This document discusses the use of process behavior charts (PBCs) to evaluate processes, metrics, and improvement efforts. It emphasizes that PBCs help distinguish common cause variation from special cause variation to avoid overreacting to normal fluctuations or missing important signals of change. The document provides examples of how PBCs can be used to evaluate metrics over time, determine if processes are predictable and capable of meeting goals, and identify when improvements have actually resulted in process changes. It argues that PBCs support a more scientific approach to problem solving and help organizations react less and improve more.

1. Mark Graban
www.MarkGraban.com
www.LeanBlog.org
Improve Your Lean Management
System With a Simple Chart
Slides & More: www.MarkGraban.com/Shingo2020

2. Scientific Problem Solving

3. Better Understanding
Cause and Effect
Relationships in Systems

4. We Need to Avoid Making Bad Conclusions
“The average patient satisfaction
increased from 87.2 to 89%”
86%
87%
88%
89%
90%
Before After

5. Two Data Points
are NOT a Trend

6. Do We Hear (or Say) This in Meetings?
“Look at that positive trend!”
Narrator: It isn’t a trend

8. “Does Toyota use Six Sigma?”
v
“No, but we teach everybody
the seven basic Q.I. tools”
(including “control charts”)

9. A Control Chart for Performance Measures
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10
20
30
40
50
60
70
80
90
100
Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19
Rate this Facility - % of Patients Giving “9” or “10”
Upper Limit = +3 sigma
Lower Limit = -3 sigma
Average
• “SPC Chart” (Statistical Process Control)
• “Control Chart”
• “XmR Chart”
• “Process Behavior Chart”

10. My Most Favorite Business Book Ever

11. Don Wheeler Says:
“SPC is a
way of thinking,
with some
tools attached.”

12. • One goal is reducing waste
• This includes “management waste”
• Wasted motion
• Overprocessing
A Lean Management System
Looking for a root cause that isn’t there

13. “Visual Management” or Just “Visual”?
“Management by Emoji”

14. One Data Point
is NOT a Trend

15. 1. Are we achieving our
target or goal?
2. Are we improving?
3. How do we improve?
Three Key Questions

16. OK, How About
More Numbers?

17. "Bowling Chart” or “Bowler”

18. 1. Are we achieving our
target or goal?
2. Are we improving?
3. How do we improve?
Three Key Questions

19. 1. Which of these numbers
(if any) suggests that the
system has changed
significantly?
2. Which of these merit
reaction, investigation, or
explanation?
3. How do we prioritize?
Three More Questions

20. #PlotTheDots

21. “Visual Trend Charts”

22. There is VARIATION in Every Metric
• The question is “how much variation is routine?”
• Personal examples:
• Body weight
• Resting heart rate
• Commuting time
60
65
70
75
80
1-Jul
3-Jul
5-Jul
7-Jul
9-Jul
11-Jul
13-Jul
15-Jul
17-Jul
19-Jul
21-Jul
23-Jul
25-Jul
27-Jul
29-Jul
31-Jul
2-Aug
4-Aug
6-Aug
8-Aug10-Aug12-Aug14-Aug16-Aug
Run Chart (Mark's Resting Heart Rate)
180
181
182
183
184
185
186
187
188
5/27/16
5/29/16
5/31/16
6/2/16
6/4/16
6/6/16
6/8/16
6/10/16
6/12/16
6/14/16
6/16/16
6/18/16
6/20/16
6/22/16
6/24/16
6/26/16
6/28/16
6/30/16
7/2/16
7/4/16
Run Chart (Weight)

23. Signals vs. Noise
“While every data set contains noise,
some data sets may contain signals.
Therefore, before you can detect a signal
within any given data set,
you must first filter out the noise."
"Process Behavior Charts"

24. #PlotTheDots — Hospital Covid-19 Dashboard
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5
10
15
20
25
30
35
40
12-M
ar
13-M
ar
14-M
ar
15-M
ar
16-M
ar
17-M
ar
18-M
ar
19-M
ar
20-M
ar
21-M
ar
22-M
ar
23-M
ar
24-M
ar
25-M
ar
26-M
ar
27-M
ar
28-M
ar
29-M
ar
30-M
ar
31-M
ar
1-Apr
2-Apr
3-Apr
4-Apr
5-Apr
6-Apr
7-Apr
8-Apr
9-Apr
10-Apr
11-Apr
X Chart (Number of Employees Out Sick)
Chart Courtesy of Memorial Health System (Marietta OH)
Goal: Avoid Reacting to Every Up & Down

