Diagnosis phase

(analyse)
Diagnosis phase (analysis) tools

Data analysis
• Charting
• Brainstorming
• Cause and effect (Fishbone) Diagrams
• 5 whys
• Interrelationship diagrams
Decision Making Analysis
• Force Field Analysis (FFA)
• Impact map
Charting

• Charting is the process of making the most sense of the data

• Its about turning ‘data’ into useful information
 Charting

Chart type Description

Pareto chart uses a bar format and represents the Pareto principle which states that 20% of the sources cause 80% of the
problems
Paynter chart is a visual representation over time relative to the sub-group based on Pareto Chart information. It a further
analysis of the bars of the Pareto Chart
Pie chart is a circular chart divided into sectors, with each sector showing the relative size of each value
Scatter plots are used to study the possible relationship between one variable and another. It reveals relationships or association
between two variables
Run chart is a method to display several data points over time. It is used to monitor the behavior of a variable over time for a
process or system
Radar chart also know as Spider Chart or Star Chart. It plots the values of each category along a separate axis that starts in the
center of the chart and ends on the outer ring
Histogram utilize data and display the spread and shape of the distribution. They are simple bar chart that represent the range,
amount and pattern of variation for data
 • List issues in descending order of importance

When to use • Generally, tallest bars indicate biggest contribution to

the problem
Pareto Chart • Good for displaying before and after improvement
initiatives
Example
 • Used to track defects over time relative to corrective
action

When to use • Similar to Run Chart

• Paynter Chart goes beyond the Pareto by sub-
Paynter Chart grouping the Pareto bars which could be days, hours,
etc
Example
 • Display relative size of each category to each other
• Good for comparing multiple sets of data
When to use • Illustrate a difference in size of the data sets
Pie Chart • Allow for quick interpretation of data
 • Allow for trends to be easily viewed
• Reveal relationship between variables
• Answer the question, are variables related?
When to use • Help to identify the ‘outliers’ which may need further
investigation
Scatter Plot • Provide data for a linear regression if there is a high
degree of positive or negative association
• Provide data for a non-linear regression if there is a
small degree of positive or negative correction
Scatter plot taken from: https://www.khanacademy.org/math/ap-statistics/bivariate-data-
ap/scatterplots-correlation/a/constructing-and-interpreting-a-scatterplot
 • Allow for a visual representation of the before and
after measurements in one view
When to use • Allow for multiple data sets to be compared to one
Radar Chart another if colors or some other indicators are used
• Provide a visual to get a ‘feel’ for data
Taken from: https://www.data-to-viz.com/caveat/spider.html
Why use Run Chart

• Allow improvements to be verified as effective

• Help to determine most effective long-term solutions
• Measure effectiveness of improvements
• Display improvements over time
Taken from: https://qi.elft.nhs.uk/resource/run-charts/
Why use Histogram

• Display data showing peaks and valleys, clusters, and outliners

• Allow visual representation of data sets
• Organize data into ‘bins’ for additional analysis
• Typically, no fewer than 5 and no more than 20 class intervals or
bins should be created
Taken from: https://www.spss-tutorials.com/histogram-what-is-it/
Brainstorming

• Brainstorming is used to generate a high volume of ideas with team members’ full participation that is free of
criticism and judgment within 5-15 minute time period.
• Methods of brainstorming :
• Structured method
• Unstructured method
• any type of brainstorming session starts with a clear question and ends with a raw list of ideas.
• Once brainstorming is done, additional lean sigma tools and exercises will help to determine which of the ideas
have the greatest impact on the identified problem
• Structured and unstructured brainstorming is used throughout and and all lean sigma projects.
• There are several available applications that can help conducting brainstorming online, add and share files; such
as TheBrain Tech and iBrainstorming
 It’s a tool to examine
Fishbone the reasons that might
have caused a certain
issue.
diagram
(Ishikawa It also can show
) relationships between
the factors.
Fishbone diagram steps

1 2
Brainstorm all
3
Add the cause to
4
Divide them into
Identify the the possible the appropriate major categories
problem causes “WHY” category
Make it as a List all possible Write major
statement : short causes Sort all the listed categories
and specific causes under the which causes
major groups the problem
Example
Examlple
 Interrelationship Diagrams

• Interrelationship diagram is an analysis tool that allows a team to

understand and identify the cause-and-effect-relationships among
critical issues
• Interrelationship diagrams are used to understand and illustrate the
inputs, outputs, and relationships of key processes or data
 How to conduct Interrelationship Diagram

