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PROBLEM
IDENTIFICATION
AND
PRIORITIZATION
1
STEP 1: PROBLEM IDENTIFICATION AND PRIORITIZATION
INSTRUCTIONS:
1. USING THE BRAINSTORMING TECHNIQUE, NOMINATE PERCEIVED
PROBLEMS IN THE WORKPLACE.
LIST OF PROBLEMS
2 2
STEP 1: PROBLEM IDENTIFICATION AND PRIORITIZATION
INSTRUCTIONS:
2. TRIM DOWN THE LIST OF PERCEIVED PROBLEMS BY GROUPING
TOGETHER SIMILAR IDEAS. ALL CAUSES MUST BE ELIMINATED BUT
NOTE THE CAUSES FOR STEP#3.
INSTRUCTIONS:
3. CLASSIFY THE CONTROLLABILITY OF THE PROBLEMS.
LIST OF PROBLEMS I C U
NOTE:
Controllable the process is fully owned by the team members themselves; the boundaries of the process are within the
circles responsibility; circle members are the one performing the activities within the process.
Uncontrollable beyond the teams control
Interface - involvement of the other section or unit or department in the process
4 4
STEP 1: PROBLEM IDENTIFICATION AND PRIORITIZATION
INSTRUCTIONS:
4. VERIFY EXISTENCE OF THE PROBLEM.
5 5
SAMPLE
6
STEP 1: PROBLEM IDENTIFICATION AND PRIORITIZATION
INSTRUCTIONS:
5. CLASSIFY PROBLEMS ACCORDING TO ITS SIGNIFICANCE.
LIST OF
Initial data
CONTROLLABLE Significance Action taken
collected
PROBLEMS
1.
2. Conclude whether the
Conclude whether
controllable problem is to Go or No Go
3. significant or simple with the problem
4. concern
5.
6.
NOTE:
Simple concern are 5S related issues; problems with obvious or ready solution; the extent of problem is relatively
small against its target performance.
7
SAMPLE
Lists of Controllable Initial Data Collected Significance Action
Problems Taken
1. Increasing number of From 2004 to 2005, we have
send out exams referred to gathered a total of 44,230 send out
Significant No Go
our affiliated laboratories exams from a total of 128,183 exams
received.
INSTRUCTIONS:
6. PRIORITIZE PROBLEMS THROUGH DATA-BASED CONSENSUS.
USE PRIORITIZATION TOOL.
SIGNIFICANT CRITERIA
TOTAL
PROBLEMS 1 2 3
1.
2. SCORE
Choose criteria that will aid you in selecting a priority
3. problem from among the significant problems.
4.
Put a score per criteria.
5.
6.
7.
8.
9
SAMPLE
CRITERIA
SIGNIFICANT
TOTAL
PROBLEMS Frequency Importance Feasibility
2. Typographical errors of
time in and out printed in 1 5 3 9
their lab result (in-house)
3. Long waiting time of
patients at Laboratory
3 5 5 13
Reception upon claiming
of results
PRIORITY PROBLEM
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
11
SAMPLE
PRIORITY PROBLEM
12
STEP 2
UNDERSTANDING
THE PRESENT SYSTEM
13
STEP 2: UNDERSTANDING THE PRESENT SYSTEM
WORKSHOP INSTRUCTIONS
INSTRUCTIONS:
1. REVIEW THE CURRENT SYSTEM AND STANDARD.
NOTE: 1. FLOWCHART THE CURRENT PROCESS RELATED TO THE PRIORITY PROBLEM NOT THE IDEAL OR SHOULD BE.
AGREE ON THE SCOPE OF THE PROBLEM.
15
SAMPLE
LAB
RECEPTION STAFF VERIFY PATIENTS DATA TAKEN ONCE THE INFORMATION HAS
IN THE LABORATORY BEEN OBTAINED, CHECK THE
REMITTANCE LOGBOOK LABORATORY REMITTANCE
LOGBOOK TO CONFIRM IT.
