Utilizing the 3Ms of Process Improvement in Healthcare ─ A Roadmap to High Reliability Using Lean, Six Sigma, and Change Leadership

Utilizing the 3Ms of Process Improvement in Healthcare supplies step-by-step guidance on how to use the 3Ms of change leadership to improve healthcare processes. Complete with forms, templates, and healthcare case studies, it illustrates the proper application of the 3Ms. It weaves stories throughout the book of role models who have succeeded, as well as some who have failed. It identifies the specific elements that were missing or defective in the failed attempts to teach readers about how the three elements work together.

Arming you with a culture change method that is 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, providing better care, and reducing costly errors.

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, 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 EasierWe Need All Three Ms to Sustain the ImprovementsThe Science of Process ImprovementQuality Foundational Process Improvement ToolsProductivity Process Improvement ToolsChange LeadershipCase Study in Process ImprovementUtilizing the 3Ms for Process Improvement3Ms, Scientific Methodology, Change LeadershipKey PointsNotes

Change LeadershipWhat Is Change Leadership? Change Management? How Do They Differ?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 Management"Definition of Manager and LeaderWhat Happens When There Is No Leader?Leadership PrinciplesAbraham Lincoln on Leading ChangeAbraham Lincoln’s Principles of LeadershipLeading Change to a Slave-Free AmericaHealthcare’s Change LeadersWalking the TalkDefinition of Common Terms across MethodologiesKey PointsNotes

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 ImprovementPiloting ChangesWhat Can Happen if Change Is Not Piloted FirstBalancing 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 Dies and So Did His ImprovementForcing Does Not Always WorkThe Force of ResistanceBen Franklin, Electricity, and Change LeadershipPrinciples of Electricity Explain Resistance to ChangeWhat You Cannot See Can Hurt YouUsing Resistance to Help Lead ChangeElectricity and Forcing Change Can Be DangerousGetting Change to FlowThe Resistance to Change Can Vary within the Same PersonResistance between Two BodiesResistance at HomeKey Points

Process Improvement MethodologiesOverview of the Most Popular MethodologiesYou Need at Least One Recipe and Do Not Forget a "Heaping Tablespoon" of Change LeadershipWhich Recipe Delivers the Culture and Change Leadership Skills?Work with Toyota and for MotorolaMotorola and Toyota Use Lean and Six Sigma Tools and ConceptsPDSA and PDCA Compared to Six SigmaAll Good Methods Analyze for Root Causes before SolutionsCase Study of Sterilized Instrument ProcessingA "Milk Run"Cross Reference of PDSA, Six Sigma, Lean, Change LeadershipHuman Factors and Ergonomics in Process ImprovementCase Study: Human Factors Added to Lean Six Sigma?Hand Hygiene Change Leadership IssueFailure to Engage Others with the MeasureBaseball and Managing to the MeasureMeasures for Research PurposesMeasures for Process Improvement PurposesCedars-Sinai Using Measure and Manage to the MeasureKey PointsNotes

Roadmap for Process ImprovementIntroductionStart the Journey on Main StreetLet Us Start on Our JourneyPossible ShortcutPrepare for ChangeTrainEnvisionArticulating a VisionElements in a Vision StatementTry Out Your Vision StatementHow Does One Communicate the Vision?Abraham Lincoln’s VisionAdvocate a Vision and Continually Reaffirm It For Whom the Bell TollsEngageEnableQuality CirclesEnabling during the Recession of the Early 1980sAssumptions and DecisionsEmpowerKey PointsNotes

Chartering the Process Improvement WorkThe CharterNo Charter? Big ProblemSharing Findings before DepartingClear Definition of the Issue and What Was to Be Measured Are KeyThe Final Report and SurpriseThe Charter TemplateThe Issue StatementThe Measures or MetricsOutcome and Process MeasuresGoalsProgressive Goals and Successive Successful ApproximationsMeasures and Goals to Build a Safer CultureHold Off on Financial Metrics Until Scope the WorkCharter "Signatories"SponsorChartering Is IterativeSign the CharterKey PointsPracticing Skills: CharteringNotes

