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Mark Graban
www.MarkGraban.com
www.LeanBlog.org
Improve Your Lean Management
System With a Simple Chart
Slides & More: www.MarkGraban.com/Shingo2020
Scientific Problem Solving
Better Understanding
Cause and Effect
Relationships in Systems
We Need to Avoid Making Bad Conclusions
“The average patient satisfaction
increased from 87.2 to 89%”
86%
87%
88%
89%
90%
Before After
Two Data Points
are NOT a Trend
Do We Hear (or Say) This in Meetings?
“Look at that positive trend!”
Narrator: It isn’t a trend
Improve Your Lean Management System With a Simple Chart
“Does Toyota use Six Sigma?”
v
“No, but we teach everybody
the seven basic Q.I. tools”
(including “control charts”)
A Control Chart for Performance Measures
-
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”
My Most Favorite Business Book Ever
Don Wheeler Says:
“SPC is a
way of thinking,
with some
tools attached.”
• 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
“Visual Management” or Just “Visual”?
“Management by Emoji”
One Data Point
is NOT a Trend
1. Are we achieving our
target or goal?
2. Are we improving?
3. How do we improve?
Three Key Questions
OK, How About
More Numbers?
"Bowling Chart” or “Bowler”
1. Are we achieving our
target or goal?
2. Are we improving?
3. How do we improve?
Three Key Questions
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
#PlotTheDots
“Visual Trend Charts”
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)
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"
#PlotTheDots — Hospital Covid-19 Dashboard
-
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
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
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
3 Rules for Finding a Signal
3 Rules for Finding a Signal
3 Rules for Finding a Signal
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
Process Behavior Charts
Help Us Evaluate
Improvement Work
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”
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
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
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
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?
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
We Need to Avoid Bad Conclusions
“Look at that positive trend!”
Narrator: It isn’t a trend
12 Data Points
Might NOT Be
a Trend
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?
Process Behavior
Charts Help Us Evaluate
Ongoing Operations
1. Are we achieving our
target or goal?
2. Are we improving?
3. How do we improve?
Three Key Questions
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?
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
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
Is our Metric
Predictable
and/or
Capable?
Unpredictable & Not Capable
STABILIZE THE SYSTEM!
ROOT CAUSE?
ROOT CAUSE?
Predictable & Not Capable
IMPROVE THE SYSTEM!
Predictable and Capable
IMPROVE THE SYSTEM?
Predictable and Somewhat Capable
IMPROVE THE SYSTEM!
DON'T OVERREACT!
From Not Capable to Capable
Looking for Signals in a Metric That Meets Target
SIGNAL
WHAT
CHANGED?
1. Are we achieving our
target or goal?
2. Are we improving?
3. How do we improve?
Three Key Questions
Process Behavior Charts
“…will make us more effective at tracking
what we improve or don’t improve.”
CEO, Health System
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
Better Cause-and-Effect Understanding
Better Scientific Problem Solving
Better Lean Management Systems
React Less
Lead Better
Improve More
Questions?
Mark Graban
• Email:
• mark@markgraban.com
• Web:
• www.LeanBlog.org
• www.MarkGraban.com
Book: www.MeasuresOfSuccessBook.com
Slides: www.MarkGraban.com/Shingo2020

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Improve Your Lean Management System With a Simple Chart

  • 1. Mark Graban www.MarkGraban.com www.LeanBlog.org Improve Your Lean Management System With a Simple Chart Slides & More: www.MarkGraban.com/Shingo2020
  • 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 - 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
  • 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 - 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
  • 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
  • 47. Unpredictable & Not Capable STABILIZE THE SYSTEM! ROOT CAUSE? ROOT CAUSE?
  • 48. Predictable & Not 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
  • 58. Questions? Mark Graban • Email: • mark@markgraban.com • Web: • www.LeanBlog.org • www.MarkGraban.com Book: www.MeasuresOfSuccessBook.com Slides: www.MarkGraban.com/Shingo2020