Listening to Voices

The voice of the process

measurement over time

What are the voices?

Work AreasThe Staff

Staff Surveys

Media AttentionCustomer/Citizen

SurveysComplaints

WasteEfficiency

Outcome & Process Measures

Wasting valuable management time

How much time do you spend trying to achieve targets?

• Trying to achieve everything• Writing reports• Holding meetings to sort perceived

performance issues

Performance Reports?

How often do you report?

• Month on month• This quarter compared to last quarter• This quarter compared to this quarter

last year• The average for the:

• Month• Quarter• Year

Average Late Starts

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Urology T&O Gen Surg

%Late start rates

How can we compare, quantify or record changes if we cannot capture our data in some numerical form?

Without measurable data we are at the mercy of anecdote. If you make an assumption based on anecdote rather than data, it will nearly always be wrong because we remember the unusual, not the mundane.

Why collect data?

What are we measuring ?

• What data is currently being collected?

• How do you interpret/use these?• Is this info fed back to those who

collect the data?

Chasing Tails!!!

Chasing Tails– learning points

• Any process contains variation

• Reacting incorrectly to variation is futile

What is variation?

Nick TysonNick TysonNick TysonNick TysonNick Tyson

“I drive to work every day. When asked, I say it takes 55

minutes. In fact, it takes about 55 minutes, but every day it is

slightly different”

What is variation?

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J ourney Time

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Time to drive to work

Histogram

The importance of time

• Time is often the most important variable, but it is often lost in the aggregation of data

Average Late Starts

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Urology T&O Gen Surg

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Run charts

• How to draw a run chart

Y axis The value (measure)

X axis Time period (e.g. days, weeks)

Run Chart Exercise

• The raw data for the three departments are attached

• Roughly plot each directorate separately on the graph paper provided

Three graphs

Future gazing

• Can you predict how your process is likely to perform?

• How can you measure the context of YOUR variation?

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Range of the process

Upper control limit

Lower control limit

• All processes contain variation

• The key in managing variation is to distinguish between

- variation caused by the process (common cause)

- variation that is caused by special events (special cause)

What is variation?

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Common cause

One-off special causeSpecial cause leading to new process

Match action to type of variation

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TYPE OF VARIATION

Common Cause Special Cause

Common Cause

Special Cause

Changing the process to deal

with one-off events is only

likely to increase variation and make things

worseInvestigate the occurrence and determine what

factor external to the process has

caused the variation

Investigating and correcting each

incidence of common cause

variation will be time consuming & won’t address the

system factors causing variation

Understand the process so that

changes introduced will

change the process

Reduce the variation e.g. by avoiding rush hour

Move the centre line e.g. by changing route

Dealing with common cause variation

Trends

• What is a change?• What is a trend?

• “Last month our waiting list was 453. This month it is 441. We’re getting better!”

Point Outside Control Limits

Average

UCL

LCL

Indicates there is something different about this point

A change in the process

8+ points in a row above or below the centreline indicates a process change

CentrelineProcess average

Trends

Upward Trend Downward Trend

6+ points in a row increasing or decreasing indicates a trend in the process

Example

Example

Dealing with rare events

PARETO CHART: EXAMPLE

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Reasons

Action taken on the key causes

Focus on the most important (Pareto Principle)