Chapter 2 Science of improvement Basic final.pptx

Chapter 2 Science of improvement Basic final.pptx

1. Science of Improvement in the Healthcare Setting 1 30 October 2025 QI Training

2. Enabling Objectives Explain the Science of Improvement Describe the two types of knowledge to develop effective change Explain the four components of Deming’s System of Profound Knowledge and their uses to understand the current problems Explain the interplay between the four components of profound knowledge 2 30 October 2025 QI Training

3. Outline Introduction Change and improvement in healthcare Deming’s “System of Profound Knowledge” Four components of profound knowledge Interaction of the four components Summary 3 30 October 2025 QI Training

4. “Science” of “Improvement” Science: “knowledge attained through study or practice” Improvement: “increase in value or in excellence of quality or condition” 4 30 October 2025 QI Training

5. Improvement Science Improvement science is a problem-solving approach centered on continuous inquiry and learning. System’s performance is a result of its design and operation, not simply a result of individuals’ efforts within the system. It helps organizations to build a shared understanding about how their systems work, where breakdowns occur, and what actions can be taken to improve overall performance. 5 30 October 2025 QI Training

6. Improvement……Con’t “Healthcare....is a moral and scientific enterprise, but not fundamentally a commercial one. We are not selling a product. We don't have a customer who understands everything and make rational choices - and I include myself here." (He alth Affairs-2001) 6 30 October 2025 QI Training

7. Which is Improvement? 2 3 7 30 October 2025 QI Training

8. Types of Knowledge to Develop Effective Changes 8 30 October 2025 QI Training

9. Knowledge for Improvement The Improvement Guide, 2 nd edition – p75c Subject Matter Knowledge Profound Knowledge Increased capability to make Improvement Knowledge for Improvement Learn to combine the two knowledges in creative way to develop effective change for improvement The ability to make beneficial changes or improvements is enhanced by combining subject matter knowledge and profound knowledge in creative ways 9 30 October 2025 QI Training

10. Profound Knowledge The Improvement Guide, 2 nd edition – p76 Appreciation of a system Understanding variation Building knowledge Human side(psychology)of change 10 30 October 2025 QI Training

11. Knowledge for Improvement The Improvement Guide, 2 nd edition – p75c Deming’s System of Profound Knowledge The System of Profound Knowledge provides a lens. Looking through this lens allows us to better understand and optimize our organizations. Describes the System of Profound Knowledge, Four elements of organizations That should work together to become more effective in leading improvement Source : Improvement Guide , Introduction, p xxiv-xxvi Dr. W. Edwards Deming(1900-1993) 11 30 October 2025 QI Training

12. Appreciation of the System Process vs. System Process: a sequence of steps/actions through which inputs from suppliers are converted into outputs for customers System: the sum of all the part (including processes) that interact together to produce a common goal ~~~ W. Edwards Deming ~~~ “If you can’t describe what you are doing as a process, you don’t know what you are doing” Adapted from Institute for Healthcare Improvement, QILM presentation 12 30 October 2025 QI Training

13. Large Group Exercise Appreciation of the System In group of 3-5 members Considering ER length of stay 24hrs at your facility Identify units involved in this system. List functions of each units Does each unit know what to do Understand interactions of interdependent units, How can you communicate and coordinate better in the future Time: 15 minutes 13 30 October 2025 QI Training

14. Appreciation for the System U nderstand the properties of a system. Identify elements/units in the system you want to improve. Understand functions of each units and who know what to do. Understand interactions of interdependent units, groups of people, procedures and items in your system Know how to communicate and coordinate “If each part of a system, considered separately, is made to operate as efficiently as possible, then the system as a whole will not operate as effectively as possible.” Ackoff, 1981 14 30 October 2025 QI Training

15. Appreciation for the System 15 30 October 2025 QI Training

16. “Every System is Perfectly Designed to Get the Results it Gets” 16 30 October 2025 QI Training

