Affinity Diagram

To construct this type of diagram, team members write their ideas about topic on cards. Those cards are randomly spread out on a table. Next, the team members assemble groups of cards that express related ideas. The display of those groups of ideas is the affinity diagram.

Aim Statement

A written, measurable, and time sensitive statement of the expected results of an improvement process. It answers the three fundamental questions of the Model for Improvement. There are four components to a good Aim Statement: rationale/importance, target population, time frame for completion, and measurable goals.

Annotated Time Series

A line chart showing results of improvement efforts plotted over time. The changes made are also noted on the line chart at the time they occur. This allows the viewer to connect changes made with specific results.

Balancing Measure

Measures that help us determine if an improvement in one part of the system will worsen another part of the system. For example, measuring cycle time to make sure that you are not increasing the length of the office visit by introducing a well-child checklist.

Bar Chart

A graphic display. A bar chart is used to illustrate elements of time, magnitude, increases, or declines. It is a comparative measure charting an element on the y-axis against that on the x-axis.

Baseline Data

Data collected (under defined conditions and time period) on the current process.

Benchmarking

When an institution or business compares its performance against the very best in its area, determines what the best do differently, and incorporates those ideas into its own procedures, it is practicing benchmarking.

Brainstorming

A technique designed to encourage creative thinking and is used to collect/generate ideas from a group. The objective is to generate as long a list of ideas as possible; quantity is valued over quality.

Change Concept

A general idea for changing a process. Change concepts are usually at a high level of abstraction, but evoke multiple ideas for specific processes. "Simplify," "reduce handoffs," "consider all parties as part of the same system," are all examples of change concepts.

Change Package

A set of bundle of key changes that have proven to be effective for driving improvement of a specific target. For example, the Central Line-Associated Bloodstream Infection Change Package includes such key changes as: educating families about sterile dressing changes, using chlorhexadine, and having dedicated teams for catheter insertion.

Collaborative

A time-limited effort (usually six to 12 months) of multiple organizations who come together with faculty to learn about and to create improved processes in a specific topic area. The expectation is that the teams share expertise and data with each other thus, "Everyone learns, everyone teaches."

Collaborative Team

Involves all participants in the improvement effort from clinics and/or health plan teams.

Control Chart

A run chart with specific limits usually depicting a quantitative characteristic of a process. The limits are calculated with a mathematical formula whose components are derived by allowing the process to go unhindered until the expected or average value of the characteristic is found.

Cost Benefit Analysis

A comparison of expenses and benefits of the current process to expenses and benefits of the solution.

Cycle Time

The total time for completing a process or an activity from start to finish; Process Time + Down Time.

Early Adopter

In the improvement process, the opinion leader within the organization who brings in new ideas from the outside, tries them, and uses experiences with positive results to persuade others in the organization to adopt the successful changes.

Early Majority/Late Majority

The individuals in the organization who will adopt a change only after it is tested by an early adopter (early majority) or after the majority of the organization is already using the change (late majority).

Fishbone Diagram

Also called a cause and effect diagram or an "Ishikawa" diagram. As used by the Japanese, it is a pictorial display (resembling a fish) used to analyze causes of a problem. The "head" represents the problem being studied while the "bones" denote possible causes.

Flowchart

A detailed illustration, usually step-by-step, that provides information for planning, understanding or describing a process under study. It uses symbols to denote the flow of the activity and places where decisions are made.

Force-field Analysis

An analytical tool based on the work of psychologist, Kart Lenis, who studies the forces that drive people toward or repel people from certain behaviors. It is used to examine the forces for or against reaching a particular goal.

Histogram

A measure of the frequency distribution of an event or an occurrence using a bar graph. A bell shape is considered normal. "Skewed" results represent problems or inefficiencies or may signal that unexpected processes are occurring.

Key Changes

The list of essential process changes that will help lead to breakthrough improvement, usually created by the Collaborative Chair and Faculty based on literature and their experiences.

Learning Session

A two-day meeting during which participating organization teams meet with faculty and collaborate to learn key changes in the topic area including how to implement changes, an approach for accelerating improvement, and a method for overcoming obstacles to change. Teams leave these meetings with new knowledge, skills, and materials that prepare them to make immediate changes.

Measure

An indicator of change. Key measures should be focused, clarify your team's aim, and be reportable. A measure is used to track the delivery of proven interventions to patients and to monitor progress over time.

