RU Practical QI Guide

Process Improvement GuidebookLocal Performance Management Initiative

Developed by NJAES Office of Continuing Professional Education (OCPE)

University Center for Organizational Development and Leadership (ODL)

and

Local Performance Management Initiative: Process Improvement Guidebook

Fall 2012

Developed by:

Office of Continuing Professional Education (OCPE), New Jersey Agricultural Experiment Station, Rutgers University

University Center for Organizational Development and Leadership (ODL), Rutgers University

This guidebook was developed for, and with support from, the New Jersey Department of Health and the U.S. Centers for Disease Control and Prevention. Contents are the sole responsibility of the developers and do not necessarily represent the views of NJDOH and CDC.

UCODLASB II, Room 21757 US Highway 1New Brunswick, NJ08901-8554(848) [email protected]

www.odl.rutgers.edu

OCPELaw’s House102 Ryders LaneNew Brunswick, NJ 08901-8519(732) [email protected]

www.cpe.rutgers.edu

mailto:center%40odl.rutgers.edu?subject=Process%20improvement%20guide

http://www.odl.rutgers.edu

mailto:ocpe%40njaes.rutgers.edu?subject=Process%20improvement%20guide

http://www.cpe.rutgers.edu

Introduction .........................................................................................4

What is a process? .........................................................................4

What is process improvement? .......................................................5

Step 1: Identify the process to improve ............................................7

Step 2: Organize the group .................................................................8

Process owner ................................................................................8

Working group ................................................................................8

Consultation group ..........................................................................8

Step 3: Map the current process .....................................................11

Define (and limit) the process .........................................................11

Construct the process map (diagram) ...........................................11

Step 4: Identify problems and potential solutions..........................13

Fully identify the problems .............................................................13

Generate plan improvements ........................................................15

Is the solution worth the effort? .....................................................15

Step 5: Map the new process ...........................................................16

Step 6: Implement and communicate changes ..............................17

Success factors ............................................................................17

Step 7: Measure success .................................................................18

Step 8: Review and plan for continuous improvement ..................20

Long-term ownership ....................................................................20

Self-check questions for process owners ......................................21

1. Identify the process to improve

2. Organize the working group

3. Map the current process

4. Identify problems and opportunities

5. Map the improved process

6. Implement and communicate changes

7. Measure success

8. Review and plan for improvement

Contents

LOCAL PERFORMANCE MANAGEMENT INITIATIVE: Process Improvement Guidebook4

INTRODUCTION

What is a process?

A process is a set of work activities that provides a service or product.

Typically a process is made up of a number of small steps that you or someone else performs to get from the start of the process to the end.

A process may occur within a single organization or it may span several organizations.

All work is part of a process.

For example:

Obtaining a dog license...

Start of process

Resident applies for dog license

Resident receives dog license

Process

Other examples include:

• Conducting a pool inspection

• Processing a retail food license

• Scheduling appointments

• Preparing a monthly report

End of process

LOCAL PERFORMANCE MANAGEMENT INITIATIVE: Process Improvement Guidebook 5

What is process improvement?

Process improvement involves analyzing a process from beginning to end to identify opportunities for improvement.

Benefits of process improvement

• Saves time.

• Makes life/work easier.

• Makes customers/clients more satisfied, more likely to comply with rules, and more likely to do things right the first time.

• Improves employee morale and job satisfaction.

• Saves money.

• Identifies and removes underlying problems.

• Reduces misunderstanding, error and waste.

• Creates clarity for those involved.

• Provides guidelines and confidence for steps requiring flexibility.

• Makes existing good ideas a reality.

• Helps people and organizations adapt to change.

• Allows for process ownership by those involved.

• Builds confidence and pride.

• Sets foundation for continuous improvement.

6 LOCAL PERFORMANCE MANAGEMENT INITIATIVE: Process Improvement Guidebook

Steps in process improvement

Identify the process to improve

Organize the group

Map the current process

Identify problems and potential solutions

Map the new process

Implement and communicate changes

Measure success

Review and plan for continuous improvement

Template 1:Organizing notes

Template 2: Current process map

Template 3: Problems and solutions

Template 4: Improved process map

Template 5: Action plan

Template 6: Measurement data

The templates provided with this guidebook are fully editable Microsoft Word and PowerPoint files for you to adapt to your needs.

Tool 1: Video

Tool 2: Short and sweet strategic plan

Template 7: Review


STEP 1

Identify the process to improve

When choosing a process to improve, identify one that:

• Is within the control of the process improvement group.

