Performance Improvement Model

(DMAIC)
DMAIC
Performance
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Control Define Improvement Model
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Improve M easure
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Analyze Define Step

Lynn Vining
Quality Management Coordinator
Clinical Outcomes and Resource Management
October 6, 2005
 Define Step Objectives

Write a problem statement

Write a team charter
 Purpose
 Importance
 Scope
 Deliverables
 Measures
 Resources

Identify area and level of impact
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Understand Voice of Customer (VOC)

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 Purpose of Define Step

Define the project's purpose

and scope

Obtain background on the
process and customer

Simply stated:
“What needs to be addressed and
what the customer expects”
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 Suggested Tools for Define Step

 Brainstorming
 Project Selection Criteria
 Team Charter
 Team Communication Plan
 SIPOC - High Level Flowchart
 VOC (Voice of the Customer)
 CTQ (Critical to Quality) Tree
 Affinity Diagram
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 Brainstorming Tool

Purpose

Generate high volume of ideas on a topic
 Free of criticism
 Allows open thinking
 Involves all members
 Generally used in analysis; included here as a tool
to identify list of possible projects

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 Brainstorming Tool

Steps

Write down brainstorming question that team has
agreed on so everyone can see

Structured – everyone takes a turn

Unstructured- ideas shared spontaneously

Can be done silently or out load

Discard agreed upon identical ideas
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Can complete in 5-20 minutes

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 Project Selection Criteria Tool

Purpose

To determine resources available as you begin
a project

Identify if the project selected is conducive to
DMAIC methodology

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 Project Selection Criteria Tool

Steps
 Write a definable problem you are interested
in improving
 Evaluate problem statement against criteria
 Rate criteria:

Relate to key business issue

Link to clearly defined process (start and end points)

Can identify customers

Clearly identify what a defect is and count occurrence

Demonstrate enhanced financial performance
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Organizational support

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Common Pitfalls to Avoid in Project Selection

Not relevant to customers/strategic plan

Scope too large

Lack authority to change process

No-identifiable start and end points

Lack definition of defect

Difficulty in data collection

Process may be changed soon
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 Problem Statement Examples
The Good, Bad, and the Ugly

Documentation of Pneumoccocal immunization

assessment for CY 2004 is < 95% target
benchmark resulting in potential missed
opportunity for immunization administration

Patient received the wrong dietary tray 2% of
the time

A sentinel event occurred causing a patient
death
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 Charter Tool

Charter

Clarifies what is expected of team

Keeps team focused

Keeps team aligned with organizational priorities

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 Charter Elements

Importance

Describes business case for the project
 Importance to customers
 Importance to business
 Importance to employees
 Reason it should be worked on now

Estimates potential impact (rough figures ok)
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 Charter Elements

Scope

Identify team work’s boundaries
 Start and end points (focus area)
 Decision making authority (areas within group’s control)
 Budgetary limits

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 Charter Elements

Deliverables

Process changes

Training

Documentation

Other processes/procedures to maintain gains

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 CHARTER

Measures (Indicators)

Establishes performance baseline

Tracks performance

Identifies target and specs for each measure
 How will they be measured and tracked?
 How difficult is it to track the measures?
 What is the target for improvement?
 What are the target dates?
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 What defects will you track?

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 Charter

Resources

Team
 Sponsor – who the team is
accountable to
 Multi-disciplinary team
 Facilitator/coach
 Process owner
 Team leader

Budget 17

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 Team Communication Plan Tool

Purpose

Identifies stakeholders (people affected by the
project)
 Understand importance of work
 Create buy-in
 Can help avoid pitfalls

Identifies communication flow with stakeholders

Identifies people who can influence project but
not directly involved with the project work
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 Team Communication Plan Tool
Role Who Main Concerns Communication Notes
(Names of people (When and how you
or groups) will communicate
with them)
Team Leader
(if someone other than
yourself)

Team Member(s)

Sponsor(s)

Facilitator

Customers

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Process Owner

Other Stakeholders

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 SIPOC- High Level Flowchart Tool

Purpose: Develop high-level understanding of the process

S
C
U U
P S
P T
Inputs Processes Outputs O
L
I M
E
E
R
R 20
S
S

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 SIPOC Tool

Benefits

Defines boundaries (see charter)

Describes where to collect data

Identifies suppliers & customers (stakeholders)

Identifies inputs and outputs

Helps support and develop process thinking

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 SIPOC Tool

SIPOC Steps

Complete main process steps (high level)
 State process purpose- why does it exist?
 Identify start and end points of process

Identify outputs
 Products, information, services

Identify customers

Identify key process inputs
 What flows into the process: a form, raw materials?
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 What triggers the process to start?

