Utilizing the 3Ms of Process Improvement

Why is it that some improvement efforts succeed while others fail despite robust change management programs and the often do-or-die pressure to improve? Quite simply, there are three elements that separate those that succeed from those that fail. They are the 3Ms—Measure, Manage to Measure, and Make-it-Easy.

Complete with forms, templates, and case studies from the aviation and manufacturing industries, Utilizing the 3Ms of Process Improvement supplies step-by-step guidance on how to use the 3Ms to achieve performance excellence that lasts. Suitable for a wide audience—including suppliers, manufacturers, and those who work in service organizations, schools, healthcare, and government—it is as much about the science of process improvement as it is about how to lead process improvement utilizing the 3Ms.

Illustrating applications of the 3Ms across a range of industries, the book weaves stories throughout about role models who have succeeded, as well as those who have failed. It identifies the specific elements that were missing or defective in the failed attempts to provide a clear understanding of how the three elements work together. Arming you with a culture change method based on changing behaviors, it provides a leadership and management guide to achieving your objectives.

The 3Ms have worked for Ben Franklin, Abraham Lincoln, and the author’s teams across the globe. Now, with this book, you can put the power of the 3Ms to work for you in your quest towards improving processes and reducing costs.

The author encourages reader interaction and feedback on his website: www.rpmexec.com. He also provides you with access to the forms and templates described in the book.

Rick Morrow is a consultant with more than 25 years of senior leadership experience in healthcare, aviation, construction, automotive and high tech. Morrow leads Healthcare Performance Partners’ Quality, Safety, and High Reliability unit, a MedAssets company. He has authored Lean Six Sigma performance excellence courses and taught and deployed programs internationally for Eaton Corporation, SKF, Motorola, United Airlines, The Joint Commission, and Healthcare Performance Partners.

Morrow is the author and leader of HPP’s Six Sigma consulting and wrote and leads the Belmont University Lean Healthcare Certification Program for Supply Chain Professionals, which is a blend of The Toyota Production System, Six Sigma, and Change Leadership. Morrow also wrote and taught The University of Penn’s Penn Medicine Leadership and Performance Improvement courses. He authored the Lean Six Sigma Program at The Joint Commission and led its Center for Transforming Healthcare, where he and his team led collaborations improving patient care and safety with major academic medical centers including Cedars-Sinai, Johns Hopkins, Mayo Clinic, Intermountain Healthcare, North Shore Long Island Jewish, and Stanford University.

Morrow earned his MBA from the University of Illinois’ Executive Program and has a B.S. in Business from Illinois State University. Certifications include Motorola Master Black Belt and Lean Enterprise from the University of Tennessee. He is an international speaker on Lean Six Sigma, Quality, and Safety at conferences including NPSF, ASC and ASQ.
Morrow is also the author of the companion book, Utilizing the 3Ms in Process Improvement in Healthcare, and is a contributing editor on performance improvement, quality and safety publications. He is as proud in his work coaching his son and daughter in baseball and soccer and leading as President of Holy Family Commission of Education.

Overview of Process Improvement and the 3MsOutcomes Are the Result of ProcessesPerformance Excellence3Ms for Process Improvement Measure Manage to the Measure Make it EasierScience of Process ImprovementChange LeadershipWe Need All Three Ms to Sustain the ImprovementsCase Study in Process ImprovementUtilizing the 3Ms for Process Improvement3Ms, Scientific Methodology, Change LeadershipKey PointsEndnotes

