TOGETHER WE RISE - Meals on Wheels America · TOGETHER WE RISE MEALS ON WHEELS CONFERENCE AND EXPO...

TOGETHER WE RISE MEALS ON WHEELS ANNUAL CONFERENCE & EXPO

AUGUST 31 – SEPTEMBER 2, 2016

INTRODUCTION TO

CONTINUOUS QUALITY

IMPROVEMENT (CQI)

THURSDAY, SEPTEMBER 1, 2016

BETH ADAMS DIRECTOR, ANN ARBOR MEALS ON WHEELS

TOGETHER WE RISE TOGETHER WE RISE MEALS ON WHEELS ANNUAL CONFERENCE AND EXPO

INTRODUCTION

About AAMOW

Case Studies

Overview of CQI Tools

Introduction to CQI

AAMOW Examples

TOGETHER WE RISE MEALS ON WHEELS

CONFERENCE AND EXPO

TOGETHER WE RISE MEALS ON WHEELS ANNUAL CONFERENCE AND EXPO

ABOUT AAMOW

People

Structure


CONFERENCE AND EXPO


WORKING WITH HEALTH SYSTEMS

• Health care providers engage in CQI – many embrace

systems such Lean Thinking

• Need to have established systems in place to have

successful contracts with health care entities

• How do you know you’re making an impact?

• Can you align the work you do with local community

health needs assessment priorities?

• Develop understanding of health system goals/pillars,

decision making structure, external pushes/pulls,

margin improvement plans, etc.

• Know schedule for accreditation/surveyor visits


Any intelligent fool can make things bigger and more complex…it takes a touch of genius – and a lot of courage to move in the opposite direction

~ Albert Einstein


CONFERENCE AND EXPO


DOES YOUR AREA HAVE PROBLEMS WITH:

• Workplace organization

• Communication

• Duplication of work

• Lack of standards, or

standards not followed

• Process issues

• Talent usage (skills,

knowledge, abilities)


CONFERENCE AND EXPO


ABOUT CQI

• An approach to quality management that focuses on

processes

• Recognizes internal and external customers

• Promotes need for objective data

• Focuses on problems with systems, not people

• Small, incremental changes using scientific method

“If it isn’t broken,

don’t fix it”

“No problem is a

problem”


CONFERENCE AND EXPO


WHY DO CQI?

• Ability to benchmark

• Need to have and follow set standards

• Identify and address waste

- Muda

- Mura

- Muri

• Evaluate areas such as

- Structure

- Process

- Outcomes


• Waiting times

• Movement

• Motion

• Inventory

• Processing

• Correction

• Overproduction

CQI & WASTE

Waste

W

I

P

C O

M

M


CONFERENCE AND EXPO


QUALITY PROGRAMS

• Are customer focused & effective in fulfilling mission

• Focus on system improvements at every level

• Everyone develops eyes for waste

• Strive to provide services consistently

• Adapt to changing environments

• Collect and track data

• Are problem solvers

• Engage in a never ending cycle of improving service

delivery


CONFERENCE AND EXPO


CQI TOOLS & TECHNIQUES – A VERY, VERY SHORT LIST

Take an organized approach – find and use the right

tool and process for each situation

• PDCA/PDSA

• Gemba Walk

• Spaghetti diagram

• SIPOC

• Value stream map

• 5-whys

• Fishbone diagram


CONFERENCE AND EXPO


PDCA

PLAN

• Identify problem or process

improvement

• Define current process

• Analyze root causes

• Identify goals

• Develop action plan

DO

• Implement solution or

process change

CHECK

• Evaluate results

ACT

• Redesign process as needed

• Implement necessary changes

• Standardize new process

• Communicate results

Time

Quality


CONFERENCE AND EXPO


DO THE GEMBA

1. Identify purpose for walk

- Known problems?

