Thank you for Subscribing to Medical Care Review Weekly Brief
Leaders want to have their work problems solved as soon as possible. They want things to be better and for their problems to simply “go away.” Many times, they implement solutions without sufficient thought. Doing so may temporarily make things seem better, but many times, such “band-aid” quick fixes mask the problem and eventually lead to the problem getting even worse. If there were a “Magic Pill” for every problem, there would be fewer and fewer problems, and eventually, “poof” – there would be no problems at all.
Unfortunately, we often jump to solutions without fully understanding what is behind the problem (its root cause). The real problem with problem-solving is that most focus on improving their “performance” instead of their “process.” The best way to bring about real and sustained improvements is to focus on the process. Once we understand the process, we can determine where we are; we can identify things (steps in the process) that are not optimal, and we can come up with a better way of doing things, like a plan to sustain the new way of doing business (the new process). Some organizations rely on a "MAGIC " performance improvement methodology to solve their operational problems. MAGIC is an acronym for measure, assess, generate ideas, implement, and check. I would venture to say that the MAGIC (magical) approach to performance improvement may sound good, but it is lacking. It lacks a true understanding (or definition) of the problem and real (meaningful) data analysis. It also lacks the necessary controls to ensure success. In my opinion, the best way to solve operational problems is to focus on improving the process rather than on improving performance. The Process Improvement methodology that leads to successful and sustainable improvements is entitled “DMAIC,” an acronym for define, measure, analyze, improve (some add an I for Implement), and control. While DMAIC may not be magical, its steps are methodically structured to achieve sustained success. "When we solve problems using DMAIC steps, we end up with an improved process, which will ultimately result in improved performance." The define phase is one of the most important ones. It starts with identifying what is critical to quality from the customers’ perspective. A Project Charter must be written to clarify what is being worked on (within scope) and what will not be worked on (out of scope). A SIPOC is a great tool to summarize the Suppliers, the process Inputs, a high-level (5-8 step) Process Map, the Outputs, and the Customers of the process. The Define phase also greatly benefits from doing a more detailed (step-by-step) map of the current (state) process (process map). To understand the problem, you definitely want to go to where the work is being performed (by going to the “gemba”). You want to see what is taking place, and you want to ask questions such as, “Why?” (respectfully). You want to try to put yourself in “their shoes” and see what is happening (not working) for those who are doing the work. The measure phase consists of selecting and measuring the data critical to quality. Hopefully, that data is available to you, and hopefully, the data is good (accurate) and meaningful (tells a story); otherwise, you may need to come up with your own data collection plan, such as manual data collection. The analyze phase requires establishing the current process capability, defining the performance objectives, and identifying where we are at and where there is variation. Cool tools that could be used here include the histogram, dot plots, run charts, hypothesis testing, and the fishbone (root cause) diagram. Finding the root cause is critical, as it will ensure that we work on solving the problem and not on improving the symptoms. The improve phase involves the charting of a new Process Map, typically with fewer non-value-added steps. The fun part of the Improve phase is that we finally get around to brainstorming on potential solutions that will address the root cause of the problem. In selecting solutions, it is imperative to select achievable solutions that will not be costly. Performing an FMEA (failure modes and effects analysis), which is a step-by-step approach for identifying possible failures in the new process, can also be very helpful in ensuring success. Lastly, there is the control phase, the most important phase. You did all this work, so now you want to make sure that your improvement plan will stick so that you are not called back in a few years to work on this problem again. You will want to determine your process capabilities and implement a process control plan. Roll out your plan and then monitor your success. To ensure project success - using the RACI tool will help identify who will own process sustainment and (how) their responsibilities. DMAIC is indeed more involved and time-consuming than MAGIC. DMAIC projects can take 4 to 7 months. But in my opinion, we cannot rely on magic to solve our work problems. Since leaders cannot wait months and want their problems solved ASAP, there is a way to do DMAIC projects in significantly less time. This can be accomplished through “Rapid Improvement Events,” also known as “Kaizen Events.” Kaizen Events follow the DMAIC format yet can get the project work done in 2-3 work days, the equivalent of a 6-month project. There is no magic involved. Rapid Improvement Events do necessitate more “pre-work” of observations, interviews, data gathering, and data analysis. It is important to make sure that you get the right participants (team members) in the room (participate) during these 2-3 days. The leadership (decision makers) need to come towards the end of the event to determine if the recommendations for change (the “asks”) are reasonable and financially feasible and should indeed be implemented. When we solve problems using DMAIC steps, we end up with an improved process, which will ultimately result in improved performance.