Transcript www.safmls.org

TSgt Brent Whitby
NCOIC, Quality Assurance
375 Medical Group, Scott AFB, IL
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Let’s Draw a Pig
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AFSO21 Implementation
Linking AFSO21 to Organizational Goals
OODA Loop process of AFSO21
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Launched in 2005
Obstacles to deployment
◦ Quality Air Force Conundrum
◦ Senior Leadership buy-in
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AFSO21 vs. QAF
◦ Value stream mapping vs. process mapping
◦ Results
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Assess outlook/future path
◦ Current state map
◦ Future state map
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Evaluate current organizational performance
Review system change/improvement capacity
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Which process needs the most attention
Where can biggest cost savings occur
How can quality be improved (to what
degree?)
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Customers are important
Speed, quality, low cost are linked
Variation/defects minimized
Time trap elimination
Data driven improvements
Teamwork
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Q1 - Immediate
attention
Q2 - Hardest decision
Q3 - Sometimes
beneficial
Q4 - Avoid
High
Benefit
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Low
Low
Effort
High
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Process elements
Stakeholder analysis
Customer data
Quality function deployment
Benchmarking
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Supplier (provide inputs)
Input (services provided)
Process (value added steps)
Output (final product)
Customer (internal/external)
Suppliers
Inputs
Process
Output
Customer
MLTs
Perform Test
Verify Patient
Acceptable
Specimen
to analyze
Patient
Patients
Provide Specimens
Accession Test
Accurate
Results
Physician
Phlebotomist
Collect specimens
Collect Sample
Timely
treatment
Technical Supervisor
Report Results
Process Sample
Physician
Put on Analyzer
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Control resistance (reduce or remove)
◦ Provide alternatives
◦ Remove pitfalls
◦ Ensure buy-in
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Perceived value drives feedback
◦ Positive
◦ Negative
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Use Service Delivery Assessment data
(customers define quality/expectation)
Listen to external/internal customers
◦ WoW Forms
◦ Internal customer surveys
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CQFA
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Cost
Quality
Features
Availability
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Often referred as “Voice of Customer”
House of Quality
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Customer needs
Design features/technical requirements
Customer priorities
Benchmarking (targeted values)
Inter-relationship between design features
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Types
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Process
Performance
Project
Strategic
Sequence
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Determine current practices
ID best practices
Analyze best practices
Model best practices
Repeat
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Originated by Col John Boyd
(USAF)
Also known as Decision
Cycle
Four Overlapping and
Interacting Processes
Observe
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Unfolding Circumstances
and Information
Orient
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Analysis and Synthesis
Decide
Act (and Test)
1. Clarify The Problem
Observe
Plan
2. Break Down The Problem/
Identify Performance Gaps
3. Set Improvement Target
Orient
4. Determine Root Causes
Decide
Do
Check
Act
5. Develop Countermeasures
6. See Countermeasures Through
Act
7. Confirm Results & Process
8.Standardize Successful Processes
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Logical Thinking Process
Objectivity
Focus on Results and Processes
Synthesis, distillation, and visualization
Alignment
Coherence & Consistency
Systems Viewpoint
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Strong emphasis on cause and effect
Focuses organization to maximize
resources by focusing on the “critical few”
Minimizes wasted time by management by
using a robust problem solving process
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Process drives employees to think with
quantitative data as opposed to emotion
and opinions
Fosters a collaborative process as opposed
to a “silo mentality”
Example:
Insurance company is losing business due to
5 day turnaround on quotes.
