: Narcotic Discrepancies at Chicago Med
Example: C‐section Rate at London Memorial
REFERENCE
CHAPTER 16 Tools to Characterize the Type of Variation : The Control Chart. THE CONTROL CHART
THE INDIVIDUALS AND MOVING RANGE (I‐MR) CHART
The Individuals Chart (I or X‐Chart)
The Moving Range Chart (mR chart)
THE UPPER AND LOWER CONTROL LIMITS OF THE INDIVIDUALS CHART
How to Calculate the Control Limits on the Individuals Chart?
Why Use an Estimated Versus a Globally Computed Standard Deviation?
The Formula for the Upper and Lower Control Limits
Why Is the Area Inside the Control Limits Three Sigma from the Mean?
What Does It All Mean?
The Problem with Relying on a Target to Set the Process Performance
UPPER CONTROL LIMIT OF THE MOVING RANGE (MR) CHART
Other Option to Calculate Limits for the I‐mR Chart
HOW TO DETECT SPECIAL CAUSE VARIATION WITH THE I‐MR CHART. Rules
Using Zones
THE I‐MR CHART GUIDES THE IMPROVEMENT STRATEGY. When the I‐mR Chart Shows Common Cause Variation
When the I‐mR Chart Shows Special Cause Variation
Is Special Cause Variation Ever Desirable?
Example: The Individuals and Moving Range (I‐mR) Chart of a Patient’s SBP
ADDITIONAL CONTROL CHARTS
Charts for Continuous Data
Charts for Discrete Data
The Preferred Control Chart
CASE STUDY: DOOR‐TO‐INFUSION (DTI) TIME AT HURON MEDICAL CENTER
REFERENCES
CHAPTER 17 Define Baseline Performance : Is the Process Capable? IS THE PROCESS MEETING THE NEEDS OF THE CUSTOMER?
PROCESS CAPABILITY. What Is Process Capability?
Conditions to Calculate Process Capability
Process Capability for Continuous Data
CASE STUDY: THE NEW BALLOON ANGIOPLASTY CATHETER AT UIC
CAPABILITY INDICES
The Cp Indices
The Cpk Indices
The P Capability Indices (Pp, Ppk)
PROCESS CAPABILITY FOR DISCRETE DATA
THE PROCESS SIGMA OR SIGMA METRIC
Example: Improving DVT Prophylaxis
PUTTING IT ALL TOGETHER: IS THE PROCESS STABLE? IS IT CAPABLE?
CHAPTER 18 How to Identify and Prioritize the Most Likely Cause of the Problem. STORIES FROM THE FRONT LINES OF HEALTHCARE: WAIT TIME IN THE ORTHOPEDIC OUTPATIENT CLINIC
THE THINGS WE DO THAT STIFLE OUR ANALYTICAL THINKING
CRUCIAL INTERACTION OF ACTIONS AND CONDITIONS
Example: Medication Error Before Initiating CPB
THE PATH TO THE ANALYSIS OF Y
TOOLS TO IDENTIFY THE POSSIBLE CAUSE(S) OF THE PROBLEM
Brainstorming Techniques
Fishbone Diagram
The 5 “Whys” Diagram
The Pie Chart
The Pareto Bar Chart
TOOLS YOU CAN USE TO FILTER AND PRIORITIZE THE MOST LIKELY CAUSE. Multivoting
The Cause‐and‐Effect Matrix
Example: Patient Satisfaction with the ED Visit
EXERCISE: IN‐TRAINING EXAMINATION AT MASS GENERAL HOSPITAL
REVIEW QUIZ
CHAPTER 19 Before Proceeding, Confirm the Cause‐and‐Effect Relationship. THE CAUSE‐AND‐EFFECT RELATIONSHIP
THE SCATTERPLOT: IS THERE A RELATIONSHIP?
THE CORRELATION COEFFICIENT: WHAT IS THE STRENGTH OF THE RELATIONSHIP?