• Is done often enough that it will make a big difference.

• Can be improved substantially through changes.

• Will have high impact on customer/client and staff satisfaction.

• Can be improved with existing resources.

• Is not so large that it cannot be managed (if necessary, start with smaller sub-processes with the greatest potential impact and then look at wider change within or between organizations).

TOOL 1: WATCH THE VIDEO

Small Steps, Big Improvements: Selecting a Process for Improvement (2:46)

CASE STUDY: Food safety inspections

This guide uses a sample case study to show how the steps might work in a particular scenario.

In our case study, a health department explores how the process of reporting restaurant food safety inspections can be improved – specifically to address clients who repeatedly score poorly. The local area appears to have a high rate of repeat offenders compared to other jurisdictions, but data to measure this is currently difficult to access.


STEP 2

Organize the group

Key roles in a process improvement project will typically include a process owner, a working group (or advisory group), and a wider group to be consulted.

Process owner

This person should have key knowledge of the entire process, but may not necessarily hold a formal management position. They should have (or be empowered with) the authority to move the process forward, such as conducting interviews, compiling data, and calling meetings. The process owner should be an excellent communicator, and trusted by key players. The process owner should have sufficient work time to manage and complete the process in a timely manner.

Working group

The working group should include key players who are interested, capable and willing to undertake the process improvement project. The group will likely meet several times to provide insight and guidance, and take on tasks between meetings: such as interviewing the people who are part of the process, as well as other knowledgeable people and stakeholders. The group should be broad enough that key personnel involved are included or represented, but not so broad that progress is unreasonable slowed.

Consultation group

The wider consultation group should include people who can provide insight into the process to be improved, for example consumers/clients, counterparts in other units or organizations, or senior managers not in the working group.

This guide includes a package of six templates that can be used during the process improvement process: three Microsoft Word files and two PowerPoint files. Each are fully editable so that they can be adapted to suit individual needs.

Template 1 provides the foundation by pulling together the starting notes for process improvement.

TEMPLATE 1: PROCESS NOTES


CASE STUDY:

Establishing the health inspection process improvement working group

The local health department unit responsible for restaurant inspections includes a supervisor, eight inspectors, an administrative assistant, and a clerk.

In this scenario, a working group is created involving the supervisor, two of the inspectors, and the administrative assistant, who is made the process owner.

The wider group to be consulted includes all inspectors, a neighbouring county with a newly streamlined reporting system, other nearby jurisdictions, and a random selection of five restaurant owners who have repeatedly failed their inspections.

Troubleshooting: At the first meeting, the working group investigates whether the administrative assistant really has the time to oversee the process improvement, which they anticipate will take 30 to 40 hours of her time over six to eight weeks. No further staff resources are available.

One of the already identified issues in the unit is that previous inspections are available only on paper and are difficult to consult quickly or in the field; the unit clerk has been scanning these into the network system. One full year of scans has already been completed.

The unit supervisor agrees to suspend the scanning for previous years, temporarily freeing up the clerk to take on more administrative duties.

The question of whether one year is sufficient is added as a question for the process owner to pursue in her consultations with inspectors.

At the end of the meeting, all members leave with tasks to be completed – largely interviews with key stakeholders – and agree that the administrator is empowered to be “taskmaster” to ensure these steps are completed (or re-delegated) before the next meeting.

At the first meeting, the working group opened the discussion by reviewing their unit’s purpose and mission statement: to serve and protect local citizens through restaurant health inspections. They also examined an existing long-term strategy for their wider health department. This helped to ground and focus their process improvement goals (see page 10).


FIRST STEP FOR WORKING GROUPS

Consult existing plans, and mission and vision statements (or create them!)

Once formed, the working group may find it helpful to begin by looking at existing planning documents, such as the organization or unit’s:

• Mission and/or vision statements

• Previous process improvement or quality improvement reports

• Long-term planning documents, such as strategic plans.

Reviewing the core goals and objectives of the organization can provide valuable insight into how the process to be improved should be envisioned.

If your organization or unit does not have a strategic plan, consider taking the time to briefly discuss your shared goals, priorities, and strategies.

For example, examining core values – why your organization exists, who it serves, how it might evolve over time – can give particular insights and perspectives to process improvement planning.

For further guidance, look in the resource package for this guidebook for Tool 2: Rapid Cycle Summary of Your Strategic Plan.