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 SIPOC Example- Making a Photocopy
Suppliers Inputs Process Outputs Customers

Put original on glass

Paper; copier
Office supply company Close lid Copies You
setup

Yourself Original Adjust settings File

Press Start Others

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Remove originals and

copies

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 VOC (Voice of Customer) Tool

Purpose

Identifies key drivers of customer satisfaction

Describes customer’s needs and their perceptions of
your product/services

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 VOC (Voice of Customer) Tool

Benefits

Provides proper focus for project

Identify critical features and services

Provides data to develop appropriate
measurements

Provides baseline measure

Identify key driver of customer satisfaction

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 VOC (Voice of Customer) Tool

Customer

Anyone who uses or benefits from the output of your
process

External people or groups who purchase and /or use
a company’s product or services

Rarely a single customer

DMAIC focus: quality as defined by the customer
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 VOC (Voice of Customer) Tool

Voice of Customer

Who are you customers?

How are they segmented?

What do you want to know about your customers?

What is important to your customers

Why is it important?

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 VOC Data Sources
Data Sources
Reactive Proactive
Customer initiated; easier to Team initiated
obtain)
Complaints Interviews

Service call logs Surveys

Web page activity Focus groups

Warranty claims Benchmarking

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Sales reports Direct observation

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 Critical to Quality (CTQ) Tool

Purpose

Translates the voice of the customer’s (VOC)
language into measurable specification
General Specific
Hard to measure Easy to measure
Need Drivers CTQ

Registered within 2 minutes

Good customer service short wait times
of arrival
In room within 15 minutes
Seen by MD within 30
minutes of scheduled
time
Friendly receptionist Greets person by name
Explains delays > 15 minutes
 Critical to Quality (CTQ) Tool

Helpful hints to creating CTQ

List each need from customer's point of view
 Good customer service

Ask “What would that mean?” about each need

 Friendly service
 No delays

These become the drivers

Keep asking “What would that mean?” until CTQ if
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identified that is measurable

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 Critical to Quality Example

Critical to Quality (CTQ)

Patient expectation for renewal turn-around-time
 53% of IM patients and 75% of FM patients expect to
receive their renewals within one business day or less
from the time of request

Based on above survey data, project CTQ measure

 Improve renewal turn-around time from current three
business days to one business day.

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 Affinity Diagram Tool

Purpose

To generate, organize, and
summarize ideas/issues into
logical categories in order to
understand problem and/or
solutions

Encourage team member’s
creativity

Overcome team paralysis
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 Affinity Diagram Example

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 Creating an Affinity Diagram

Phrase issue under discussion

 What are issues in vaccinating patients

Each member records ideas on Post-it® notes

 Use bold print with noun & verb
 10-40 typically generated; dependent on team size

Group silently sorts ideas into related groups

 Members can move ideas from one group to another
 Can have loners

Create headers for grouping

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Create concise statement of grouping’s central idea

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 Define Step Summary

Defined the project's purpose and scope

in Charter

Obtained background on the process and
customer
Performance Improvement Model
(DMAIC)

5 1
Control Define

4 2
35 Improve M easure
3
Analyze

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 Additional Information & References

http://www.3m.com/us/healthcare/his/products/coding/refined_drg.jhtml

http://www.qualityindicators.ahrq.gov/specific_faq.htm

http://www.3m.com/us/healthcare/his/press/archive/20041006.jhtml

http://multimedia.mmm.com/mws/mediawebserver.dyn?ttttttb9lEHtNXut2X
uttUwYYdpTTTT6-

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