A 16
SAMPLE
LAB
RETRIEVES PATIENTS RESULTS FROM THE FILE, GET THE
RECEPTION STAFF COPY OF THE PATIENTS
ON FILES
LABORATORY RESULT/S.
PATIENT
END
17
STEP 2: UNDERSTANDING THE PRESENT SYSTEM
WORKSHOP INSTRUCTIONS
NOTE: IDENTIFY THE DATA NEEDED; SPECIFY ASSIGNMENT OF MEMBERS AND SET DEADLINES; AGREE ON THE
METHODS TO USE FOR COLLECTING DATA; SUMMARIZE DATA USING QC TOOLS; INTERPRET AND EXPLAIN
INFORMATION.
NOTE: ELEMENTS OF EFFECTIVE PROBLEM STATEMENT: SHOULD CONTAIN THE FOLLOWING : WHAT, WHERE,
EXTENT, WHEN
Problem Statement
NOTE: ELEMENTS OF EFFECTIVE OBJECTIVE STATEMENT: SHOULD CONTAIN THE FOLLOWING : S- SPECIFIC, M-
MEASURABLE, A- ATTAINABLE, C- CHALLENGING, T- TIME- BOUND (SMACT).
25
STEP 3: INSTRUCTIONS
INSTRUCTIONS:
1. IDENTIFY PROBABLE CAUSES.
PROBLEM
ENVIRONMENT METHOD
NOTE: NOMINATE PROBABLE CAUSES OF THE PROBLEM USING THE FISHBONE DIAGRAM; SUB-CAUSES SHOULD REACH AT
LEAST 5TH WHY LEVEL; RELATIONSHIP BETWEEN CAUSES AND EFFECTS MUST BE CLEARLY UNDERSTOOD.
4 5
No Standard Procedure Results not properly
in Claiming of Result arranged
METHOD ENVIRONMENT
29
STEP 3: ANALYSIS OF THE ROOT CAUSES
INSTRUCTIONS:
3. VALIDATE PROBABLE ROOT CAUSES. IDENTIFY CONTROLLABILITY
OF THE VERIFIED ROOT CAUSES.
NOTE: COLLECT DATA FOR EACH ROOT CAUSES IDENTIFIED AND DRAW CONCLUSION FOR EACH ROOT CAUSE; CLASSIFY
EACH ROOT CAUSE IF IT IS W/N CONTROL, BEYOND CONTROL OR INTERFACE.
VA L I DAT I O N O F P R O B A B L E C AU S E - E X A M P L E
Root Causes Validation Method Findings Controllability Conclusion
(April 24-28, 2006)
1. The only reference on Actual -Based on the data gathered, C TRUE
what and when the exam was Observation our receptionists consumed an CAUSE
done is the remittance average of 8 minutes in
logbook. verifying patients info in the
remittance logbook
2. No patients copy of the Actual -Charge slips (for cash basis) C TRUE
tests done Observation and diagnostic requests are CAUSE
taken from the patients.
3. Verbal Instruction on the Actual -Out of 490 patients who were C TRUE
release of result. Observation instructed verbally there were CAUSE
a total of 120 patients who
claimed their result/s as
instructed.
4. No Standard Process in Actual -Out of 3 laboratory C TRUE
Claiming of result. Observation receptionist, all of them have CAUSE
different process in claiming
laboratory results.
5. Results are not properly Actual -Based on the actual C NOT A
arranged Observation observation, results are filed TRUE
and sorted
Continuous Quality alphabetically
Improvement in the per CAUSE
10/2/2017 31
Hospital
month.
STEP 3: ANALYSIS OF THE ROOT CAUSES
INSTRUCTIONS:
CREATE A PARETO CHART
EX:
STEP 1. ARRANGE FACTORS FROM HIGHEST TO LOWEST.
STEP 2. COMPUTE THE PERCENTAGE OF EACH DATA ITEM
Ex: 20 / 50 x 100 = 40 %
STEP 3. COMPUTE FOR THE CUMULATIVE PERCENTAGE
Ex: 0 + 40% = 40%
40% + 20% = 60%
STEP 4. DRAW THE PARETO DIAGRAM
STEP 5. INTERPRET THE RESULTS AND IDENTIFY THE VITAL FEW
CAUSES (80-20 RULE).
