The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, 2nd Edition

Foreword xi

Preface xv

Acknowledgments xviii

The Authors xix

Introduction: The Improvement Guide, Second Edition 01

PART ONE: INTRODUCTION TO IMPROVEMENT 13

Chapter One: Changes That Result in Improvement 15

Principles of Improvement 15

The Model for Improvement 23

Key Points from Chapter One 25

Chapter Two: Skills to Support Improvement 27

Supporting Change with Data 28

Developing a Change 35

Testing a Change 41

Implementing a Change 43

Spreading Improvements 44

The Human Side of Change 45

Key Points from Chapter Two 46

Chapter Three: Improvement Case Studies 49

Case Study 1: Improving the Morning Meeting 49

Case Study 2: Improving Service in a Dental Office 54

Case Study 3: Improving Methods for Teaching Biology 60

Case Study 4: Contamination in Shipping Drums 63

Case Study 5: Reducing Energy Use in School 66

Key Points from Chapter Three 71

PART TWO: METHODS FOR IMPROVEMENT 73

Chapter Four: The Science of Improvement 75

Profound Knowledge 76

Milestones in the Development of Profound Knowledge 85

Key Points from Chapter Four 88

Chapter Five: Using the Model for Improvement 89

What Are We Trying to Accomplish? 89

How Will We Know That a Change is an Improvement? 93

What Changes Can We Make That Will Result in Improvement? 96

The Plan-Do-Study-Act Cycle 97

Using the Cycle to Build Knowledge 100

Key Points from Chapter Five 106

Chapter Six: Developing a Change 109

Some Typical Problems in Developing Changes 110

Reactive Versus Fundamental Change 111

Theory for Change 116

Methods for Developing Fundamental Change 120

Key Points from Chapter Six 136

Chapter Seven: Testing a Change 139

Applying the Science of Improvement to Testing 140

Principles for Testing a Change 144

Designs for Testing a Change 153

Strategies for Testing 168

Key Points from Chapter Seven 170

Chapter Eight: Implementing a Change 173

Testing a Change 174

Implementing a Change 174

Implementation as a Series of Cycles 175

Implementing Changes to Achieve and Maintain Improvement 179

The Social Aspects of Implementing a Change 186

Key Points from Chapter Eight 193

Chapter Nine: Spreading Improvements 195

A Framework for Spread 196

Phase for Organizational Readiness for Spread 197

Phase for Developing an Initial Spread Plan 205

Phase for Executing and Refining the Spread Plan 210

Key Points from Chapter Nine 216

Chapter Ten: Integrating Methods for the Improvement of Value 217

Eliminating Quality Problems 218

Reducing Costs While Maintaining or Improving Quality 224

Expanding the Expectations of Customers to Increase Demand 230

Developing an Environment Conducive to the Improvement of Value 235

Key Points from Chapter Ten 236

Chapter Eleven: Improving Large or Complex Systems 237

Project Setup and Management 239

Understanding the System and Developing High-Impact Changes 243

Testing and Learning Systems 250

Key Points from Chapter Eleven 262

Chapter Twelve: Case Studies of Improvement Efforts 263

Case Study 1: Reducing the Occurrence of No-Fault-Found Components 264

Case Study 2: Improving the Drill Process 269

Case Study 3: Reducing Infection and Mortality Rates in a Pediatric Intensive Care Unit 276

Case Study 4: Improving Safety at a Manufacturing Plant 285

Case Study 5: Improving the Credentialing Process at CareOregon 291

Case Study 6: Improving Sales at a Specialty Chemical Company 292

Key Points from Chapter Twelve 305

PART THREE: IMPROVING VALUE AS A BUSINESS STRATEGY 307

Chapter Thirteen: Making the Improvement of Value a Business Strategy 309

Building the System of Improvement 312

Key Points from Chapter Thirteen 328

Chapter Fourteen: Developing Improvement Capability 331

Developing Improvement Capability in the Workforce 333

Organization to Support the Focus on Improvement 340

Development of Other Capabilities 343

Key Points from Chapter Fourteen 346

Sample Agendas for Getting Started, Sponsors, and Improvement Advisors 348

Development of Internal Improvement Advisors: Topical Agenda 352

APPENDIXES 355

Appendix A: A Resource Guide to Change Concepts 357

How to Use Change Concepts 358

The Change Concepts 363

Appendix B: Tools and Methods to Support Improvement 409

Methods and Tools for Viewing Systems and Processes 410

Methods and Tools for Gathering Information 417

Methods and Tools for Organizing Information 423

Methods and Tools for Understanding Variation 433

Methods and Tools for Understanding Relationships 440

Methods and Tools for Project Management 442

Standard Forms for Improvement Projects 445

Appendix C: The Model for Improvement and Other Roadmaps 453

Fundamental Questions for Improvement 454

Alternative Roadmaps for Improvement Projects 456

Summary 464

Notes 465

Index 479