Possible Solutions:
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Hire more people to reduce time
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Incentivize employees to work harder
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Find the root cause for lengthy turnaround
and implement permanent corrective
action
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Minimizes “Death by PowerPoint”
Forces brevity and clarity
Only most vital points used for proper
understanding
Utilizes graphs, pictures, and sketches to
promote understanding (visualization)
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3D Communication
◦ Up and down the hierarchy
◦ Horizontally across the organization
◦ Back and forth in time
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Heavy emphasis on consensus decision
making
Avoids:
 Tackling problems that are not important
to organizational goals
 Solutions that do not address root cause(s)
 Incomplete implementation plans
 Omission of follow up plans and standard
work
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The impact of the proposed solution must
not adversely impact other parts of the
organization (i.e. transferring a problem
from one department to another)
The good of the whole organization takes
clear precedence over the individual
departments
SA&D
SWOT
Voice of Customer
VSM
Go & See
KPI/Metrics
Performance Gap
Analysis
Bottleneck Analysis
Ideal State
Future State Mapping
B-SMART
Brainstorming
Pareto
Affinity
Fishbone
Control Charts
A3
Action Plans
Timelines
Financial Reporting
Template
6S & Visual Mgt
Standard Work
Cell Design / Variation
Reduction
Error Proofing
Quick Changeover
TPM
RIE
KPIs/Metrics
Performance Mgt
SA&D
Standard Work
Audit
Checkpoints /
Standardization Tbl
Report Out Theme Story
Broad Implementation
CPI Mgt Tool
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Clarify the Problem
◦ Strategic Alignment and
Deployment
◦ Voice of Customer
◦ Value Stream Mapping
◦ Go & See
Break Down the Problem and
Identify Performance Gaps
◦ Key Process Indicators / Metrics
◦ SWOT
◦ Performance Gap Analysis
◦ Bottleneck Analysis
OODA
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Strategic Alignment & Deployment (SA&D)
◦ Ensuring that activities are linked to the key strategies
and directives of the organization
Strengths, Weaknesses, Opportunities & Threats (SWOT)
Analysis
◦ Assessing the organization from a SWOT perspective to
identify areas of need
◦ Needs to be rolled into SA&D at appropriate levels
Voice of Customer (VOC)
◦ Understanding who the customer is and what they
need from the process or problem area
Value Stream Mapping (VSM)
◦ Overview of Process to determine areas of needed
focus
Go & See
◦ Determine issues by actually walking the process or
problem area (Gemba or Genchi Genbutsu)
OODA
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Does this problem, when solved, help meet needs
identified by the organization?
Is it linked to the SA&D of organization?
Does it help satisfy customer needs (VOC)?
Does this problem, when solved, address key issues
identified during SWOT analysis?
Has this problem been identified and directed by a
Value Stream Map at the appropriate level?
What does the “Future State” need?
What resources have been identified to address
this issue?
What opportunities were identified or observed by the
process or problem area “walk”?
Will addressing or improving these issues deliver
results that relate to #1 or #2?
Will addressing or improving this problem deliver
the desired future state from #3?16
OODA
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Gather and Review Key Process Indicators and Metrics
◦ Problem Solving and Process Improvement begin with
Data
◦ Understanding what data is necessary and what the
data means is critical to true “root cause” problem
solving
Performance Gap Analysis
◦ Once data has been gathered, analyzing the gap
between the current state and the desired state directs
efforts
Bottleneck Analysis
◦ Bottlenecks are inhibitors to the flow of the process
◦ Understanding bottlenecks (TOC) is critical to flow
OODA
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Does the problem require more analysis or
does leadership have enough information
to execute a solution?
◦ Is this simply a leadership directive?
If more data is needed, how do we
measure performance now?
◦ What are the Key Performance
Indicators (KPI)?
◦ What is the performance gap?
Does other “non-existent” data need to be
gathered?
What does the data indicate are the
potential root causes?
Does the data review indicate a bottleneck
or constraint?
OODA
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Ideal State Map
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Future State Mapping
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B - SMART Action Plan
◦ Brainstorming “Could-Be” without
constraints
◦ “Vision” of Future for Process
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Balanced
Specific
Measurable
Action Oriented
Results Oriented
Time-based
OODA
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Target characteristics
◦ Must be measurable, concrete,
challenging and achievable
Statement of a Target
◦ Do what: (examples include “decrease
____?”, “increase ____?”, eliminate ____?,
reduce ____?)
◦ By how much: (measured in the same
terms as the standard)
◦ By when: (specific date)
Must be output oriented
◦ Things to be achieved, not things to do
OODA
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Is
Is
Is
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the Improvement Target measurable?
it Concrete?
it Challenging?
the Target “Output Oriented”?
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What is the desired output?
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Should be “things to achieve”
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Should avoid “things to do”
– Will be addressed by Action Plans in “Develop
Countermeasure”
The desired target should:
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Do What?
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By How Much?
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By When?
If it is a Process Problem, what is the future state?
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How will it be realized?
OODA
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Root Cause Characteristics
OODA
◦ The root cause is the most likely source of the
discrepancy or greatest possible improvement
target
◦ The root cause can be dealt with directly and a
countermeasure can be planned to address it
◦ If root cause is addressed, it will address the
performance gap
◦ The root cause must be verified by “go and see”
Determining the Root Cause is easier with Data
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Tools for Step 4
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OODA
5 Whys
Brainstorming
Pareto Analysis
Affinity Diagrams
Fishbone Diagrams (also called Cause & Effect)
Control Charts
Additional Data Gathering Tools
◦ Check Sheets, Chonbo Charts, Scatter Diagrams
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What root cause analysis tools are necessary?