Tool 2 is the Microsoft Word document Rapid Cycle Summary of Your Strategic Plan. It provides guidance to focus discussion, and ends with a template you can use to create a one-page strategic plan summary for your organization or unit.

TOOL 2: STRATEGIC PLANNING


STEP 3

Map the current process

Define (and limit) the process

To ensure that process improvement is focused and targeted, first:

• Define the beginning and end of the process.

• Define what is “inside” the process and what is “outside.”

Construct the process map (diagram)

• Do not diagram the ideal — diagram how the current process actually functions.

• Keep it fairly high level (details of each activity can be charted later).

• Make sure all activities are taken into account, even the “undesirable” ones.

• Rely on people who actually do the work, not on individual team members’ observations.

• Verify and refine the map through consultation with the people who actually conduct the process.

Template 2 is a PowerPoint file that can be used to map out the current process. Benefits include visual understanding of process and editability.

Look in the resource package for this guidebook for Template 2.

TEMPLATE 2: PROCESS MAP


CASE STUDY:

Mapping the health inspection reporting process

The administrative assistant (process owner) was already very familiar with the process involved in inspection reporting. She drafted the process map, and quickly consulted others in the office (the supervisor, the clerk, and two of the inspectors) for their feedback.

The process owner also noted on the process map some of the obvious issues with the process as it currently exists.

Administrator distributes assignments

Inspector conducts inspection

Inspector does not always check past reports in the filing

cabinet or on the server

Inspector returns to office, gives copy of report to clerk

Clerk types up report, gives one paper copy to

supervisor, files one paper copy in cabinet, adds data to master file on network

Handwriting on reports are often hard for clerk to read

Inspector connects laptop to network to get updated

master file for next day

Notes on current process

5 of 8 inspectors do not regularly update to network

Re-inspections are inconsistent (or do not occur

until the following year)

Inspector leaves written report with establishment

If fined, establishment sends in payment; administrator

tracks and confirms payment


STEP 4

Identify problems and potential solutions

Mapping the current process will immediately reveal gaps – and potential solutions. Deeper insights will be revealed through the wider consultation process that follows. If conducted by the working group, all interview notes – including problems and proposed solutions – should be provided to, and tracked by, the process owner to create a full picture.

Fully examine problems with the process

There is a natural tendency to jump to solutions without fully examining all of the underlying problems and their causes.

Make sure that you:

• Identify why the problem exists and where in the process it occurs.

• Examine how each problem contributes to overall performance.

• Identify underlying problems – not just their symptoms.

• Determine which problems are most critical.

• Highlight unnecessary steps that can be eliminated.

• Identify activities that are best done at the same time rather than waiting for the first step to complete.

• Examine anything that gets lost or misinterpreted between steps.

• Separate occasional problems from chronic problems – which may have been accepted as “the way things are” and are often more difficult to solve.

• Determine the extent to which roles and responsibilities related to the process are clearly defined and well-communicated.

• Assess problems in light of your overall vision and/or strategic plan.

• Determine gaps that exist between your performance and that of best-in-class organizations.

• Examine whether the problem can be counted or tracked so that the success of process improvement can later be measured.

Template 3 Problems and solutions is a Word file that can be used to track issues and proposed solutions as that data is gathered.


TEMPLATE 3


CASE STUDY:

Fully identifying problems with inspection reporting and repeat offenders

In research and interviews conducted for the health inspection process improvement project, members of the working group received extensive feedback, criticisms, and potential creative solutions to a variety of concerns, from a range of staff, key stakeholders, and counterparts in other jurisdictions.

Data gathered that was determined to be outside (or additional to) the process scope was forwarded separately to the unit supervisor – for example, Inspectors often leave the field without the tools, signage or forms they need; the training “shadow” process is far longer than it needs to be; consistent routine by inspectors means establishments can too often predict when inspector is coming...

In focusing on the key questions – the reporting process and repeat offenders – deeper gaps were revealed.

• Inspectors were frustrated that fines and penalties in the jurisdiction were too low, but changing them required complicated legislative steps. They did not see report tracking and re-inspections of repeat offenders as useful, as establishments simply paid the fines as “the cost of doing business” and carried on without making changes.

• Nearby jurisdictions with low rates of repeat offenders had one thing in common: they posted inspection reports on the Internet. Particularly high compliance rates were achieved where consumers came across inspection reports simply by Googling the name of the establishment (e.g. reports were not buried in databases or PDFs).

• Repeat offender establishments reported that inspectors were often quick to write up reports, but did not appear to be approachable in terms of providing practical guidance or assistance with solutions.