The Pearson Correlation Coefficient
The Square of the Pearson Correlation Coefficient
REGRESSION ANALYSIS
Evaluating Regression Models
HYPOTHESIS TESTING
THE THIRD TOLLGATE REVIEW
REVIEW QUIZ
CHAPTER 20 Develop and Prioritize Your Improvement Ideas. BARRIERS TO CREATIVE THINKING
SETTING THE RIGHT CONDITIONS FOR CREATIVE THINKING
THE CREATIVE SCAFFOLD
DIVERGENT THINKING: DEVELOPING IDEAS USING EXISTING SOLUTIONS
DIVERGENT THINKING: FINDING NEW SOLUTIONS. Brainstorming Sessions
Group Brainstorming Techniques
Individual Brainstorming Techniques
Negative Brainstorming Sessions
Assumption Busting
SCAMPER
CONVERGENT THINKING: USING THE TEAM’S KNOWLEDGE TO PRIORITIZE IDEAS
Triage
Multivoting
The Impact/Effort Matrix
The How‐Now‐Wow Matrix
CONVERGENT THINKING: PRIORITIZE IDEAS BY COMPARING OPTIONS. Pairwise Comparison
CONVERGENT THINKING: PRIORITIZE IDEAS USING ASSESSMENT CRITERIA
Solution Desirability Matrix
Pugh Matrix
CASE STUDY: DECREASING UNPLANNED READMISSIONS AFTER TONSILLECTOMY
ASSESSING RISK: FAILURE MODE AND EFFECTS ANALYSIS (FMEA)
The Problem with the Risk Priority Number (RPN)
USING THE FMEA WITHOUT THE RISK PRIORITY NUMBER (RPN)
REVIEW QUIZ
REFERENCES
CHAPTER 21 Test the Effectiveness of Your Ideas with a Pilot. THE PILOT STUDY. What Is a Pilot?
How Do We Conduct a Pilot?
THE BEST‐KNOWN PILOT IS THE PDSA CYCLE. What Is a PDSA Cycle?
ADVANTAGES OF THE PDSA CYCLE
THE PDSA CYCLE IS A “LEARNING RAMP”
REVIEW QUIZ
REFERENCES
CHAPTER 22 Improve “Flow” and Work Conditions. PROCESS FLOW. What Is “Flow”?
Why Is Flow Important?
STRATEGY FOR CREATING PROCESS FLOW
STEPS AND SEQUENCE TO CREATE FLOW
WHAT IS STANDARD WORK?
THE CRITICAL ROLE OF WORK CONDITIONS
5S TO OPTIMIZE YOUR WORKSPACE. What Is 5S?
The Significance of 5S
The First Pillar of 5S: Sort or S1
The Second Pillar of 5S: Set in Order or S2
The Third Pillar of 5S: Shine or S3
The Fourth Pillar of 5S: Standardize or S4
The Fifth Pillar of 5S: Sustain or S5
A 5S Audit Checklist
VISUAL MANAGEMENT. What Is Visual Management?
Types of Visual Management Systems
MISTAKE‐PROOFING SYSTEMS. What Is It?
The Mistake‐Proofing Strategy
Where Can We Use the Mistake‐Proofing System?
Characteristics of a Good Mistake‐Proofing System
Approach to Mistake Proofing
REVIEW QUIZ
REFERENCES
CHAPTER 23 Now Roll‐Out Your Improvement Ideas and Make Them “Stick” STORIES FROM THE FRONT LINES OF HEALTHCARE: THE EARLY DISCHARGE QI PROJECT AT MEMORIAL HOSPITAL
BEFORE YOU ROLL‐OUT, YOU NEED AN IMPLEMENTATION PLAN
First Decide on the Scale‐Up Approach
Put the Right Team in Place
Make Sure the Process Is Standardized and Documentation Updated
Make Sure the Work Environment Supports the New Way of Doing Things
Choose the Right Training Method, Time, and Location
Monitor, Monitor, Monitor
ASSESS THE POTENTIAL IMPACT OF YOUR IMPROVEMENT IDEAS
ASSESS THE POTENTIAL FOR PUSHBACK: THE STAKEHOLDER ANALYSIS. The Crucial Role of the Stakeholders
The Stakeholder List
The Stakeholder Analysis
The Power and Influence diagram
The Stakeholder Analysis Bar Graph
YOUR STAKEHOLDER ENGAGEMENT STRATEGY
ASSESS THE LEVEL OF SUPPORT: THE LOCAL SPONSOR ANALYSIS. The Role of the Local Sponsors
The Sponsor Analysis
THE LOCAL SPONSOR STRATEGY
THE MONITORING AND CONTROL PLAN
THE FOURTH TOLLGATE REVIEW
PROJECT CLOSURE. Complete the Project Review
Gather the Lessons Learned
Transfer the Ownership of the Processes and Deliverables to the Process Owners
REFERENCES
CHAPTER 24 How to Prepare and Conduct a Tollgate Review. THE TOLLGATE REVIEWS. What Is a Tollgate Review and Why Do We Need One?