17. Complete each of the steps in this process NO YES Step 1: Pick any number from 3 to 9 Step 2: Multiply your number by 9 Step 3: Add 12 to the number from step 2 Step 7: Write the name of a the fastest mammal in the world that begins with your letter Step 4: Add your 2 digits together Step 5: Divide # from step 4 by 4 to get a 1 digit number Step 6: Convert your Number to a letter: 1=A 2=B 3=C 4=D 5=E 6=F 7=G 8=H 9 = I Step 9: Add 8 to your # from step 5 Step 11: Write down the name of a country in Africa, beginning with the letter from step 10 Step 8: Write down the color of your animal Do you have a 2-digit number? Step 10: Convert your Number to a letter: 1=A 2=B 3=C 4=D 5=E 6=F 7=G 8=H 9 = I 10= J 11=K 12= L 17 30 October 2025 QI Training

18. A “brown-dotted” Cheetah in Kenya “Every system is perfectly designed to get the results it gets” 18 30 October 2025 QI Training

19. Understanding Variation Variation exist with the performance data Listening to a process through data overtime and use data for improvement Example How does the number of daily outpatient visits vary over the days of the week? 19 30 October 2025 QI Training

20. Understanding Variation - Exercise Write with your dominant hand, the small letter “a” ten times on a paper Do the same with your non-dominant hand 20 30 October 2025 QI Training

21. Understanding Variation Variation is unavoidable Common and special cause variation Common cause: inherent in the process or system Special cause: not inherent in the process or system The Improvement Guide, 2 nd edition – p79-81 21 30 October 2025 QI Training

22. Types of Variation Common Causes Those causes that are inherent in the process (or system) over time, and affect all outcomes of the process Predictable ACTION: Redesign the process Time (Minutes) Day 35 40 45 50 55 5 10 15 20 25 30 35 Avg=45.9 LCL=40.2 UCL=51.6 22 30 October 2025 QI Training

23. Types of Variation Special Causes Causes that are not present in the process or system all the time A rise because of specific circumstances and create disturbances ACTION : Investigate special cause and take appropriate action 23 30 October 2025 QI Training

24. Mistakes in understating Variation Mistake 1: Assuming Special Causes when common causes exist. Mistake 2: Assuming Common Causes When Special Causes exist. 24 30 October 2025 QI Training

25. The application of plan, do, study, act (PDSA) cycles help us better learn, innovate and  improve. The theory of change that you introduce is predicted to lead to improvement This prediction needs to be tested to learn how it is influencing the system you are trying to improve. Comparing predictions to results is a key source of learning Theory of Knowledge 1 3 2 4 25 30 October 2025 QI Training

26. Theory of knowledge cont’d A change is a prediction Learning from theory and practice Testing of change – Plan-Do-Study-Act cycles 26 26 30 October 2025 QI Training

27. Psychology of Change Reflection How do you respond to change in your facility? Pair and Share experience with your neighbor 27 30 October 2025 QI Training

28. Psychology of Change “A square man cannot be expected to fit in a round hole right away. He must have time to modify his shape.” - Mark Twain 28 30 October 2025 QI Training

29. Psychology – Human Side of Change The rate at which improvements spread relies on people implementing the change in practice. Improvement leaders frequently experience resistance and struggle to overcome resistance to change W hen introducing change, it should be made attractive, aiming for something better and motivate people 29 30 October 2025 QI Training

30. Psychology of Change Helps to , Predict how people will react to change Understand behaviors that drive people’s motivation intrinsic and extrinsic motivation Avoid blaming the people for the poor outcome, rather review the process design and its operation. Fundamental attribution error 30 30 October 2025 QI Training

31. Psychology in Improvement People want to create value when doing something When introducing change focus on intrinsic motivators rather than fear and extrinsic motivators. Creating a culture that respects people and treats them as partners galvanizes commitment to act What drives the fishes to jump to the bigger containers? 31 30 October 2025 QI Training

