How To Improve A Recipe Card

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2 Improve Your Workshop: New Tools and Techniques for Challenging the Process Presenters: Evans Kerrigan & Tracy O Rourke

3 Who Is This? Who Is This?

4 What if you found that creative genius does not lie in knowing all of the answers? But lies in asking profound questions?

5 A Profound Question One that challenges assumptions, considers new possibilities, and has potential to serve as a catalyst for action and change.

6 Why Do We Stop Asking Why?

7 Creative Genius That Started With Why Why do we have to wait for the photo?

8 Creative Genius That Started With Why Why do I have to listen to all the voic s to find the one that I really need?

9 Creative Genius That Started With Why If they can put a man on the moon, why can t they make a better foot?

10 Building Skills to Challenge the Process

11 Tools to Challenge the Process Process Improvement Tools: A3 5 Whys Cause and Effect

12 What is an A3? An A3 document records the thinking process around a solving a problem Benefits: Helps people to challenge the process by asking profound questions around the why Focuses on the root cause, not just solutions

13 Title: What you are talking about Names Date Background - What is the issue you are looking at? - What is the reason for choosing this issue? Current Conditions What does it look like today? Think graphical process map, graph of results Proposed Countermeasure(s) What is the proposal to reach the future state, the target condition. - What alternatives could be considered? - How will you choose among any options? What decision criteria? How your recommended countermeasures will impact the root cause to change the current situation and achieve the target. Implementation Plan Target/Goal(s) What is the specific outcome that we need to accomplish? How will you measure success? Analysis The root cause(s) of the problem. - Why are we experiencing the symptom? - What constraints prevent us from the goal? Choose the simplest problem-solving tool for this issue: -Five whys - Fishbone - Other problem solving tools A chart or table that shows actions/outcomes, timeline and responsibilities. May include details on the specific means of implementation. - Who will do what, when and how? What are Indicators of performance, of progress. - How will we know if the actions have the impact needed? - What are the critical few, visual, most natural measures? Followup Remaining issues that can be anticipated. - What to watch out for? Are there any unintended consequences? Ensure ongoing inquiry and learning

14 Eliminate Late Payments on Purchases Fred Barnett Nov 15, 2007 Background: We have been paying large late charges for noninventory purchases of materials for our locations in the US. Goals and Targets: Paid $1,202,000 in late charges across 726 location in Target to cut late charges in 2008 by at least 50%, saving $500,000 from year over year expenses Current State Initial Observations: Managers process is very manual Low on managers priority list Great deal of variation among managers Managers know it is an issue when vendors complain Different process from ordering and paying for inventory There was over $1.2 million in late fees during The location in the New York Metro area with 11% of the locations accounted for more than 30% of all late fees in the country. Next Steps What Who When Talk with Site Managers Stephanie 1/5/2008 Check system constraints Melinda 12/22/2007 Schedule Improvement Kaizen Melinda 12/20/2007 Determine market for pilot test of solutions Fred 11/30/2007 Build communication plan to get buy in and proposals Stephanie from site managers 11/30/2007 What is the financial impact on negotiations Jennifer 12/10/2007 Vendor complaints have risen over the past two years. Several vendors have declined to negotiate for discount pricing due to our payment problem. Not part of site manager performance metrics. Open issues: Will need to build a feedback loop for our solution to make sure it works and continues to improve Who can we work with to build better ongoing reporting of the issues?

15 PCPs not Notified when their Patients are seen in ED Draft proposal, PCP Review Committee 1/29/10 Background: Primary Care Providers frequently report that they do not receive accurate notification when their patients are seen in the ED they receive no notification, intermittent notifications, or are sent information on patients that are not theirs. Improvements to Implement: Small subgroup to evaluate data inconsistencies, correct errors, and develop go-forward plan to maintain data integrity within Siemens and SCM New Notification letter set to notify PCP via AutoFax from Physician Referral DB software when patients are discharged to home from ED Utilize existing QA processes within the Physician Referral Service team to track all PCP complaints re: incorrect identification of them as PCP, or lack of notification. Review with Patient Access management for improvement opportunities. Eliminate use of the efax machine in the ED for faxing Discharge Summaries Goals and Targets: PCP information is captured correctly at time of registration. Information is sent on a timely basis to the PCP. Analysis (Problems with this process): PCP Name and Number inconsistent between Siemens and SCM Manual process for ED PAA staff to look up physician, fax # and fax documents, every time PAA staff has many responsibilities in addition to this efax database stands alone, and does not provide good monitoring tools Due to above issues, it is difficult to quantify the true errors, for re-training purposes. Implementation Steps What Who When Analyze and Correct Incorrect Physician Number Revenue Cycle, IS mappings Send ED outpatient discharge messages to Physician Referral Services IS Interfaces Team Create new letter for PCP ED patient notification Luisa, Dr. Klimek Communicate proposed changes to PCP population Drs. Nestler, Klimek, Smally Test, Implement new Process IS, Luisa Remove efax server process from PAA workflow Dr. Smally Set up ongoing 100% review when physicians notify Luisa, Jo Ann Physician Referral Services that PCP information is incorrect Determine appropriateness/necessity of changing PCP Review transcription service programmming to send out ED Committee outpt details for PCPs Follow-up: Evaluate use of existing inpatient AutoFax process from Sunrise Record Manager for ED outpatient visits.

16 The Five Whys: Help! The Jefferson Memorial is Crumbling Why is the Memorial crumbling? > Because of the frequent washings Why do we have to wash it so frequently? > Because of large quantities of bird droppings Why are there so many birds? > Because there is an abundant food supply Why is there an abundant food supply? > Because there are lots of spiders Why are there so many spiders > Because there are lots of midges Why are there so many midges? > They re attracted to the lights at night

17 The Fishbone Diagram A fishbone diagram helps to brainstorm the possible root causes of an undesirable outcome Lack of training Lack of skills No project mgmt People offer new input at last minute People don t think it through at onset Concept Development Original writing not submitted on time Author doing other things Other projects get in the way Authoring Lack of incentive to meet deadline Last minute changes to text or graphics Forgot to send Poor communication between author & publisher Publisher has too many other projects High incidence of missed deadlines in book publishing process Competing demands on editors time Competing demands on printing of materials The goal is to focus on root causes before jumping to solution Poor planning Editing Short on staff Copy Layout How often do people brainstorm solutions versus root causes?

18 Fishbone Diagram Example: MEASURES PEOPLE PROCESS Undesirable Effect MATERIALS EQUIPMENT ENVIRONMENT

19 Exercise: Apply the Fishbone Diagram At your table groups, create a Fishbone Diagram Select one of the following as your stinky fish head: Senior Leadership is not adopting the TLC Behaviors Attendees slip back to old habits after workshops People not continuing their growth outside the workshops Remember, don t brainstorm solutions, brainstorm possible ROOT CAUSES!

20 Challenge The Process The power of these tools is in the questions Profound questions are critical Every leader can help build the problem solving muscle

21 Van continues to Challenge The Process with a new set of profound questions

22 Thank You!