1. Develop the problem or improvement statement

2. Develop issues around the problem or improvement statement
3. Arrange the issues in a circular format
4. Identify cause-and-effect relationships starting at any issue
5. Draw arrows to indicate directions of influence
6. Total the number of arrows going in and out for each issue
7. Identify possible root cause(s) and process drivers from the problem or improvement
statement noting the greater number of incoming arrows
8. Use the information for proposed improvement activities
 Example
Main factors influencing patients’ experience in a dental clinic

Scheduling
In: 2 out: 1
Capacity Staff training
In: 1 out:1 In: 0 out: 3

Ability to
EMR system ensure a good
utilization patient visit
In:1 out:1 Staff experience
knowledge In: 4 out:0
In:1 out: 3
 Example

Main factors to improve patients’ experience in a dental clinic

Scheduling
In: 2 out: 1
Capacity Staff training
In: 1 out:1 In: 0 out: 3

Ability to
EMR system ensure a good
utilization patient visit
In:1 out:1 Staff experience
knowledge In: 4 out:0
In:1 out: 3
5 WHYS
• Started by Sakichi Toyoda “Toyota Family “
• The purpose of this tool is to reach to the root of the problem
• 5whys allows organized brainstorming to methodically
determine the causes of a problem (evidence-based analysis).
• It is considered as one of the Institute for Healthcare
Improvement (IHI)’s Patient Safety Essentials Toolkit
5 WHYS
The
problem
Why why
why

why

why
why
Root Cause
To have a successful 5 WHYS

1. Identify the problem that needs to be solved.

2. Establish a team meeting
3. Write everything down
4. Ask the first why and include the team
5. Repeat the whys until you find the root cause
6. Develop an action plan to solve the issue
7. Make it as small tasks and then assign a task to each team member.
5WHYs tamplate
5WHYs example
Decision making analysis-FFA

• Force field analysis (FFA) is an extremely useful tool for

understanding and illustrating the forces for and against an idea,
direction, decision, or strategy.
• The logic behind this technique is that when change occurs there are
always two sides to change:
• Proactive: driving change
• Resistant: preventing change
How to conduct FFA?

1. Summaries the change and document it in a central location (some place where
comments can be listed for both sides)
2. Use brainstorming and list forces driving the change
3. Use brainstorming and list forces resisting the change
4. Estimate on a scale 1-10 the estimated strength relative to the change
5. Sum the strengths ratings
6. Use the information to better understand resistance to change in the upcoming
improvement activities
What are the benefits of FFA?

• Allow everyone to participate

• Promote creative through on proposed changed
• Assist to built consensus and fain process change buy-in
• Anticipate resistance systematically
Example

• The team created the following force field analysis for the EMR system upgrade:

Forces for the change Forces against the change

Patient information more quickly accessed Already too busy
Ability to gather more data Current system work fine
Reduction in paperwork for staff and patients Uncertainty
Mandated by system and government Disruption of the workflow and protocol
Proven successful System bugs and failures
Assessable anytime Training takes time and effort
Improve patient safety
Decision making analysis-Impact map

• Impact map allows teams to identify solutions most likely to have the greatest
impact on the problem with the least effort
• How to create an impact map:
1. List the proposed improvement activities or containment actions that are in
place
2. Create a graph with the vertical-axis denoting Impact and the horizontal-axis
denoting Ease
3. Divide the graph into four quadrants
Decision making analysis-Impact map

4. Brainstorm with the team and assign each item listed in step 1 to
an area on the map
5. Determine which items have the greatest impact with the least
amount of effort. Consider these as improvement activities
6. Communicate to management those items that are very difficult
and may have a high impact, but may be beyond the scope of this
improvement project
Example- Impact map

• To improve access, speed of diagnosis, speed of starting appropriate

treatment and patient and carer experience for those with proven
breast cancer.
Example- Impact map

No. Opportunity log items EASE IMPACT

1 Increase the number of oncologists at the hospital
2 Initiate an electronic booking system
3 Reduce time for PHC referral
4 Simplify and standardize registration procedures for new admitted patients
5 Simplify discharge process
6 Initiate EMR system
7 Nurses training
Example - Impact map

No. Opportunity log items EASE IMPACT

1 Increase the number of oncologists at the hospital 8 9
2 Initiate an electronic booking system 6 9
3 Reduce time for PHC referral 4 8
4 Simplify and standardize registration procedures for new admitted patients 3 9
5 Simplify discharge process 4 8
6 Initiate EMR system 8 3
7 Nurses training 2 3
 Example - Impact map

IMPACT

EASE
Thank you