- What portion of process observing (portion or all)

2. Ensure understand process will be observing

3. Select dates/times

4. Go, observe & show respect

- Go where work is done

- Observe process, quality of service, interactions

- Ask questions, take notes, avoid giving answers

5. Visualize gap between current and ideal states

http://www.google.com/url?sa=i&rct=j&q=jeffy+walk+the+family+circus&source=images&cd=&cad=rja&docid=dYW4gdAmp1O7cM&tbnid=faliRBQX_jv0wM:&ved=0CAUQjRw&url=http://blueskygis.blogspot.com/2011/08/billys-trail-map-two-fer.html&ei=96wnUcbkDpT5qAHM2oGgCA&bvm=bv.42768644,d.aWM&psig=AFQjCNGOdvAE7LP0ds8UrZiGkuzFrjTuIw&ust=1361641039073339

Spaghetti Diagram - Before

Spaghetti Diagram - After


SIPOC


VALUE STREAM MAP


An action or set of actions

that seeks to prevent the

problem from arising again

Seeks to deal with the

immediate situation

ROOT CAUSE PROBLEM SOLVING

People

Materials

Environment

Method

Equipment


CONFERENCE AND EXPO


5 WHY ROOT CAUSE ANALYSIS

• Start by defining the problem

• Document potential causes by asking “why”

• Drill down

- Do you think this is the root cause?

- Should we ask “why” again?

- If we address the root cause, will the problem be

permanently fixed?

• Which is the most likely?

• Therefore Test

- Start at root cause, if work way up and logic

doesn’t make sense, likely skipped steps

Root Cause

Why?

Why?

Why?

Why?


FISHBONE DIAGRAM – CAUSE & EFFECT

Problem Statement:

Food temperatures

are not in the safe

zone by the last stop

Staff/

Volunteers

Equipment

Delivery process


CONFERENCE AND EXPO


SCENARIOS - INSTRUCTIONS

• You have 20 minutes for this exercise.

• Individually read through the 3 case studies.

• Decide as a table which one you want to work on. You

can use your own program’s challenge with one of these

issues as a springboard for discussion.

- It is okay to change tables if there is one scenario that

is more applicable to your own program.

• Use one or more of the CQI tools to start the journey in

finding the countermeasure(s).

• Tables will be asked to do a short report-out.


I don’t know what’s expected of me…

Now, how do I do this again?

Let’s hope this is right!

I’m frustrated!!

Where is this written down? Oh, it’s not…

But she told me this is how it’s done!

Where do I find….?


CONFERENCE AND EXPO


LACK OF WRITTEN STANDARDS

• Leads to inevitable break-downs in processes

• Adversely impacts service delivery

• Increases cost of service

• Difficult to measure employee performance

• Creates opportunities for perceived favoritism

• Makes it difficult to train new employees

• Leads to errors and waste

• Lack of consistency for customers

• Difficult to do process improvement


CONFERENCE AND EXPO


AAMOW’S CQI ACTIVITIES

• Developed procedure manuals for social work functions

and front office/database functions

• Use checklists for training volunteers and new employees

• Visual cues for staff and volunteers

• Value stream maps to make process improvements

• Look for root cause

• Run “missing fields” and “not home/late cancel” queries

• Program impact questions/annual survey

• Daily “huddles”

• Empower staff to be change agents


PROCEDURE MANUALS AS QUALITY IMPROVEMENT

Plan

Do

Check/Study

Act/Adjust

P

C

D

A


NAVIGATION TOOLS


VISUAL CUES


USE EXAMPLES OF RIGHT & WRONG



CONFERENCE AND EXPO


CONTACT

Beth Adams Ann Arbor Meals on Wheels 2025 Traverwood Suite F Ann Arbor, MI 48105

[email protected]

734-998-6780

Find me on: Elizabeth Adams @eliadamso

www.med.umich.edu/aamealsonwheels [email protected]

mailto:[email protected]

http://www.med.umich.edu/aamealsonwheels

mailto:[email protected]

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