one of the goals of quality improvement is to reduce variability in processes

dr. Deming once used a funnel to depict what could happen when one reacts to variation
within a stable system in fact let's head over to dr. Bachman who can tell us a little bit more
about dr. Demings funnel experiment thanks Ramone well today what we're going to do is
demonstrate Demmings funnel experiment all processes vary when we look at the process
and it and how it varies what we want to do is we want to interfere with it Deming use this as
an example of how when we interfere with processes things get worse it's very simple we
have a little X down here you take a little marble you put it in to the funnel you aim at the X
and you do that oh say a hundred times and what will happen is that over that time you'll get
a pattern and that pattern will look something like this you'll have all your dots within the
circle and it will vary all over the place all processes vary you can imagine like shooting a
gun if you take a gun and even lock it down and shoot it at a target it'll have that same type of
pattern all right well when people look at that variation they want to change things and
Deming then went on to show that but before we do that we should talk a little bit about what
things could actually change a process would it be really cool if you came into a group and
they were talking about changing things and you could make yourself look really really smart
in front of that group well you can do so all you have to do is take a look at whatever process
you have and then go to a board and you draw a line across and you do what's called a
fishbone diagram and then all processes can be separated into various components so we're
going to give you some picture images that you can imagine in your mind and that'll remind
you what to do when you're looking at a process and how it varies the first thing is imagine
yourself okay and you're walking down the road okay so things that alter processes people
with this experiment I'm doing it one way perhaps another person would do it a little bit
different people so imagine the person going down the road and in front of him is a wheel
barrel that wheelbarrow is a machine so again looking at this the process could be very by
using different sized funnels and things of that sort the third thing is that you see yourself
pushing this wheelbarrow and you're coming up to a big building and there's two doors and
one person is pointing to one side and another person is pointing to the other side so you're
being pushed in one side methods again we might have a so that I'm put the marble way up
here way down here there are various methods to how processes do so your person going
down the wheel barrel you see some other people they're moving you to the left or the right
you go inside a building and there's this big huge funnel pouring cement and it comes into
your wheel barrel materials if you use marbles that are different weight different sizes again
the materials would alter the process and then of course the cement goes up into your
wheelbarrow to a certain level and then you would measure that so measurements how you
actually measure things alters the process whether I use little X's or in this case aluminum foil
the method is dependent on how we measure things so if we measure things differently you
can get different outcomes in your process finally you take that wheelbarrow with all that
cement that you've measured in there and you go outside and as soon as you gooutside you're
hit by a huge huge wave of heat from the Sun environment too hot too cold too humid in this
case the environment B might be changed by the differences in temperature if there's a big
wind coming it could blow things off it both a funnel around so that we have things so those
are the six basic ways of measuring things now there's two others that sometimes get put into
this one and they're very easy to remember one is money and then the final is maintenance
after time what happens is this may wear down now if you can write those things down you
can then break down the process into things that are causing variation and you can find those
things that would be most important in how they vary it so people machine methods materials
measure environment and two others two M's money and maintenance as each time the
marble goes down and hits there's going to be variation in where it hits and we just can't help
ourselves but wanting to interfere with this there's several ways of doing it the first way we're
going to do is is what's called a type 2 error what we're going to do is we'll drop the ball and
then we'll put a little spot there where it was off now we know it's often what we're going
going to do is respond to the last fall well this is the first fall so we name the target once
again and this time now we have two places where the ball dropped what we do is take the
distance that was from here to here and just shoot move the target over so that we will be able
to compensate we'll kind of aim a little bit over to the side and that use that last point as our
marker and sure enough we get a little spot here well then we take this point in this point and
go over here so let me mark over here and sit there and see what you're doing is using the last
ball and are the last marble that's hitting the surface and then using that as your reference
point and what that happens after about hundred Falls well if you take a look at the board
what you'll see is that when we were just dropping it by itself we had a tight circle by just
using the last point as our reference point that circle expands it's about 50 percent bigger than
it was before all we were doing though was changing our behavior based on the last point
well what are some examples of that the most classic example is some people take out a
cannon and they shoot the cannon at a target at the beginning of the day and they find it's 10
feet off site off the side of the target they just move the cannon then so it chews ten feet to the
