The Basic Improvement Toolkit

As an improvement advisor in large scale improvement collaboratives, one of my responsibilities is to provide instruction on the theories and tools of improvement science. A key aim is to teach this content at a level appropriate for the audience and even more importantly enable people to turn around and apply the concepts to their own work. If I’m not careful, I can be guilty of throwing a lot of tools (PDSA, Pareto Chart, Run Chart) and concepts (aims, measurement, process) at people, but miss a step in helping them connect it all together in a way that enables improvement.

One of the exciting projects in my current portfolio is supporting the Early Years Collaborative in Scotland. At a recent learning session in Glasgow, I attempted to string together several basic tools using an example to help the audience appreciate how to apply these tools to their improvement work. These tools were based of the “basic 7”: cause & effect diagrams, check sheets, Pareto charts, time series charts, histograms, scatter plots, and stratification. Here’s a summary of the session. I’ll post the video when it becomes available.

If you’ve been in one of my sessions or follow me on social media, you’ve likely been exposed to this great video of two Kindergartners in Pinellas County, Florida, USA discussing their use of improvement methods to enhance their classroom experience. I’ll use Scott & Michael’s project to discuss some of the basic tools. First, here’s their video:

So, let’s imagine Scott & Michael began their work by trying to answer the question: What are we trying to accomplish? What’s our aim? Here’s what they might have come up with if they tried to write down specifically what they were trying to improve, by how much, and by when.

Aim: Improve classroom management by 31 October by:

• 95% of children will remove backpack when entering the room
• 95% of children will sign in
• Time from door opened to children sitting on the rug and focused on the calendar will be 5 minutes or less 95% of the time
• Reduce clean up time to an average of 5 min or less.

To kick off their learning, Scott and Michael use a tool I call one of my secret weapons of improvement: the process map or flowchart. Below they visually display their classroom procedure.

As Scott & Michael describe the process, they highlight several steps that have to happen:

• Remove backpack
• Sign in
• Sit on the rug and focus on the calendar
• Cleaning up

To learn about the opportunities for improvement, they could use a check sheet to identify what parts of the process has the most opportunity for improvement.

This simple data collection tool can then be summarized and converted into a type of bar chart known as a Pareto Chart showing the activities in order from the most in need of improvement to least.

In the video, Scott walks us through a hand drawn Shewhart Statistical Process Control Chart (SPC) showing the time to complete classroom clean up and the difference between “good out-of-control” and “bad out-of-control”.

I’ve recreated Scott’s Shewhart SPC chart using MS Excel. In my version, I created a run chart which shows the data overtime and includes a median. For most improvers, a run chart is more than enough to get you started and can be a very powerful tool (secret weapon #2).

Ta-da! Using a few basic improvement tools, Scott and Michael are able to understand the process, identify opportunities for improvement to make a big difference, and use measurement to understand variation and see the results of their improvement efforts. If the boys were to brainstorm improvement ideas with their classmates, they might develop a driver diagram similar to the following as a visual display of their theory of change.

Finally, Scott, Michael, and his classmates could use the Plan, Do, Study, Act cycle to rapidly test small process changes to learn what works and what doesn’t to improve the process while they continue to review their run chart to see the results of their improvement efforts.

The approach just described is one pathway, using a simple example to profile a sequence of process improvement. I hope it was helpful in appreciating how you might tackle approaching your improvement efforts. I didn’t include examples of all of the basic tools commonly used including histograms, cause and effect diagrams, and scatter plots. This was mainly due to my use of Scott & Michael’s example than the value of the tools themselves. As you think about your own improvement work, how could you use these basic tools to enable your learning and support your improvement effort?

David M. Williams, Ph.D. is an improvement advisor and founder of DMWAustin Improvement. He is an improvement advisor and faculty at the Institute for Healthcare Improvement. Learn more at www.DMWAustin .com