• While no-one in the office found the paper files to be useful or easy to access, staff had not been trained to use existing web-based technologies to their full capacity.

• While laptops in the field did not have the wireless functionality to access network data at the office, all eight inspectors reported they could do so using the handheld (cellular) devices provided by the office, without further cost or training, if the data was made available on-line.


Generate plan improvements

Once you have identified the problems and proposed solutions for your process, the working group should select which process improvement ideas to move forward with.

Questions to be considered include:

• What easy solutions (“low hanging fruit”) can easily be implemented?

• Of the more difficult solutions, what steps can be initiated now, even if the solution cannot be implemented right away?

• Which gaps or problems are so critical that existing resources should be re-allocated to solve them?

• What are the barriers or likely opposition to the improvements, and how can they best be negotiated or overcome?

• How can the improvements be communicated to smooth the transition and ensure “buy in” from stakeholders?

• How will the improvements be measured?

• Use reverse brainstorming. Ask: “What’s wrong with this solution?”

• Ask: “Is the process change worth the time and energy needed? It may be a wiser choice to cancel a marginal, “high-cost” improvement than to implement it.

It may be helpful for your working group to place potential solutions on a graph like this one, to help prioritize improvements.

HIGH COST/DIFFICULT

LOW COST/EASY

BIG IMPACT SMALL IMPACT

FOCUS EFFORTS

HERE


CASE STUDY:

New process map

The administrative assistant received training in advance of the new process being implemented. Establishments were notified with sufficient time and guidance to be in compliance. All inspectors confirmed they had the skills and tools to implement the new process. The supervisor shortened the training period (upon proven capability) to free up inspector resources. Upper management approved of the plan.

STEP 5

Map the new process

In constructing a diagram showing the new process:

• Diagram how the new process will ideally function.

• Keep it fairly high level; address details in revised documentation or job descriptions, as needed.

• Verify and refine the map through consultation with key players before it is released for implementation.

Administrator distributes assignments

Inspector accesses online past reports, then conducts inspection

Inspector uploads electronic report to online database, supervisor e-notified

If problems are found, establishment is given written report, and time and

guidance to solve the problem

After minimal but sufficient time to solve the problem, inspector conducts

unannounced follow-up inspection

Administrator confirms fines are paid

If problems resolved, inspector updates online database

If problems persist, inspector forwards report to clerk to post in public area online,

supervisor e-notified

Template 4 Improved process map is a PowerPoint file that can be used to visually demonstrate the proposed new process.


TEMPLATE 4


STEP 6

Implement and communicate changes

Merely issuing a document or stating that there is a new process will not ensure people will follow it.

Start by creating an implementation or action plan:

• Solicit feedback from key players before the action plan is released.

• Set a reasonable implementation date, allowing for unanticipated barriers (e.g. delays in the availability of training or testing).

• List each individual action that needs to be completed (e.g. education, training, communication, approvals, notification), along with who will do it, and when they will do it by.

• Communicate the implementation plan widely. Use this opportunity to reinforce buy-in by briefly summarizing how the plan evolved, why it is being implemented, the outcomes hoped for, and how success will be measured.

• The process owner should act as taskmaster to make sure everyone is getting their tasks done.

• If the implementation is to be piloted, inform and educate participants. Communicate pilot results and next steps widely.

Success factors

• Implement changes within a reasonable time frame; set realistic deadlines for key tasks and steps.

• Encourage feedback and address concerns as they arise.

• Confirm ongoing progress and support from key players.

• Provide timely response to unanticipated barriers or issues (consumer, cultural, community, regional).

• Communicate progress toward implementation.

• Ensure that measures to track success are in place.

Template 5 Action plan is a Word file that can help you itemize – in detail: what, by whom, when – the steps needed to implement and communicate the revised process.


TEMPLATE 5


STEP 7

Measure success

Measures are needed to ensure that the new process is working, and to set the stage for continuous improvement. Measures should:

• Be realistic for staff to collect and track.

• Help identify and correct process problems early.

• Help identify areas where process procedures should be modified.

In general:

• The process group is responsible for defining, collecting, using and communicating data resulting from the process improvement.

• Success should be measured by facts and not “intuition.”

• Only data that will realistically be used should be collected.

• Results should be communicated widely – particularly to stakeholders who invested time and energy in improving the process.

Effective measures

• Relate to agency standards.

• Focus on the process, not the people.

• Are understood and accepted by those who implement the process.

• Are specific, simple and straightforward.