How to Conduct a Tollgate Review
FOUR TOLLGATE REVIEWS OF A FIVE “R” PROJECT PHASE. The First Tollgate Review
Second Tollgate Review
Third Tollgate Review
Fourth Tollgate Review
CHAPTER 25 How to Communicate Effectively to Engage the Front Line. STORIES FROM THE FRONT LINES OF HEALTHCARE: THE NICU TEAM AT ST. AGNES HOSPITAL
THE IMPORTANCE OF COMMUNICATION
WHY PROJECTS OFTEN FAIL …Because We Don’t Communicate
…Because We Don’t Have a Good Communication Strategy
PEOPLE’S BRAINS OFTEN CREATE BARRIERS TO EFFECTIVE COMMUNICATION
WHAT SHOULD YOU DO TO COMMUNICATE EFFECTIVELY?
…Start Early
…Begin with the Leader
…Communicate Face‐to‐Face
…Create a Compelling Argument
…Use Stories
…Leverage Early Adopters
…Create Certainty
…Give Hope
…Repeat the Message Often
… Listen and Get Feedback
TIPS FOR ONE‐ON‐ONE COMMUNICATION
USE A COMMUNICATION PLANNER TO MAKE IT EASIER
TIPS TO ANNOUNCING A DIFFICULT CHANGE
REVIEW QUIZ
REFERENCES
CHAPTER 26 How to Lead an Effective Team Meeting. STORIES FROM THE FRONT LINES OF HEALTHCARE: BRANDON, THE AMBULATORY CLINIC MANAGER
THE IMPORTANCE OF MEETINGS
THE PROBLEM WITH MEETINGS
ANATOMY OF A GREAT MEETING
FIRST PHASE: BEFORE THE MEETING
First, Ask the Question: Why Are We Meeting?
Second, Ask Yourself: What Are We Trying to Accomplish?
Plan Where, When, and with What?
Share the Agenda
Prepare Homework
SECOND PHASE: DURING THE MEETING
Introductions / Break the Ice
Does Everybody Have a Role?
Follow the Agenda
Run the Meeting
Decisions, Decisions, Decisions!
What’s Next?
How Did We Do?
THIRD PHASE: AFTER THE MEETING
A TEMPLATE FOR ALL YOUR MEETINGS: THE TEAM MEETING ORGANIZER
TEAM MEETING GROUND RULES. What Are They and Why Do We Need Them?
Steps to Developing Ground Rules
Example of Ground Rules
BRUCE TUCKMAN AND THE FOUR STAGES OF TEAM DEVELOPMENT
Forming Stage: The Beginning of the Team and Team Meetings
Storming Stage: Differences Arise
Norming Stage
Performing Stage
UNDERSTANDING DIFFERENCES IN PEOPLE’S BEHAVIOR
REFERENCES
CHAPTER 27 How to Help Your QI Team Become a High‐Performing Team. THE USUAL REASONS WHY WE LAUNCH A QI TEAM
WHAT MAKES A TEAM, A TEAM?