25. Process Behavior Chart
(10)
(5)
-
5
10
15
20
25
30
35
40
3/12/20
0:003/13/20
0:003/14/20
0:003/15/20
0:003/16/20
0:003/17/20
0:003/18/20
0:003/19/20
0:003/20/20
0:003/21/20
0:003/22/20
0:003/23/20
0:003/24/20
0:003/25/20
0:003/26/20
0:003/27/20
0:003/28/20
0:003/29/20
0:003/30/20
0:003/31/20
0:004/1/200:004/2/200:004/3/200:004/4/200:004/5/200:004/6/200:004/7/200:004/8/200:004/9/200:004/10/20
0:00
X Chart (Number of Employees Out Sick)
Upper Limit = +3 sigma
Lower Limit = -3 sigma
Average
NOISE
“COMMON CAUSE”
Chart Courtesy of Memorial Health System (Marietta OH) PREDICTABLE SYSTEM

26. Has the System Changed?
(10)
-
10
20
30
40
50
3/12/20
0:003/13/20
0:003/14/20
0:003/15/20
0:003/16/20
0:003/17/20
0:003/18/20
0:003/19/20
0:003/20/20
0:003/21/20
0:003/22/20
0:003/23/20
0:003/24/20
0:003/25/20
0:003/26/20
0:003/27/20
0:003/28/20
0:003/29/20
0:003/30/20
0:003/31/20
0:004/1/200:004/2/200:004/3/200:004/4/200:004/5/200:004/6/200:004/7/200:004/8/200:004/9/200:004/10/20
0:004/11/20
0:00
X Chart (Number of Employees Out Sick)
SIGNAL
“SPECIAL CAUSE”
What changed?
What is the root cause?
Note: The last data point is a hypothetical situation

27. 3 Rules for Finding a Signal

28. 3 Rules for Finding a Signal

29. 3 Rules for Finding a Signal

30. A PBC for the Toyota Way Fieldbook “Trend Chart”
NOISE
“COMMON CAUSE”
There is NO “root cause” for
any of those data points
But we CAN improve the
system systematically

31. Process Behavior Charts
Help Us Evaluate
Improvement Work

32. We Made Improvements (?) to the System
-
10
20
30
40
50
60
70
80
90
100
Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19
Rate this Facility - % of Patients Giving “9” or “10”

33. We Made Improvements (?) to the System
-
10
20
30
40
50
60
70
80
90
100
Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19
Rate this Facility - % of Patients Giving “9” or “10”
SIGNAL

34. We Made Improvements (?) to the System
-
1.00
2.00
3.00
4.00
5.00
6.00
January-17
February-17M
arch-17
April-17
M
ay-17
June-17
July-17August-17
Septem
ber-17October-17
Novem
ber-17
Decem
ber-17January-18
February-18M
arch-18
April-18
M
ay-18
June-18
July-18August-18
Septem
ber-18October-18
Novem
ber-18
Decem
ber-18January-19
February-19M
arch-19
X Chart -- Pain Score (0-10)
Caudal Epidural Analgesia in 2017 Pudendal Nerve Block in 2018

35. We Made Improvements (?) to the System
-
1.00
2.00
3.00
4.00
5.00
6.00
January-17
February-17M
arch-17
April-17
M
ay-17
June-17
July-17August-17
Septem
ber-17October-17
Novem
ber-17
Decem
ber-17January-18
February-18M
arch-18
April-18
M
ay-18
June-18
July-18August-18
Septem
ber-18October-18
Novem
ber-18
Decem
ber-18January-19
February-19M
arch-19
X Chart -- Pain Score (0-10)
Caudal Epidural Analgesia in 2017 Pudendal Nerve Block in 2018
NO CHANGE

36. We Made Improvements (?) to the System
-
20
40
60
80
100
120
January-18 February-18 March-18 April-18 May-18 June-18 July-18 August-18 September-18 October-18 November-18 December-18
X Chart (PACU Minutes)
(Old Protocol) (New Protocol)
NO CHANGE?

