Continuous Improvement

The basic tenets of the Continuous Improvement process involve understanding a problem, defining a manageable goal/aim, identifying the drivers that could help reach that goal/aim, and then testing small ideas to change those drivers.
When done in a network, this cycle of improvement is expedited as various participants test different change ideas and share their findings with the team. Through the constant interplay of these elements, a few change ideas will rise to the top and can be scaled across a system.

How we wtarted

Why we use Continuous Improvement at FGCU

Understanding the problem requires evaluating many types of knowledge. It involves bringing the best research literature to bear on the problem, and sometimes, representing the process involved in the problem can illuminate some areas that are breaking down. This stage is crucial and should not be rushed. It is seen that projects require up to a year of study to fully understand the problem, its root causes, and the levers of change available to leaders.

1. Why are we doing this project?
2. What is the problem we are addressing?
3. Who is affected?
4. When is it a problem?
5. Why does it matter?
6. How does it affect the students/university?

Ex) The current situation is ______________, leading to _______________ (undesirable event).

The fishbone diagram is a key part of the Continuous Improvement methodology. It allows for brain storming, facilitates cause and effect analysis, and defines and simplifies the problem or situation. This concept focuses the content of the problem rather than its history or the differing interests of team members. 

The simple format of the diagram allows us to focuse on the root-cause of the problem while gaining an idea of the collective knowledge and consensus of the team that is tackling the issue. Greatly resembling actual fish bones, the diagram consists of an effect or "problem in process" on the right, with a collection of causes or conditions on the left of the diagram. These causes are divided and categorized into specific themes to form the individual bones of the diagram.

Diagram Source: Gazi Sanaul Hasan via Supply Chain Leader

Please select sample below to view larger sample:

How has FGCU used this concept?

At FGCU, the Continuous Improvement Initiative Team is incorporating the fishbone diagram as an everyday tool for the tackling of both small and large issues. One issue the team has addressed during its workshops is obtaining the Hispanic Serving Institution (HSI) designation for the university. For this example, our problem in process was the designation, with the bones of the diagram divided into the different categories our team thought affected our missing HSI designation. 

This is our example!

CI Team diagram - View/Print Larger Version

Creating an aim statement allows the team to come to a consensus about what needs to be done to improve, what resources are necessary to accomplish the aim, and measure whether or not improvement has occured.

A strong aim statement will answer the following questions:

1. What outcome or process needs to be improved?
2. For whom will it improve?
3. How much will it improve?
4. When will it improve?
5. What tool, method, resource or system will we use to make the change?

Aim statements should be SMART: specific, measurable, achievable, realistic/relevant, and timely. It should be as specific as possible and measurable. Below is an example of how an aim statement can be constructed.

A driver diagram is a visual display that includes several "drivers" or contributors to the problem being addressed. These drivers are what the team believes provides the most leverage to meet the goal and are within the span of control. This diagram shows the relationship between the overall goal of the project, primary/key drivers that directly contribute to the aim, secondary drivers that connect to primary drivers, and specific change ideas to test for each secondary driver.

Source: Lothian Quality, NHS

Select sample driver diagram for larger view

Ideas for change often come from those working in the system, from other similar improvement efforts, or from change concepts and theory.

• What are some opportunities for change and improvement?                                                                                                                    
• What changes are you considering?
• What specific change concepts will achieve the aim? 

1. Plan
   • What is the objective of this particular test of change?
   • What do you think will happen and why?
   • How, when, where, and by whom will the change be tested?
   • What data did you collect?
2. Do
   • What happened as you conducted the test?
   • What did you observe?
   • What problems or unexpected observations were encountered?
3. Study
   • What data did you collect?
   • What does the data show?
   • How does it compare to your predictions?
   • Is the quality of the data adequate?
4. Act
   • If the test did not show ideal improvement, what modifications should be made to your change?
   • What would be the plan for the next test?
   • If the test showed desired improvement, what are the next steps for implementing or spreading the change?

 Source: Institute for Healthcare Improvement (IHI)