THE CHALLENGE FOR QI TEAMS IN HEALTHCARE
FRAMEWORK FOR BUILDING A HIGH‐PERFORMING TEAM
THE FIRST STEP TO HIGH PERFORMANCE
THE TEAM “BUILDING BLOCKS”
Engage the Team in a Common Purpose
Connect the Team to a Common Goal
Define the Common Work Strategy
HIGH LEVERAGE BEHAVIORS OF HIGH‐PERFORMING TEAMS
Robust Dialogue
Mutual Accountability
Follow‐through
FOCUS ON THESE SIX DRIVERS TO ACHIEVE HIGH PERFORMANCE
A Team’s Best Practice: The Essentials
HOW TO IMPROVE TEAM COMMUNICATION
Developing Trust Among Team Members: the Johari Window
WORKING WITH TEAM CONFLICT: THE KEYS TO MANAGING IT. The Role of Team Conflict
Conflict Models
General Guidelines to Managing Team Conflict
Specific Strategies
CONFLICT RESOLUTION AND THE THOMAS KILMANN INSTRUMENT
REVIEW QUIZ
REFERENCES
CHAPTER 28 Steps and Strategies for Effective Decision‐Making. PROBLEM‐SOLVING VERSUS DECISION‐MAKING
DECISIONS: TYPES & CONDITIONS
SOURCES OF ERRORS AND BIASES IN PEOPLE’S DECISION‐MAKING PROCESS. Faulty inputs
The Influence of “Decision Framing” or Option Presentation
Heuristics
Biases
The Effects of Time
THE DECISION‐MAKING PROCESS
FOUR WAYS QI TEAMS CAN MAKE DECISIONS
IMPROVING THE EFFECTIVENESS OF A TEAM’S DECISION‐MAKING PROCESS
REFERENCES
CHAPTER 29 What Neurosciences Can Teach Us to Motivate People to Change. STORIES FROM THE FRONT LINES OF HEALTHCARE: “MAKE IT HAPPEN”
THERE IS NO IMPROVEMENT WITHOUT CHANGE
WE THINK OF CHANGE IN TERMS OF OUR OWN INTEREST
THE TRADITIONAL APPROACH TO MAKING CHANGE HAPPEN
TO UNDERSTAND CHANGE, WE NEED TO UNDERSTAND THE DRIVERS OF HUMAN BEHAVIOR. The Central Organizing Principle
The Brain’s Mini‐Guides
How the Central Organizing Principle affects our interpretation of change
TO UNDERSTAND CHANGE WE NEED TO UNDERSTAND THE DRIVERS OF SOCIAL BEHAVIOR. Social Needs
How We Roll‐out Change Impacts our Social Needs
CHANGE IS PSYCHOLOGICALLY PAINFUL
BASIC PRINCIPLES FOR LEADING A SUCCESSFUL CHANGE INITIATIVE
THE WINNING CHANGE STRATEGY
FIRST, MAKE IT SAFE: REMOVE UNCERTAINTY
Help People Understand “Why” Change Is Needed
Help People Understand What the Change Entails
Help People See Change Is in Their Best Interest: Explain the “WIIFM”
SECOND, CREATE THE RIGHT CONDITIONS TO SAFEGUARD STATUS AND AUTONOMY. Create a Change Space
…and Then Provide Them with the Knowledge and Tools They Need to Succeed
THIRD, MAKE IT STICK AND INTERNALIZE THE CHANGE. Leverage the Influence of the Leader
Leverage the Influence of Peers
Leverage the Influence of the Environment
REFERENCES
CHAPTER 30 How Does it All Fit Together? The MRI Suite at St. Mary’s Hospital. SIMULATION BACKGROUND
THE FIRST “R”: THE RIGHT PROJECT
Problem Statement
Project Charter
Reasons for action/Background
Project Scope and Boundaries
Key Metric (Primary Project Metric)
Project Goals
Timeline
Electronic Signatures
THE SECOND “R”: THE RIGHT PEOPLE. Organize a QI Team
The First Tollgate Review
THE THIRD “R”: THE RIGHT PROBLEM
The Project Scope and Boundaries: the SIPOC Diagram
The Voice of the Customer
The Voice of the Stakeholder
The Second Tollgate Review
THE FOURTH “R”: THE RIGHT CAUSE. Visit to the Gemba and Process Map
Metric Selection and Collection of Baseline Data
Data Analysis and Baseline Process Performance
Identify and Confirm the Most Likely Cause
The Third Tollgate Review
THE FIFTH “R”: THE RIGHT SOLUTION. Develop and Prioritize Improvement Ideas, and Run Pilots
Roll Out Full‐Scale Change and Project Summary
The Fourth Tollgate Review
Appendix I: Common Improvement Tools and Techniques
Appendix II: Glossary of Improvement Terms
Additional Resources. BOOKS
ARTICLES
WEBSITES
Index
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