Module 2 _ Science of Improvement_basic
Module 2 _ Science of Improvement_basic
QI Training 1
Enabling Objectives
• Explain the Science of Improvement
Discuss the change and improvement
Describe the two types of knowledge to develop
effective change
Explain the four components of Deming’s System of
Profound Knowledge and their uses to understand
the current problems
Explain the interplay between the four components
of profound knowledge
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Outline
• Introduction
• Change and improvement in healthcare
• Deming’s “System of Profound Knowledge”
• Four components of profound knowledge
• Interaction of the four components
• Summary
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“Science” of “Improvement”
Science:
“knowledge attained through
study or practice”
Improvement:
“increase in value or in
excellence of quality or
condition”
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Science of Improvement
• Science of improvement is a problem-solving
approach centered on continuous inquiry and
learning.
• It promotes the organization,
To explore new ways of working in small
incremental improvement steps
In more innovative ways and
how improvements are achieved and sustained
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Why Improvement?
• To Transforming Healthcare (Improve patient outcomes & experience, Lower
costs, workforce satisfaction)
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Two Types of Change
• Reactive Change (1st order Change)
Response to sudden problem in the system
Returns the system to prior condition
Impact only a few parts of the system
Short term impact
• Fundamental Change (2nd order Change)
Create a new system of performance
Redesign processes
Impacts various part of the system
Long term impact
Designed byThe Improvement
Alemu Guide, 2nd Edition – p111-116
Kejela Feb 2021 7
Change for Improvement
When choosing changes avoid:
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Types of Knowledge to Develop
Effective Changes
Types of Knowledge
Subject Matter
Knowledge Profound Knowledge
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Knowledge for Improvement
• The ability to make beneficial changes or improvements is enhanced by
combining subject matter knowledge and profound knowledge in creative
ways
Profound Knowledge
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The Improvement Guide, 2nd edition – p75c
Kejela Feb 2021
Knowledge
Deming’s System for Improvement
of Profound Knowledge
• The System of Profound Knowledge
provides a lens. Looking through
this lens allows us to better
understand and optimize our
organizations.
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The Improvement Guide, 2nd2021
Kejela Feb edition – p76
Appreciation of the System
• Interdependent group of items,
peoples, processes working
together towards a common goal.
Process: a sequence of
steps/actions through which
inputs from suppliers are ~~~Edwards Deming~~~
converted into outputs for
customers
System: the sum of all the
part (including processes) that “If you can’t describe what
interact together to produce a you are doing as a process,
common goal you don’t know what you
are doing”
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Appreciation for the System
• Understand the properties of a system .
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Appreciation for the System
• System’s performance is the
results of :
Its design and operation
Not simply a result of individuals’
efforts within the system
• Technical tools to understand
a system
Fishbone
Process map
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“Every System
Complete is of
each Perfectly Designed
the steps in this to Get the Results
process
it Gets”
NO
Step 3: Do
Step 1: Step 2:
Add 12 to the you have
Pick any number Multiply your
number from step 2 a 2-digit
from 3 to 9 number by 9
number?
YES
Step 6:
Step 7:
Step 4: Step 5: Convert your
Write the name of a
Add your 2 Divide # from step 4 Number to a letter:
the fastest mammal
digits together by 4 to get a 1 1=A 2=B 3=C
in the world that
digit number 4=D 5=E 6=F
begins with your letter
7=G 8=H 9 = I
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A “brown-dotted” Cheetah in Kenya
“Every
system is
perfectly
designed
to get
the
results it
gets”
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Large Group Exercise
Appreciation of the System
In group of 3-5 members
Considering ER length of stay >24hrs at your facility
List units involved in this system.
List functions of each units
Does each unit know what to do
Understand interactions of interdependent units,
How can you communicate and coordinate better in the future
Time: 15 minutes
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Understanding Variation
• Variation exist with the
performance data
• Variation is the voice of the
process
Learn to Listen, understand it
through data overtime and use
data for improvement
• Example
How does the number of daily outpatient
visits vary over the days of the week?