STEP 6: PUT THE TITLE ON THE DIAGRAM.
Percentage Cumulative
CAUSES Frequency
total %
TOTAL
Continuous Quality Improvement in the
Hospital
SAMPLE
Percentage Cumulative
CAUSES Frequency
total %
TOTAL 50 100%
33
SAMPLE
50 100.00%
45 90.00%
40 80.00%
35 70.00%
30 60.00%
25 50.00%
TOTAL
20 40.00% cumulative %
15 30.00%
10 20.00%
5 10.00%
0 0.00%
B. Long queue E. Dirty wares F. Others A. Food served C. Late D. Dirty linens
for food and dining no longer hot replenishment (table cloth)
utensils of continuous
coffee
STEP 3: ANALYSIS OF THE ROOT CAUSES
INSTRUCTIONS:
4. SET FINAL OBJECTIVE STATEMENT.
NOTE: RE-STATE THE OBJECTIVE; CONTROLLABILITY OF THE REAL CAUSES MUST BE CONSIDERED IN THE OBJECTIVE; SET
TARGET PERFORMANCE BASED ON THE TEAMS CAPABILITY; FOLLOW THE SMACT RULE.
37
STEP 4: SELECTION OF BEST ALTERNATIVE SOLUTION
INSTRUCTIONS:
1. GENERATE ALTERNATIVE SOLUTIONS FOR EACH REAL ROOT CAUSE.
EVALUATE AND SELECT BEST ALTERNATIVE SOLUTIONS.
Total
CAUSE TIVE lity TAGES ADVANTAG ABCD
SOLUTION ES
NOTE: BEST ALTERNATIVE SOLUTION MUST SIGNIFICANTLY REDUCE THE ROOT CAUSE IT IS ADDRESSING.
38
SAMPLE
Formula: A + B + C + D
CRITERIA
A Effectiveness of
solution Overall Disposition:
B Probability of 10 points and above= GO
success Below 10 points= NO GO
C Ease of
implementation
D Reasonable cost
LEGEND: RATING 4 () (EXCELLENT)
3 () (SATISFACTORY)
2 () (GOOD)
1 ( ) (POOR)
39
SAMPLE
Selection of Best Alternative Solution
TRUE ALTERNA Controllabili ADVAN DIS- Criteria Decision
Total
CAUSE TIVE ty TAGES ADVANTAG ABCD
SOLUTION ES
Issue - Less - Non-
duplicate paper to conformity
charge slip use to financial
Controlla 2 2 1 4
to patient - Less audit NO GO
9
ble
1. The only effort
reference from
on what staff
and when Formulate a -Check - Additional
the exam claim stub sheet form for
was done is form style printing
the - - Additional
remittance Controlla Presenta work to 3 4 3 3
13
logbook. ble ble staff GO
- All of
the info
needed
included 40
SAMPLE
Selection of Best Alternative Solution
Writes - Less paper - No space to
exams done to use write in the
and its - No O.R.
releasing Contro additional - Needs to 2 2 1 2
NO GO
7
time to llable expenses make 3
official copies
receipt - Additional
work to staff
Formulate a -Check sheet - Additional
claim stub style form for
2. No patients form Contro - Presentable printing 3 3 3
13
4 GO
copy of the tests llable - All of the - Additional
done info needed work to staff
included
Writes - Less paper - Needs to
exams done to use write all the
and its - No patients info
releasing additional and exam
Contro 2 2 1
time in a expenses - Can be 4 NO GO
9
llable
scratch misidentified
paper as a trash
- Additional
work to staff 41
SAMPLE
Selection of Best Alternative Solution
Formulate -Check sheet - Additional
a claim style form for
stub form - printing
Presentable - Additional
- All of the work to staff
info needed
3 4 3 3
13
Controllable included
GO
3. Verbal
Instruction
on the
release of
result.