Stakeholder AnalysisPurpose of Stakeholder AnalysisCase Study in Stakeholder AnalysisMission and Values of the OrganizationStakeholdersOverview of the SHAMeasuring the Gap: The Level of ResistanceThree Stakeholder Analysis Scenarios to Know Up Front for Your StrategyDesigning the "Circuit" to Achieve Flow and Manage ResistanceDifficult to Be PerfectThem Is Us EventuallyStarting a New ClinicTime to Assess Each Stakeholder’s Buy-inKey PointsNotes

Finding the Root Causes, Improving, and ControllingExplore TogetherDoctor Livingstone, I Presume?Explore Together with Empathy and PatienceBuilding the TeamCase Study: Patient Feeds Go MissingWork-Arounds in the "Factory of Hidden Defects"Exploring Using the "Five Whys"ExplainExperimentExploreBrainstorming for SolutionsBuilding ConsensusResistanceAdditional Benefits from the Process ImprovementTrain, Enable, Empower, Hold AccountableTraining in the ImprovementsCase Study: Enabling and Engaging the Customer in the ProcessThere Are Good Times, and There Are Bad TimesEnableEmpowerHold AccountableTimes Not to Speak Up? Key PointsNotes

Utilizing the 3Ms: Measure, Manage to the Measure, and Make It EasierIntroductionMeasurePracticing MeasureManage to the MeasureMake It EasierVisual ManagementMeasuring ExampleManaging to the Measure ExampleMake It Easier ExampleTakt Time: A Measure of the Pace Needed to Meet Customer DemandMeasuring: The Most Important MApplying the First of the Three Ms and Seeing the ValueSetting Up Your ExperimentMeasuring the BaselineStatistical Process Control Charting: Turning Data into InformationSample SizeHand Hygiene and the 3MsReady to ObserveAlternative ExperimentThe Hawthorne EffectDesire to Increase ProductivityUtilizing the 3Ms by Changing the MeasureIncentive Piecework as a MeasureMore on the Perverse Incentive MeasureFrench Restaurant DiningThe Hawthorne Effect RevisitedCase Study in Timeliness in Sharing the MeasureKey PointsNotes

What to MeasureIntroductionHidden Factory of Rework and Swiss CheeseGetting Started: Preparing for Change, Chartering, and Stakeholder AnalysisCase Study: 3Ms Improving Surgical SafetyThe Measure Is InventedMeasuring the Errors to Reduce the Risk of Wrong-Site SurgeryMeasuring the Quality of a DecisionPracticing MeasuringSetupA Change in One Area May Affect Other AreasInventory ManagementBalancing Metrics, Be Careful What You Measure!Measure 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 CultureKey PointsNotes

Measure Risk to Achieve High ReliabilityIntroductionThe FMEA FormThe Process Step or Design FunctionInput, Failure Modes, Effects, Causes, and Scoring of RiskExisting ControlsRisk Priority NumberOne FMEA Every Eighteen Months Sends the Wrong MessageFMEA for Information TechnologyData Can Be a Component in Today’s High-Tech EquipmentBut There Never Has Been an FMEA on Data ComponentsFMEAs Do Not Always Prevent Catastrophic FailureLesson of 3Ms: Must Manage to the Measure, Not Just MeasureFacilitating an FMEAKey PointsNotes