OODA
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Why are these tools necessary?
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What benefit will be gained by using them?
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Who will need to be involved in the root cause analysis?
– 10 heads are better than one
– Remember “cultural” issues related to problem
What is (are) the root cause(s) according to the tools?
How will the root cause be addressed?
Will addressing these address the performance gap?
Can the problem be turned on or off by addressing the root
cause?
Does the root cause make sense if the problem solving 5 Whys
are worked in reverse?
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Working in reverse, say “therefore” between each of the
“whys”
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Decide Stage – Develop Countermeasures
◦ A3 Problem Solving and Reporting Format
 Common Structure and Concise Reporting
◦ Action Plans
 SMART Action Items
◦ Timelines & Project Management
 Managing complex Problem Solving in a project
fashion
◦ FM Tool
 Understanding the impact of the improvements OODA
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Develop potential countermeasures
◦ Tools and philosophies from Lean, TOC, 6 Sigma
and BPR as appropriate
Select the most practical and effective countermeasures
Build consensus with others by involving all
stakeholders appropriately
OODA
◦ Communicate, communicate, communicate
Create clear and detailed action plan
◦ SMART Actions
◦ Reference Facilitation Techniques as appropriate
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Process Improvement Philosophies
◦ Lean, TOC, 6 Sigma, BPR
Lean and Process Improvement Tools
◦ 6-S & Visual Management
◦ Standard Work
◦ Cell Design
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Variation Reduction
Error Proofing
Quick Changeover
Total Productive Maintenance (TPM)
Rapid Improvement Events (RIE)
OODA
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Which philosophy best prescribes tools that
address root cause(s)?
Which tools best address root cause(s)?
Which method for implementation fits the
tool and improvement need?
◦ Rapid Improvement Event?
◦ Improvement Project?
◦ Point Improvement or “Just Do It”?
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OODA
If RIE or Project, create “Charter” and
communicate
What training or education is needed? By
Whom?
How are we performing relative to the Observe
phase (Steps 1 & 2)?
How are we performing relative to Step 3?
How are we performing relative to FM Tool
projections?
If we are not meeting targets, do we need to
return to OODA Step #4?
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Most problem solving “breakdowns” occur relative
to improper root cause identification
OODA
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Checkpoints and Standardization Tables
Report-out Storyboards
Board Implementation
Capture Results in Powersteering
Sharing of Results
◦ Communication of Best Practices
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Restart OODA Loop
OODA
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What is needed to Standardize
Improvements?
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Tech Order changes?
Air Force Instruction changes?
Official Instruction changes?
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Powersteering
Key meetings?
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Restart OODA Loop
How should improvements and lessons
learned be communicated?
Were other opportunities or problems
identified by the Problem Solving Process?
OODA
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Checkpoints and Standardization Tables
Report-out Storyboards
Board Implementation
Capture Results in Powersteering
Sharing of Results
◦ Communication of Best Practices
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Restart OODA Loop
OODA
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What is needed to Standardize
Improvements?
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Tech Order changes?
Air Force Instruction changes?
Official Instruction changes?
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Powersteering
Key meetings?
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Restart OODA Loop
How should improvements and lessons
learned be communicated?
Were other opportunities or problems
identified by the Problem Solving Process?
OODA
Problem Solving Process & Related Toolsets
 SA&D
 SWOT
 Voice of Customer
 Value Stream Mapping
 Go & See
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KPI/Metrics
Performance Gap Analysis
Bottleneck Analysis
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Ideal State
Future State Mapping
B-SMART
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5 Whys
Brainstorming
Pareto
Affinity
Fishbone
Control Charts
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6S & Visual Management
Standard Work
Cell Design
Variation Reduction
Error Proofing
Quick Changeover
TPM
RIE
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KPIs & Metrics
Performance Management
SA&D
Standard Work
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Checkpoints & Standardization Table
Report Out theme Story
Board Implementation
Powersteering
Start OODA
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Effective Problem Solving must follow the
Observe, Orient, Decide and Act process
Following OODA ensures actions will result in
desired results
Following OODA ensures results will meet the
needs of the organization
Meeting the needs of the organization will
lead to a stronger Air Force (Culturally as
well)
A stronger Air Force leads to a Safer Country!