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Understanding Variation - Exercise
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Understanding Variation
• Variation is unavoidable
• Common and special
cause variation
Common cause: inherent in
the process or system
Special cause: not inherent
in the process or system
The Improvement Guide, 2nd edition – p79-81
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Common and Special Cause Variation
46
Body Temp._ Individual chart
Measure
44
42
40
38
Temp.
Subgroup
Center
UCL
LCL
36
34
32
30
1
10
11
12
13
14
15
16
17
Time
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Theory of Knowledge
2
1 This prediction needs to
The theory of change be tested to learn how
that you introduce is it is influencing the
predicted to lead to
system you are trying
improvement
to improve.
3 4
The application
of plan, do, study, act Comparing predictions to
results is a key source of
(PDSA) cycles help us learning
better learn, innovate
and improve.
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Theory of knowledge cont’d
• A change is a
prediction
• Testing of change –
Plan-Do-Study-Act
cycles
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PSYCHOLOGY – HUMAN SIDE OF CHANGE
• Reflection
How do you respond to change in your facility?
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Psychology of Change
“A square man cannot
be expected to fit in a
round hole right away.
He must have time to
modify his shape.”
- Mark Twain
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Psychology of Change
• Helps to,
Predict how people will react to change
Understand behaviors that drive people’s
motivation
intrinsic and extrinsic motivation
Source: The Science Behind Resistance to Change: What the Research Says & How it Can Help You, KaiNexus
Presentation by Mark Graban and Mark Jaben
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Psychology: Resistance to Change
• People’s resistance to change comes from
fear.
Fear of failure, of losing control, of moving from
habit to uncertainty
Fear of loss: of attachments, structure, future,
meaning & identity
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N
Resistance to Change-Pyramid
o
t
N w
o il Lack of Motivation to enact the change
N t l Performance Management
o i
n
t a g
Lack of skills to execute the change
b Training
K l
n e Lack of understanding regarding
o
the change
Communication
w Adapted from “The Resistance Pyramid” elaborated from Nieder and Zimmerman by Galpin (The Human Side of Change 1996)
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Interaction of the Four Components
• Example:
You cannot appreciate the
system without considering the
impact on variation
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Small Group Exercise
• Tena Lehulu Hospital has a long elective surgical cases waiting list which has led to
significant complaints. The hospital has two well-equipped operating rooms
functioning twice a week for elective surgeries. The hospital has 4 surgeons who
alternate to operate on elective cases as per their schedule.
• The hospital director regularly communicates the complaints on the prolonged time
patients are waiting to get a scheduled for the elective surgery. The surgeons justify
the high case load the hospital is accommodating and how busy they are in their
day-to-day activities.
• One day the hospital director wants to discuss the problem with the surgical
department and came up with his regular monthly KPI report. The KPI report states
that, the previous month, the delay for elective surgical admissions was 145 days
while major surgeries per surgeon were only 20. He explained to the surgeons that
they did not even operate 1 case a day while the waiting list is so long.
• Finally, he told them his subsequent expectations of at least 3 surgeries a day from
each of the surgeons which ended the agreement.
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Small Group Exercise
• Interconnection b/n each element • What is it telling you about the long elective surgical
backlog?
Theory of knowledge
Knowledge of Human Psychology
• Theory of change that will help you overcome the problem • How ready do you think people in your system are for change?
• Knowledge and prediction • Are some people more ready for change than others? -Motivation
Applying PDSA framework • How do you think people feel about the issue you are going to work on?
•
• Is there anything else external that might be influencing the surgical
team?
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Summary
• To be an effective leader of improvement
Apply the central principles of improvement
Combine subject matter knowledge with profound
knowledge
Understand the four components of profound
knowledge and their interactions
Appreciate differences in people, value teams
Know that we have poor systems and not poor
performing people
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Thank
you!
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