• Provide a way for you to track your agency or unit’s progress on key goals and priorities for the process.

Template 6 is a fully editable Word file that can help you determine how best to track data to show whether the improved process is working: and if so, how much time and effort it saves, how client/customer satisfaction has been improved, or the extent to which your unit/organization’s goals are being advanced.


TEMPLATE 6: MEASUREMENT DATA

Examples of measures:

• No-show appointments at the clinic before process improvement were 12 per week; now with telephone reminders the day before, no-shows are less than once per week.

• Under the old process, it took 8 weeks to complete the client’s license renewal, now it takes two weeks.

• Before, 40 percent of applications were rejected for being incomplete; now, 5 percent are.

• The old process was deemed cumbersome by 6 out of 7 staff in the process; now, all report being satisfied that the system is efficient.


CASE STUDY:

In closing: Measuring success and repeat offenders in food inspections

One of the issues that led to process improvement of reporting for restaurant food safety inspections was that data on repeat offenders was not being sufficiently tracked. This made measuring the success of process improvement more challenging.

To create a baseline so that success could be measured, the process owner – the office administrator – asked the supervisor and each of the eight inspectors to each recall one dozen establishments that had repeatedly failed food safety inspections.

Once verified, this created a list of 100 repeat offenders. Further investigation of data sources revealed that 32 percent of the repeat offenders had failed inspections for three consecutive years or more.

At the top of the list of infractions was the temperature of refrigerators and coolers used for food storage.

Feedback from the establishments revealed that the majority of establishments did not know of a source for simple, low-cost temperature gauges. The restaurant food inspection unit acquired these units in bulk and provided them to establishments at cost during initial inspections: $5 per gauge.

One year later, the number of repeat offenders had dropped from 32 per cent to 19. Violations due to food temperature dropped from 92 per cent of citations to 34.


STEP 8

Review and plan for continuous improvement

Once you attain a new level of improvement, the challenge is to maintain long-term improvement – both in the process that has been improved, and in new areas.

The working group should determine how often the process holder will report on data from the new process, and how often the wider working group will meet to review data (e.g. quarterly, annually).

The new level of performance can become the standard against which you measure your future performance.

Continuously review:

• What data to collect.

• Who will collect it, how, and where it will be stored.

• How long to collect the data.

• Who will analyze and report on it.

Long-term ownership

• The process owner is responsible for long-term maintenance of the process.

• If not monitored and owned by someone, gains may be lost.

• The group should be recalled periodically to assess process performance based on collected data.

• Once the process is established at the new level, consider attacking the next level of problems within the process.

• Once you have established a new, improved level of success for this process, consider tackling related processes or looking for ways to improve the outcomes of this process even further.

Template 7 Process improvement review is a Word file that can be used to ensure that the process receives continuous review and improvement.


TEMPLATE 7


CASE STUDY:

Six-month follow-up on the new process for restaurant inspections

At a six-month follow-up meeting of the new process, inspectors reported that one of the steps in the process – giving establishments time to correct the problem before the results were published to the public – appeared to be creating a culture where establishments were not proactive about safety – for example, providing gloves for sandwich makers who are also cashiers, or repairing broken soap or paper towel dispensers – as they knew they would have time to solve any issues before the results were made public.

The process improvement working group, after additional consultation, decided that this part of the process would be eliminated in the following year. This information was provided to establishments well in advance of the upcoming change. Measures were put in place to track the results.

The working group agreed to meet six months later to determine whether the revised solution was effective.


Self-check questions for process owners

An important aspect of improvement is to make sure the results of your improvement efforts do not fade with time. Use the following questions to assess how well your process is being managed.

1. If you own an ongoing process, do you periodically monitor it for potential improvements?

2. Who knows you own this process? Do they consult with you and offer you feedback?

3. Who gives you information, start-up materials or other criteria for beginning your process?

4. What is the goal or purpose of your process? How does it fit with your unit’s mission? Does everyone understand the goal?

5. Who are the consumers for the process? How are their needs being assessed and included in the goal?

6. Are the major affected parties involved in developing changes and making decisions?

7. How are the needs of the most affected parties considered in your objectives?

8. Have you identified value-added qualities, steps or traits in the process which contribute to your goal?

9. Have you and your process group weighed the cost, in terms of budget, time and energy, of the proposed process change(s)?

10. What would happen if breakdowns were to occur in this process?

11. How do you know the process is working? What ongoing assessment measures do you use?

12. If you own a new process, do you reassess it regularly (every six months or year, for example)?

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