Post - Less paper - May not be
Releasing to use seen by
time in the patients
Reception 2 2 1 4
Controllable NO GO
9
area
42
SAMPLE
Selection of Best Alternative Solution
13
results Controllable
GO
4. No
Standard
Process in
Claiming
of result.
- Adopt - Acquire - May not be
claiming process thru appropriate
process of Bench- to our set-up
other marking 2 2 2 2
laboratorie Controllable NO GO
8
s
43
STEP 4: SELECTION OF BEST ALTERNATIVE SOLUTION
INSTRUCTIONS:
3. identify details of the solutions. Draw an action plan by doing Gantt
Chart
Activity Person
In-Charge
2. Implementation of Juliet/
revised Work Instruction Rhanty
4. Standardization Juliet/
Rhanty
Legend: Target
45
STEP 4: SELECTION OF BEST ALTERNATIVE SOLUTION
INSTRUCTIONS:
4. IDENTIFY POTENTIAL PROBLEMS THAT MAY OCCUR. DRAW
PREVENTIVE AND CONTINGENCY PLAN BY USING POTENTIAL
PROBLEM ANALYSIS TABLE.
46
SAMPLE
48
INSTRUCTION:
MONITORING PLAN
WHO
HOW WILL WHEN WILL TOOLS FOR
DATA TO BE DATA SOURCE WILL
DATA BE DATA BE DATA
COLLECTED AND LOCATION COLLECT
COLLECTED COLLECTED PRESENATION
DATA
50
SAMPLE
MONITORING PLAN
DATA SOURCE HOW WILL WHEN WILL TOOLS FOR
DATA TO BE WHO WILL
AND DATA BE DATA BE DATA
COLLECTED COLLECT DATA
LOCATION COLLECTED COLLECTED PRESENTATION
1. Total no. AMC Main Tallying AMC Main June 2-6, Bar Graph
of patients Clinical the total Laboratory 2006
claiming Laboratory number of Reception-
their lab Reception patients On Duty
results Area who
2. Total waited
number of more than
patients 5 minutes
who to claim
waited their lab
more than results
5 minutes
in claiming
their lab
results
STEP 6
EVALUATION OF
RESULTS
52
STEP 6: EVALUATION OF RESULTS
INSTRUCTIONS:
1. PREPARE A COMPARATIVE DATA (HYPOTHETICAL) OF BEFORE AND AFTER
IMPLEMENTATION. USE APPROPRIATE TOOLS.
53
SAMPLE
BEFORE AFTER
No Standard Procedure in Claiming of Revision of work instruction to include the
Result process of claiming results
START START
END
Issues results to patient
54
END
BEFORE AFTER
No Standard Procedure in Claiming of Revision of work instruction to include
Result the process of claiming results
START START
END
Issues results to patient
Date Standardized: Aug. 14, 2006
Observation and continuous
55
END monitoring until Standardized.
SAMPLE
90
80
Before: 81%
70
60
percentage
50
40
30
94.07% Reduction
20
10
After: 4.8%
0
March 17- 21, 2006 June 2-6, 2006
Analysis:
The team attained 4.8 % of patients with waiting time of more than 5
minutes before they received their results, in which it even exceeded their
goal of 5% target.
56
SAMPLE
Evaluation of Results
Included in claim Stub Delegated to Lab Staff Delegated to patient
1 2 3 4 5
mins
min min min min min
N
Activities
O
10
20
10
40
20
50
40
60
30
40
60
10
20
30
40
50
60
30
40
60
10
50
10
50
60
30
40
50
60
20
50
1
20
30
10
20
30
0 2 3 4 5 6
secs 1 0 0 0 0 0
0
Before
Calls patients no.