37. Evaluating Clinical Process Change (2)
-
20
40
60
80
100
120
January-18 February-18 March-18 April-18 May-18 June-18 July-18 August-18 September-18 October-18 November-18 December-18
X Chart (PACU Minutes)
(Old Protocol) (New Protocol)
SIGNAL

38. We Need to Avoid Bad Conclusions
“Look at that positive trend!”
Narrator: It isn’t a trend

39. 12 Data Points
Might NOT Be
a Trend

40. Process Behavior Chart
78
80
82
84
86
88
90
92
Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09
Patient Satisfaction
PROCESS CHANGE
SIGNAL
Cause & Effect?

41. Process Behavior
Charts Help Us Evaluate
Ongoing Operations

42. 1. Are we achieving our
target or goal?
2. Are we improving?
3. How do we improve?
Three Key Questions

43. Bowling Chart as Run Charts - #PlotTheDots
0%
10%
20%
30%
40%
50%
60%
70%
80%
Jan Feb Mar Apr May Jun Jul Aug Sep
Run Chart (Team Engagement)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Jan Feb Mar Apr May Jun Jul Aug Sep
Run Chart (Recommend)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Jan Feb Mar Apr May Jun Jul Aug Sep
Rating
0.0
0.2
0.4
0.6
0.8
1.0
1.2
Jan Feb Mar Apr May Jun Jul Aug Sep
Run Chart (Falls w/ Sev Injury)
0.0
0.5
1.0
1.5
2.0
2.5
Jan Feb Mar Apr May Jun Jul Aug Sep
Run Chart (CLABSI)
0.0
0.2
0.4
0.6
0.8
1.0
1.2
Jan Feb Mar Apr May Jun Jul Aug Sep
Run Chart (CAUTI)
WHEN SHOULD WE REACT?

44. Bowling Chart as PBCs
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (Falls w/ Sev Injury)
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (CLABSI)
0.0
0.2
0.4
0.6
0.8
1.0
1.2
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (CAUTI)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (Team Engagement)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (Recommend)
50%
55%
60%
65%
70%
75%
80%
85%
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (Rating)
SIGNAL
NOISE
SIGNAL

45. Bowling Chart as PBCs with Red/Green
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (Falls w/ Sev Injury)
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (CLABSI)
0.0
0.2
0.4
0.6
0.8
1.0
1.2
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (CAUTI)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (Team Engagement)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (Recommend)
50%
55%
60%
65%
70%
75%
80%
85%
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (Rating)
SIGNAL
SIGNAL
NOISE

46. Is our Metric
Predictable
and/or
Capable?

47. Unpredictable & Not Capable
STABILIZE THE SYSTEM!
ROOT CAUSE?
ROOT CAUSE?

48. Predictable & Not Capable
IMPROVE THE SYSTEM!

49. Predictable and Capable
IMPROVE THE SYSTEM?

50. Predictable and Somewhat Capable
IMPROVE THE SYSTEM!
DON'T OVERREACT!

51. From Not Capable to Capable

52. Looking for Signals in a Metric That Meets Target
SIGNAL
WHAT
CHANGED?

53. 1. Are we achieving our
target or goal?
2. Are we improving?
3. How do we improve?
Three Key Questions

54. Process Behavior Charts
“…will make us more effective at tracking
what we improve or don’t improve.”
CEO, Health System

55. Process Behavior Charts
“A simple tool that helps drive a mindset
change to being more systematic about
the success of improvement work.”
President, Ambulatory Services

56. Better Cause-and-Effect Understanding
Better Scientific Problem Solving
Better Lean Management Systems

57. React Less
Lead Better
Improve More

58. Questions?
Mark Graban
• Email:
• mark@markgraban.com
• Web:
• www.LeanBlog.org
• www.MarkGraban.com
Book: www.MeasuresOfSuccessBook.com
Slides: www.MarkGraban.com/Shingo2020