32. Psychology: Resistance to Change Must I suffer resistance? Yes! Resistance is what we want! Resistance to change in not a problem—it’s expected Resistance indicates engagement with change and poses a dilemma about how we will work together to address it Source: The Science Behind Resistance to Change: What the Research Says & How it Can Help You, KaiNexus Presentation by Mark Graban and Mark Jaben 32 30 October 2025 QI Training

33. Psychology: Resistance to Change People’s resistance to change comes from fear . Fear of failure , of losing control, of moving from habit to uncertainty Fear of loss : of attachments, structure, future, meaning & identity 33 30 October 2025 QI Training

34. Rate at Which Change Spreads: People People are different and react differently to new way of doing things – influenced by peoples’ culture, values, education etc. We all respond to innovation different – explained in Rogers’ Diffusion of Innovation curve 34 30 October 2025 QI Training

35. Resistance to Change Adapted from “The Resistance Pyramid” elaborated from Nieder and Zimmerman by Galpin (The Human Side of Change 1996) 35 30 October 2025 QI Training

36. Addressing Resistance to Change Begin by letting people know why the change is needed Gather input about the ideas from those affected by the change Share specific information on how the change will affect people once it is implemented: to gain and lose Focus on the people who already are committed to change: Innovtors Continue to inform everybody of the progress made (results) during testing of the change Addressing Resistance to Change 36 30 October 2025 QI Training

37. Interaction of the Four Components Improvement is derived mainly from the interaction of the four components Example: You cannot appreciate the system without considering the impact on variation Including the human side of change is critical for effectively building knowledge about change for improvement Profound Knowledge 37 30 October 2025 QI Training

38. Small Group Exercise Tena Lehulu Hospital has a long elective surgical cases waiting list which has led to significant complaints. The hospital has two well-equipped operating rooms functioning twice a week for elective surgeries. The hospital has 4 surgeons who alternate to operate on elective cases as per their schedule. The hospital director regularly communicates the complaints on the prolonged time patients are waiting to get a scheduled for the elective surgery. The surgeons justify the high case load the hospital is accommodating and how busy they are in their day-to-day activities. One day the hospital director wants to discuss the problem with the surgical department and came up with his regular monthly KPI report. The KPI report states that, the previous month, the delay for elective surgical admissions was 145 days while major surgeries per surgeon were only 20. He explained to the surgeons that they did not even operate 1 case a day while the waiting list is so long. Finally, he told them his subsequent expectations of at least 3 surgeries a day from each of the surgeons which ended the agreement. 38 30 October 2025 QI Training

39. Small Group Exercise Work in groups of 4 participants Read the scenario in the participant manual Answer the following questions Describe how the components of profound knowledge were applied in this scenario What did the hospital director do well? What could the hospital director have done better, if he had had knowledge of profound knowledge? Time: 35 minutes 39 30 October 2025 QI Training

40. Case: Long elective surgical backlog Appreciation of the System Understanding Variation concerning the long elective surgical backlog, in the Hospital… What are the key processes? Functions of each element/process Interconnection b/n each element Concerning the long elective surgical backlog, in the Hospital… What data do you have already? What is it telling you about the long elective surgical backlog?   Theory of knowledge   Knowledge of Human Psychology Theory of change that will help you overcome the problem Knowledge and prediction Applying PDSA framework   How ready do you think people in your system are for change? Are some people more ready for change than others? -Motivation How do you think people feel about the issue you are going to work on? Is there anything else external that might be influencing the surgical team? 40 30 October 2025 QI Training

41. Summary To be an effective leader of improvement Apply the central principles of improvement Combine subject matter knowledge with profound knowledge Understand the four components of profound knowledge and their interactions Appreciate differences in people , value teams Know that we have poor systems and not poor performing people 41 30 October 2025 QI Training

42. Thank you! 42 30 October 2025 QI Training