1
on queue After
Before
2 Asks patients info
After
Before
Retrieves patients
4
results on file After
Tangible Benefits
Computation of Gross Probable Savings:
No. of Patients waited > 5 min Before Costs After Costs
(5 days) (5 days)
Probable loss of income 47 P 11, 750 3 P 750
(refund)
GROSS SAVINGS P 2,200/day
Cost of Improvement:
Item Quantity Unit Price
1 ream P 280/ ream
RISO of Claim Stub (3,000 pieces of claim stub)
1 claim stub/ patient 10 cents / piece
TOTAL P 11.50/day
Cost of Improvement:
Gross Savings Cost of Improvement Net Probable
Savings
P 2,200/day P 11.50/day P 2,188.50/day
SAMPLE
A
Intangible Benefits 5
I 4 B
In the process 3
2
Criteria Befor Targe After H 1 C
e t 0
A. Knowledge in QCC 2 4 4
G D
B. Interest in QCC 1 4 3
Circle Level F E
61
STEP 7: STANDARDIZATION
INSTRUCTION:
PREPARE A WRITTEN DOCUMENTATION OF THE NEW SOP BY USING THE
5W AND 1H.
62
SAMPLE
Standardization
WHAT WHEN WHERE WHO WHY HOW
What to Effective What Person Objective Monitoring
Standardize Date Area Responsible
Claim Stub Aug 15, 2006 Laboratory Jocelyn To reduce Actual
Reception Rhea the Observation
percentage Interview
of patients
waited for
more than 5
minutes
which is
81% to 5%
by the end
of June 200
Revised WI to Aug 30, 2006 Laboratory Juliet Review
include the Reception Rhanty
process of
claiming results
63
STEP 8
SELF-EVALUATION
AND
FUTURE PLANS
64
STEP 8: SELF- EVALUATION AND FUTURE PLANNING
INSTRUCTION:
1. IDENTIFY GOOD AND BAD POINTS IN GOING THRU EACH OF THE PROBLEM
SOLVING STEP. USING A RADAR CHART, ASSESS TEAMS SKILLS IN
APPLYING QC TOOLS AND TECHNIQUES THEN PREPARE A TEAM
DEVELOPMENT PLAN.
2. MAKE A RADAR CHART
65
SAMPLE
66
SAMPLE
KNOWLEDGE ON QI METHODOLOGY AND 7 BASIC QC TOOLS
LEVEL 0 NOT HEARD ABOUT IT
LEVEL 1 CAN DO IT WITH SUPERVISION
LEVEL 2 CAN DO IT ALONE PROB ID/ PRIORITIZATION
LEVEL 3 CAN TEACH OTHERS
HISTOGRAM UNDERSTANDING PRESENT SYSTEM
SCATTER 3
DIAGRAM ANALYSIS OF ROO CAUSES
2
FORMULATION OF
CONTROL
ALTERNATIVE
CHART
1 SOLUTIONS
0
ISHIKAWA 0 1 2 3 SOLUTION
DIAGRAM 3 2 1 0 IMPLEMENTATION
2
GRAPHS STANDARDIZATION
BEFORE
3 SELF EVALUATION/ FUTURE PLANS
AFTER CHECKSHEET
BRAINSTORMING
FUTURE PLANS
1. ____________________________________
____________________________________
____________________________________
2. ____________________________________
____________________________________
____________________________________
68
10/2/2017 Continuous Quality Improvement in the Hospital
SAMPLE
FUTURE PLANS
69
10/2/2017 Continuous Quality Improvement in the Hospital
OUTLINE OF PRESENTATION
COMPLETED CQI PROJECT
INTRODUCTION (ORGANIZATIONAL PROFILE)
CIRCLE HISTORY
ABSTRACT OF THE PROJECT (NOT MORE THAN MORE THAN 100 WORDS)
ACTIVITY PLAN
STEP 7 STANDARDIZATION
CIRCLE HISTORY
The Disclaimers was formed in March 2006 which composed of 6 members from
the Laboratory Department of Alabang Medical Clinic-Main Branch.
ACTIVITY PLAN
Activities Year 2006 March April May June July August
1. Circle Formation
2. Problem Identification &
Prioritization
3. Understanding the present
system
4. Problem Statement
5. Objective Statement
6. Root Cause Analysis
7. Validation of Root Causes
8. Formulation of Best Solution
9. Solution Implementation
10. Evaluation of Results
11. Standardization
12. Future Plans/ Self-
Evaluation
Legend: Target
Actual