other side and they think they're doing a good job in fact what they've done is made their
errors worse well how does that involve patient care well a type of to air would be you get a
complaint from somebody and because of that you might alter things a bit you might have
just gotten a survey and again you just alter it based on that survey you just adjust things in
your schedule because of the previous person this is a very common type of air a type two
error reacting to the last point of information all right once again we're going to demonstrate
another error the first error that we did was tweaking or we use just the last piece of
information a type 3 area is where we use the target as our reference point we drop the ball
and in this case we get a little spot and then we use the target as our reference and we would
move the same distance from the where the ball hit and the target in the opposite direction so
we'd move it out somewhere over here so let's see what happens with that so we would hit
that and what's there it goes alright so after a while if you go to the board here we had a nice
tight band if we just adjust to the target what happens is it tends to go off in directions into
quadrants something like this or it might go in something in a different direction in another
quadrant but it gets farther and farther away from the target well what are some examples of
this this is usually related to supply and demand I make an impact on one side but then the
demand on the other side is different a classic example that's used is drug trade I put in
tougher restraints so people cannot bring drugs across the border what happens the price of
drugs goes up so people will try harder to get it across examples in our practice would be
appointments what happens with that is oh my gosh we have a certain amount of patients we
need to see so we adjust things back and forth and back and forth and soon what happens is
over a period of time you end up being farther and farther away from your target the stock
market is notorious for doing this type of thing farmers do this they plant a lot of crops the
price of the their crops goes down the next season they price a little what happens then is
there's a huge increase in the price so we have tweaking where you use the last piece of
information and then the second is when you use the target the next method is also used and
is very common but it has the worst results of all now instead of adjusting things to the target
or from the last position what we do is instead of aiming at where we had as our goal we
shoot at what we had is our last target and we keep moving the funnel to hit our last target
and as you can see we get farther and farther away from the target so this is the worst thing
possible what we're ending up doing is shooting at the last target and what happens is we just
keep traveling until finally we reach the Milky Way and it's off we go we do this a lot some
examples of this train-the-trainer you train somebody that person trained is trained they don't
get it all they train someone else they train someone else and soon it's off to the Milky Way
passing down information think about how you do management I tell someone they tell
someone they tell someone and then we wonder why they mark the message gets
garb into garbage back in the old days when you used when you're kids using the telephone
game where you would whisper something into somebody's ears at the end of the end of the
game it nobody knew what was going on a classic is meeting times you say well we'll start at
8:00 and nobody's there at 8:00 so then you start at 8:05 and it could be 8:10 827 finally you
don't even have to have a meeting because people will be so late this is called shooting for the
Milky Way so we have three things tweaking where we use the last piece of information the
second thing when we adjust to the target or to the goal and finally the worst thing where we
just keep following things from the last moment on until you get to the Milky Way so let's
take a look at what I think is even more important lesson from this you have a target whatever
intervention you do it stays close to the target initially no matter what thing is going on
wrong but over time is that you do it more and more what happens is that you start seeing
bigger and bigger errors now think about changes within your system they always
start out really really good but then as time goes on more and more variation occurs and we
now know why remember we listed the six types of variation other things start coming in
here to interfere with this so when you start something you'll start good but then over time
other things will break it down unless you have another method of dealing with variation all
these things are called tampering well-meaning people are trying to add value to the system
they do not all they do is add complexity and the system suffers tampering and so we can
thank Demi for its funnel experiment in showing us some of the things that we need to know
so that we will make our system even better and so the funnel experiment shows us a number
of things despite our good intentions to fix a stable system manipulations only made the
outcomes worse over time all systems have a certain level of inherent variability and
attempting to adjust a stable process will only make things worse and so a lot of times when
we do what makes sense variation only increases so reflect upon your own system explain
why picking the low-hanging fruit may be a problem think of projects where you have been
given the opportunity to make improvements do you focus on the outcomes or on the
processes leading to the outcomes how does your job relate to the manager who tries to fix
the funnels output and lastly dr. Bachman talks about how early ideas start out is inexpensive
but how costs tend to increase if you change your mind later think of projects you have
started how often have you watched and measured a system before an intervention how long
might be reasonable