4 - Process Improvement

Question 1

Which type of change?

• Problem is clearly defined
• Involves changing product/process
• Solved by experts

•Faces less resistance
Change may not even be noticeable

•No “loss” experienced

Improvement of current practice

Answer 1

TECHNICAL CHANGE

Take a blood pressure medication

Require airbags in new vehicles

Repair broken bone via surgery

Create a new drug interaction alert

Provide influenza vaccines for employees during work hours

Question 2

Which type of change?

• Problem hard to clearly define
• Involves changing hearts and minds
• Solved by stakeholders

•Resistance is high
choose between contradictory values
Experience loss

•Require new practice

Answer 2

ADAPTIVE CHANGE

Adapt lifestyle to increase exercise, reduce stress, and eat healthier

Convince people to drive more safely

Reduce participation in high risk activities

Improve prescriber interaction with alert systems

Convince employees that getting influenza vaccine is important

Question 3

Donald Norman User Centered Design
– Six Strategies

Answer 3

• Make important information visible
• Simplify the structure of tasks
• Affordances and Natural Mapping
• Use constraints (forcing functions) to guide the user
• Make it easy to reverse error prone operations and hard to carry out non-reversible ones.
• Standardize and simplify actions

Question 4

Donald Norman User Centered Design
– Six Strategies

Affordance vs Natural Mapping

Answer 4

•Affordance:
A characteristic of equipment that communicates how it is to be used.

•Natural mapping:
intuitive relationship between the control and its function.

Question 5

• *Six Sigma & DMAIC**
• *“Lean”**

Lean = Process that looks at making systems more Efficient

Six Sigma = Systems more safe / less faults

Answer 5

•Define
–Define the problem–Identify the “customer”

•Measure
–Establish current baselines as the basis for improvement

•Analyze
–Analyze/prioritize problems (latent conditions)
–Consider risks associated with proposed solutions

•Improve
–Consider starting with a pilot–Prepare stakeholders for the change

–Collect data along the way–Implement

•Control
–Lock in the gains–Manage resistance–Celebrate wins

Question 6

PDSA

Cycle

Answer 6

PLAN
Seek Sponsorship / Identify Stakeholders
Include stakeholder input (Go to the Gemba – “The Real Place”)
Plan for Resistance (especially if level of adaptive change is high)

DO
•Communicate (up and down the ladder)
Though education is a low level intervention, it is almost always necessary to include with higher level interventions

STUDY
Share data –Stakeholders can be highly driven by data on their own performance
Share successes

ACT
New Study