Model for Improvement

An approach to process improvement, developed by Associates in Process Improvement, which helps teams accelerate the adoption of proven and effective changes. In conjunction with the PDSA cycle, the Model for Improvement ask three fundamental questions: "What are we trying to improve?" "How will we know that an improvement has been made?" "What ideas do we have for making an improvement?"

Outcome Measure

Also called Global Measures or the "voice of the system." These measures are related to the Aim Statement in that they measure the ultimate outcome of the project. An example is measuring Hgb A1c values for diabetic patients.

Pareto Chart

A vertical bar graph, or column graph, that displays the relative importance of the problems or causes identified. The most important or influential problems or causes are represented by the tallest bars on the left of the chart. The goal is to focus attention on the "vital few" in contrast to the "trivial many."

Pareto Principle

Vilfredo Pareto, a 19th century European economist, depicted in a graph the unequal distribution of wealth among different social classes. Simply stated, 80 percent of the effect is attributed to 20 percent of the causes. The Pareto principle has become known as the 80 to 20 rule.

Plan, Do, Study, Act (PDSA) Cycle

A small-scale structured test of a process change. Steps include:

Plan: Writing your plan for the cycle; who, what, when, where the change will be tested

Do: A time to try the change and observe what happens

Study: an analysis of the results of the trial

Act: devising next steps based on the analysis

This PDSA cycle will naturally lead to the Plan component of a subsequent cycle.

PDSA Method

An overall methodology for improving quality. The stages of the PDSA Method are similar to the PDSA cycle:

Plan: Planning the QI project, form the team, formulate the Aim Statement

Do: Conduct PDSA cycles to test changes

Study: Review the data collected during the project, implement the changes to lead to improvement

Act: Plan for sustainability of the improvement, "hardwire" key changes into the system

Pilot Site

The clinic location for initial focused changes. After implementation and refinement, the process will be spread to additional locations.

Process Change

A specific change in a process in the organization. More focused and detailed than a change concept, a process change describes what specific changes should occur. "Institute a pain management protocol for patients with moderate to severe pain" is an example of a process change.

Process Measures

Also called Intermediate Measures or the "voice of the process." These measures are related to the Key Changes in that they tell us whether our system is effective. An example is measuring the number of asthma patients with completed Asthma Action Plans in their chart.

Quality Improvement (QI)

Quality improvement is defined as the result of a continuous, executive-driven program that seeks to reduce systemic defects to as close to zero as possible.

Resident Physician Champion

Leadership ability is an important attribute for physicians working on QI teams. The Resident Physician Champion aspires to the qualities of the Physician Champion, which they can attain with time and experience. The expectations for a Resident Physician Champion are defined as:

  • Functions as the team leader on a small project or co-leads a larger project
  • Performs with supervision and support of a faculty member
  • Takes a key role in writing the Aim Statement, designing PDSA Cycles, and delegating tasks to other members of the team
  • May be asked to meet one-on-one with the QI Coach
  • Involves CAPE staff throughout the project
Root Cause

A circumstance, event or condition that gives rise to performing an activity.

Run Chart

A graphic representation of data over time, also known as a "time series graph" or "line graph." This type of data display is particularly effective for process improvement activities. Time is usually plotted along the horizontal axis while what is being studied is displayed on the vertical axis.

Sampling Plan

A specific description of the data to be collected, the interval of data collection, and the subjects from whom the data will be collected. This is included on all Senior Leader reports. It emphasizes the importance of gathering samples of data to obtain "just enough" information.

Scatter Diagram

A graphic aid to determine if specific variables are related. The "cause" usually is placed on the horizontal axis with the "effect" along the vertical.

Spread

The intentional and methodical expansion of the number and type of people, units, or organizations using the improvements. The theory and application comes from the literature on Diffusion of Innovation (Everett Rogers, 1995).

System

A group of related processes.

Trend

A trend is a direction of movement; a course. If there is a continued rise or fall in a series of data points, it is considered a trend. Trending can be easily observed when using run charts.

Variation

Variation exists in every process. There are two types of variation, common-cause variation, due to many small causes that occur constantly and is usually system-related; and special cause variation, due to significant and specific problems and is often related to individuals and/or circumstances.

85/15 Rule

At least 85 percent of problems can only be corrected by changing systems (largely determined by management) and less than 15 percent are under a worker's control. This rule evolved from the observation of Dr. Joseph M. Juran that the potential to eliminate errors lies primarily in improving systems, not in changing the workers.

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