Change LeadershipWhat Is Change Leadership? Change Management? How Do TheyDiffer? The Need for Leadership in Change: A Case Study in HealthcareToo Many Examples of Not Leading Change WellManagement and Leadership: Scientific ManagementPerfect Example of Scientific ManagementDefinition of Manager and LeaderWhat Happens When There Is no Leader?Leadership PrinciplesAbraham Lincoln on Leading ChangeLeading Change to a Slave-Free AmericaIndustry’s Change LeadersWalking the TalkDefinition of Common Terms across MethodologiesKey PointsEndnotes
Resistance to Change and Process ImprovementForces against Change: Resistance, Time, Natural LawsA Quick Win against ResistanceRole of the Change LeaderA Policy of Change and Continuous Improvement Piloting Changes What Can Happen If Change Is Not Piloted First Balancing Change and ContinuityThe Emancipation ProclamationWhat Happens When One or More of the Ms Is Missing? Dr. Semmelweis and Washing Hands: The Right Change, but Why Is Change Needed In Healthcare? Semmelweis’s Improvement Dies with Him Forcing Doesn’t Always WorkThe Force of ResistanceBenjamin Franklin, Electricity, and Change Leadership Principles of Electricity Explain Resistance to Change What You Can’t See Can Hurt YouUsing Resistance to Help Lead Change Electricity and Forcing Change Can Be Dangerous Getting Change to Flow Resistance to Change Can Vary within the Same Person Resistance between Two Bodies Resistance at HomeKey PointsPracticing Change LeadershipEndnotes
Process Improvement MethodologiesOverview of the Most Popular MethodologiesWork with Toyota and for Motorola Motorola and Toyota Use Lean and Six Sigma ToolsPDSA and PDCA Compared to Six Sigma All Good Methods Analyze for Root Causes before SolutionsCase Study of Late ShipmentsCross Reference of PDSA, Six Sigma, Lean, Change LeadershipHuman Factors and Ergonomics in Process Improvement Case Study: Human Factors Added to Lean Six Sigma Hand Hygiene Change Leadership IssueFailure to Engage Others with the Measure Baseball and Managing to the Measure Measures for Research Purposes Measures for Process Improvement Purposes Cedars–Sinai Using Measure and Manage to the MeasureKey PointsEndnotes
Roadmap for Process ImprovementIntroductionStart the Journey on Main StreetGetting Started on Our JourneyPossible ShortcutPrepare for ChangeTrainEnvision Articulating a Vision Elements in a Vision Statement Try Out Your Vision Statement How Does One Communicate the Vision?Abraham Lincoln’s Vision Advocate a Vision and Continually Reaffirm It For Whom the Bell TollsEngageEnable Quality Circles Enabling during the Recession of the Early 1980s Assumptions and DecisionsEmpowerKey PointsEndnotes

Chartering the Process Improvement WorkThe CharterNo Charter? Big Problem Sharing Findings before Departing Clear Definition of the Issue and What Was to Be Measured Are Key The Final Report and SurpriseThe Issue Statement The Measures or Metrics Outcome and Process Measures Goals Progressive Goals and Successive Successful ApproximationsMeasures and Goals to Build a Safer CultureHold Off on Financial Metrics Until Scope the WorkCharter "Signatories" Sponsor Chartering Is Iterative Sign the CharterKey PointsPracticing Skills: CharteringEndnotes

Stakeholder AnalysisPurpose of Stakeholder AnalysisCase Study in Stakeholder AnalysisMission and Values of the OrganizationStakeholdersOverview of the SHA Measuring the Gap: The Level of Resistance Three SHA Scenarios to Know Your Strategy Upfront Designing the "Circuit" to Achieve Flow and Manage ResistanceDifficult to Be PerfectThem Is Us EventuallyLet’s Learn Stakeholder Analysis by Doing Using the SHA Template Time to Assess Each Stakeholder’s Buy-InKey PointsEndnotes
Finding the Root Causes, Improving, and ControllingExplore Together Doctor Livingstone Explore Together with Empathy and Patience Building the TeamCase Study Poor Service for a Major Customer and Its Customers Work-Arounds in the "Factory of Hidden Defects" Exploring Using the "Five Whys" Explain Experiment Explore: Builds on Experimentation Build Consensus Train, Enable, Empower, Hold Accountable Training in the ImprovementsEnableEmpowerHold AccountableKey PointsEndnotes
Utilizing the 3Ms: Measure, Manage to the Measure, and Make It EasierIntroductionMeasure Practicing MeasureManage to the MeasureMake It EasierVisual ManagementMeasuring ExampleManaging to the Measure ExampleMake It Easier Example Takt Time: A Measure of the Pace Needed to Meet Customer DemandMeasuring: The Most Important MApply the First of the Three Ms and See the Value Setting Up Your Experiment Measuring the BaselineStatistical Process Control Charting: Turning Data into Information Sample Size Hand Hygiene and the 3Ms Ready to Observe Alternative ExperimentThe Hawthorne Effect Desire to Increase ProductivityUtilizing the 3Ms by Changing the Measure Incentive Piecework as a Measure More on the Perverse Incentive MeasureFrench Restaurant DiningThe Hawthorne Effect Revisited Case Study in Timeliness in Sharing the MeasureKey PointsEndnotes

