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  1. Welcome Back Fee-for-Service, Level II (Title) Name(s) of presenter(s) Organizational Affiliation January 2012 Project Funded by CSAT

  2. NIATx Model (Title) Name(s) of presenter(s) Organizational Affiliation

  3. "Never invest in any idea you can't illustrate with a crayon." – Peter Lynch

  4. Process Improvement Model People Change Tools Executive Sponsor Change Leader Change Team aim Walk-through Flowcharting Nominal Group Technique PDSA Cycle Project Rules Use existing resources Sustain the gains Measure change

  5. Who’s Who in Process Improvement? (Title) Name(s) of presenter(s) Organizational Affiliation

  6. Executive Sponsor Authority to Allocates resources

  7. Executive SponsorResponsible for Communicating the Vision Martin Luther King

  8. Executive SponsorSees change as a priority Barack Obama, President

  9. Executive SponsorEmpowers the change leader

  10. Change Leader 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 Reggie White

  11. Change Leader Focuses the team on the change team objective Uses mandates Michelle Obama Oprah Winfrey

  12. Change Leader Challenges the status quo Reports directly to the Executive Sponsor Gets results mandated by data Queen Rania of Jordan

  13. Change Team Members 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 Samaritan Village, Inc. Jamaica Outpatient Program

  14. 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 Change Team Responsibilities

  15. Key Roles:Change Team 1 AIM LOCATION POPULATION

  16. 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

  17. To often we design processes to meet the organization’s needs and not the needs of the customer.

  18. Using Rapid Cycle Testing Plan Do Study Act Why? Evaluate the impact of potential changes on a given aim

  19. Model for Improvement 1. What are we trying to accomplish? 2. How will we know that a change is an improvement? 3. What changes can we make that will result in an improvement? Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide P A D S

  20. 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. Learning Objectives

  21. Name of Organization: Wing and a Prayer Airlines, Inc.


  23. PDSA Cycle for Improvement Flight • 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 meansmore chances to improve, means a better score

  24. PDSA Cycle for Improvement Flight Rules 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

  25. Have Fun & Fly Safe!!!

  26. Discussion What did you learn about rapid cycle change projects?

  27. Designing Change Projects Unfocused improvement efforts are a waste of time and resources AIM

  28. Designing Change Projects Writing a good aim statement

  29. Flowcharting (Title) Name(s) of presenter(s) Organizational Affiliation

  30. Flowcharts force an organizational focus on process. Why Flowchart?

  31. Flowcharting is useful for: Providing a starting point to understand the process as it is today. Identifying key problems/bottlenecks Showing where to test ideas for most impact Adding interactivity & fun - gets the team together Creating a simple & succinct visual process overview Why Flowchart?

  32. Intake appt. Is scheduled Customer calls office Where does the process begin? Where does the process end? Setting up a flowchart Verifying Coverage. START Title the process you are flowcharting. END

  33. Key Symbols for Flowcharts Post-It Notes are great for flowcharting. A square identifies a step in the process Action Yes ? 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. No

  34. Process name: Customer 1st Contact (phone call) to Agency Response Customer phones agency Receptionist books the appointment “thanks” customer Transfer customer to qualified staff person Customer routed to voicemail Hang up phone Sample Flowchart START 1 person to answer phone Receptionist answers phone? Receptionist able to help customer? Yes Yes Website No No Walk-in Referral Other 1st Contact Options Checked 1x per day END Staff not available

  35. Change Team Assignment Before You Start 1. Identify a Change Leader to lead the flowchart discussion. 2. Choose one person’s organization and complete the flowchart exercise.

  36. Flowchart the billing process. Remember the steps to follow: Define where the process begins and ends Give your flowchart a title: e.g., “FirstContact to Scheduling First Appointment” Define process steps Review/refine flowchart Identify problems and bottlenecks Customer barriers Change Team Assignment

  37. 1.Useful? 2. How could you use your flowchart to help engage your organization in the change process? Large Group Discussion

  38. The importance of data in a change project. A six-step process for the effective measurement of the impact of change. Learning Objectives

  39. Data answers three common change project questions…..

  40. Data directs the action steps toward a change project improvement goal.

  41. Keep data collection and reporting as simple as possible, but be specific.

  42. A Step Process for Measuring the Impact of Change 6


  44. 1. Define your measures. Clear definitions of your measures should: - Clarify project objectives - Be agreed upon by stakeholders This ensures that the results are interpretable and accepted within the organization.

  45. 2. Collect baseline data. Never start a change project without it. QUESTIONS TO ASK: Was the data defined to ensure that we collect exactly the information needed? How accurate is the data? Does accuracy matter? Does the process ensure that the measures will be collected consistently? Do trade-offs exist? Is quality more important than the time required to collect data?

  46. 3. Establish a clear goal. • A goal should: • Be realistic yet ambitious • Be linked to project objectives • Avoid confusion This ensures that the results are interpretable and accepted within the organization.

  47. 4. Consistently collect data. As a team, decide: Who will collect the data? How will they collect it? Where will the data be stored? Monday Tuesday Wednesday Thursday Regular data collection is a crucial part of the change process.

  48. 5. Chart your progress. • Share pre-change (baseline) • and post-change data with: • Change Team • Executive Sponsor • Others in the organization Use visual aids for sharing the data. Line graph

  49. A simple line graph example Remember: One graph, one message.

  50. 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.