Measurement as a SystemOverviewMeasurement as a SystemMeasuring the Quality of a Measurement System (Measurement System Analysis)Qualities of an Acceptable Measurement SystemMeasuring the Quality of a Measurement System: A Measurement System AnalysisAccuracy and PrecisionAccuracyPrecisionRepeatabilityReproducibilityDesigning a Measurement SystemPerforming a Measurement System AnalysisMSA Can Be Really EasyMSAs Are Critical in Utilizing the 3MsInaccurate Measurement Systems Can Lose You CustomersA Measurement System Using Actual Data by Surgeon and by ProcedureDrawdownMeasurement Systems that Add No Value to the ClientCalibrating a Measurement SystemCategories and Types of DataChecklists as Measurement SystemsGranularityDiscriminationOverview of Performing a Gauge R&R StudyMSA for Blood Pressure ReadingMSA for Attribute DataAttribute Agreement AnalysisThe Soft Drink Challenge with AAAStabilityLinearityOverview of MSA for Continuous Data and High GranularityGauge Repeatability and ReproducibilityExample of a MSA and StepsPrecision to Tolerance (%P/T)Knowing Good from BadPercentage Precision to Total Variation (%P/TV)Percentage ContributionSamplingShould I Measure 100% or Sample?Sampling QualityKey PointsNotes
How to Share and Communicate MeasurementsChartingPareto ChartsPareto Analysis to Reduce ResistanceAsk Why Five TimesStatistical Process Control (SPC) ChartsMay 1924High-Reliability Organizations and SPCThe "Swiss Army Knife" for Process ImprovementComponents of the Control ChartControl and Out of ControlCase Study: Ambulatory Surgical Center Wait TimesInterpreting SPC ChartsReliability and SPCSPC Is Often Preferred in Managing to the MeasureProve Change Really OccurredChange Management without SPC?Frontline Workers Have Been Using SPC Since the 1920sRun ChartsMeasuring Common Healthcare MeasuresKey PointsNotes

3Ms: Manage to the MeasureThe ScoreboardVisual ManagementWhat to Expect Short and Long Term from MeasuringInstructing and CoachingTraining within IndustryJob InstructionsJob MethodsJob RelationsProgram DevelopmentStandard Work to Manage to the MeasureCoaching Is Key in Managing to the MeasureCoach’s PlaybookKey PointsNotes
3Ms: Make It EasierPerformance Improvement Makes It Easier to ChangeThe "Laws" in Change LeadershipCase Study: Nurses Spending Time with PatientsJob SatisfactionMaking Change Easier Is What We Need to DoSatisfaction and Loyalty MeasurementExplainExperiment, Explore, Build ConsensusChoosing the Best CountermeasuresPiloting and Choosing the Best CountermeasuresPiloting to See if the Measure MovesTrain, Enable, Empower, and Hold AccountableMindfulness and ControlMindfulnessCommitment to ResilienceCase Study: Penn Medicine Utilizing the 3MsSPC Making It EasierKey PointsNotes

High ReliabilityIntroductionCase Study: SKFHigh-Reliability Program Number 1High-Reliability Program Number 2The Products Surrounding the VariationScrapping versus InspectingUtilizing the 3Ms in Zero Defects and SWOCProgram 3: Building a Safety Culture2A Story of a Seal and Its GreaseChange Is Not Always Easy, Except Stakeholder Analysis Revisited for Making It EasierDesigning an Experiment Should Start with the People Doing the WorkKey PointsNote
SummaryUtilizing the 3Ms Is the AnswerMistake-Proofing?Mistake-Proofing Promotes Defect Prevention versus DetectionTypes and Levels of Mistake-Proofing DevicesStart with Failure Modes and Effects Analysis, Then Mistake-Proof the High RisksErrors Cause DefectsHuman Error Drives the Need for Mistake-ProofingMistake-Proof ApproachesTrain, Engage, Enable, and Empower the People Doing the WorkControl PlansLast and Definitely Not Least: Reinforcing Continuous Process ImprovementKey PointsNotes

Appendices:Roadmap for Performance ExcellenceProcess Improvement Foundational ToolsThe Emancipation ProclamationCharter TemplateStakeholder Analysis TemplateHand Hygiene Data Collection SheetHand Hygiene Compliance Chart for PostingMeasure Data Collection ToolFMEA Severity, Occurrence, Detection TablesThe Soda Drink Challenge to Learn Attribute Agreement Analysis
Index