What to MeasureHidden Factory of Rework and Swiss CheeseGetting Started: Preparing for Change, Chartering, and Stakeholder Analysis (SHA) Case Study: 3Ms Improving Surgical Safety The Measure Is Invented Measuring the Errors to Reduce the Risk of Wrong-Site SurgeryMeasuring the Quality of a DecisionPracticing Measuring SetupA Change In One Area May Affect Other Areas Inventory ManagementMeasure What the Customer MeasuresBase the Measure on Correlation with the OutcomeHigh Reliability Organizations: What Do They Measure?A Safety Culture and How to MeasureMeasuring the Inputs versus Just the OutcomesMeasuring the CulturePresident Franklin D. Roosevelt’s First Inaugural AddressKey PointsEndnotes
Measure Risk to Achieve High ReliabilityMeasuring RiskThe FMEA Form The Process Step or Design Function Input, Failure Modes, Effects, Causes, and Scoring of Risk Existing Controls Risk Priority Number (RPN)FMEA for IT Data Can Be a Component In Today’s High Tech EquipmentFMEAs Don’t Always Prevent Catastrophic Failure3Ms Lesson: Must Manage to the Measure, Not Just MeasureFacilitating a FMEAKey PointsEndnotes
Measurement as a SystemOverviewMeasurement as a SystemMeasurement System Analysis (MSA) Critical in Utilizing the 3MsAnalyzing a Measurement SystemQualities of an Acceptable Measurement SystemAttributes of a Measurement System Accuracy Bias Precision Repeatability ReproducibilityDesigning a Measurement SystemPerforming a Measurement System Analysis (MSA) MSAs Can Be Really Easy Inaccurate Measurement Systems Can Lose Customers A Measurement System Using Actual Data by Surgeon and by Procedure Drawdown Measurement Systems That Add No Value to the Client Calibrating a Measurement SystemStatistical MSA Methods Categories and Types of Data Checklists as Measurement Systems Granularity Discrimination Overview of Performing a Gage R&R MSA for Blood Pressure ReadingMSA for Attribute Data Attribute Agreement Analysis Moderate Risk of Harm The Soft Drink Challenge with AAA Stability LinearityOverview of MSA for Continuous Data and High Granularity Gage Repeatability and Reproducibility (Gage R&R) Precision to Tolerance: (%P/T) Knowing Good from Bad Percent to Total Variation %P/TV % Contribution Using Minitab in Measurement System Analysis for Gage R&R Sampling Should I Measure 100% or Sample? Sampling QualityKey PointsEndnotes

How to Share and Communicate MeasurementsChartingPareto Charts Pareto to Reduce ResistanceStatistical Process Control Charts (SPC) First SPC Chart: May 1924 High Reliability Organizations (HROs) and SPC The "Swiss Army Knife" for Process Improvement Components of the SPC Control Chart Control and Out of Control Case Study Call Center Wait Times Using a Simple Histogram to Create SPC Chart Parameters Reliability and SPC SPC Is Often Preferred in Managing to the Measure Prove Change Really Occurred Change Management without SPC? Frontline Workers Have Been Using SPC Since the 1920sRun ChartsKey PointsEndnotes
3Ms: Manage to the MeasureThe ScoreboardVisual ManagementWhat to Expect Short Term and Long Term from Measuring Instructing and Coaching Training within Industry Job Instructions Job Methods Job Relations Program DevelopmentStandard Work to Manage to the MeasureCoaching is Key in Managing to the Measure Coach’s PlaybookKey PointsEndnotes

3Ms: Make It EasierPerformance Improvement in Making It Easier to ChangeCase Study Store Staff Spending Time with Customers Job SatisfactionMaking Change Easier Is What We Need to DoPrepare Stakeholders for the Change Train Envision Engage Enable Empower Explore TogetherSatisfaction and Loyalty Measurement Explain Experiment, Explore, Build ConsensusChoosing the Best CountermeasuresPiloting and Choosing the Best CountermeasuresPiloting to See if the Measure Moves Train, Enable, Empower, and Hold AccountableMindfulness and Control MindfulnessCommitment to ResilienceCase Study University of Pennsylvania, Penn Medicine Utilizing the 3MsSPC Making It EasierThe 3Ms Are the Most Important Tool for Leadership and ProcessImprovement Leaders Including Change Leaders to Sustain the GainsKey PointsEndnotes
High ReliabilityCase Study: SKF High Reliability Program Number 1 High Reliability Program Number 2 The Products Surrounding the Variation Scrapping versus Inspecting Utilizing the 3Ms in Zero Defects and SWOC High Reliability Program Number 3: Building a Safety Culture A Story of a Seal and Its GreaseChange Isn’t Always Easy, ExceptStakeholder Analysis Revisited for Making It EasierDesigning an Experiment Should Start with the People Doing the WorkKey PointsEndnotes
SummaryMistake-Proofing?Mistake-Proofing Promotes Defect Prevention versus Detection Types and Levels of Mistake-Proofing DevicesHuman Error Drives Need for Mistake-ProofingMistake-Proof ApproachesTrain, Engage, Enable, and Empower the People Doing the WorkReinforcing Continuous Process ImprovementKey PointsEndnotes
Appendices: Roadmap for Performance Excellence™Process Improvement Foundational ToolsThe Emancipation ProclamationCharter TemplateStakeholder Analysis TemplateHand Hygiene Data Collection SheetHand Hygiene Compliance Chart for PostingMeasure: Data Collection ToolFMEA Severity, Occurrence, Detection TablesGage Repeatability and Reproducibility Measurement System Analysis
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