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Quality and Performance Improvement Samaritan Institute Annual Conference, August 5, 2011 Linda La. Ganga, Quality and Performance Improvement Samaritan Institute Annual Conference, August 5, 2011 Linda La. Ganga, Ph. D. , LPC, NCC Director of Quality Systems & Operational Excellence Mental Health Center of Denver, CO, USA Linda. [email protected] org Websites for Publications and Presentations: https: //secure. smhcd. org/Outcomes. Pubs. aspx http: //leeds-faculty. colorado. edu/lawrence/apptsched/ Samaritan Institute Conference, © 2011 Linda La. Ganga 1

Quality Systems and Operational Excellence Act Operational Excellence Clinical Quality Improvement Consumers Consumer Advocacy Quality Systems and Operational Excellence Act Operational Excellence Clinical Quality Improvement Consumers Consumer Advocacy Plan Continuous Quality Improvement Staff Tools, Processes Knowledge Project Research, Coordination Training & Staff Development, Development Evaluation Check Samaritan Institute Conference, © 2011 Linda La. Ganga Health Information Systems Management Quality Systems Analysis Do 2

Learning Objectives This workshop is designed to help you: 1. Analyze your current approaches Learning Objectives This workshop is designed to help you: 1. Analyze your current approaches to quality improvement 2. Select appropriate activities to strengthen your quality improvement program 3. Develop and interpret flow charts to improve processes 4. Facilitate effective brainstorming sessions 5. Apply tools of quality for problem solving and process improvement 6. Develop effective quality improvement plans 7. Find and utilize resources for training and dissemination of QI tools Samaritan Institute Conference, © 2011 Linda La. Ganga 3

Workshop Topics 1. The Tools of Quality 2. Continuous Improvement: The Deming Wheel 3. Workshop Topics 1. The Tools of Quality 2. Continuous Improvement: The Deming Wheel 3. The Six Sigma Cycle 4. Choosing Appropriate Measures 5. Developing a Quality Improvement Plan 6. Resources for Continuous Improvement Samaritan Institute Conference, © 2011 Linda La. Ganga 4

The Seven Basic Tools of Quality • A fixed set of graphical techniques identified The Seven Basic Tools of Quality • A fixed set of graphical techniques identified for addressing issues related to quality • Suitable for people with little formal training in statistics • Developed in Japan after World War II (late 1940 s-1950 s) • “Democratizing Statistics” Samaritan Institute Conference, © 2011 Linda La. Ganga 5

What are the Seven Basic Tools? 1. The Cause-and-Effect diagram – Fishbone chart/diagram – What are the Seven Basic Tools? 1. The Cause-and-Effect diagram – Fishbone chart/diagram – Ishikawa diagram 2. 3. 4. 5. 6. 7. Check sheet Histogram Pareto chart Control chart Flow chart Scatter diagram Samaritan Institute Conference, © 2011 Linda La. Ganga 6

Brainstorming • Not one of the actual 7 Tools • Idea generation • Plays Brainstorming • Not one of the actual 7 Tools • Idea generation • Plays a crucial role – Problem solving – Quality improvement – Analysis • Flow of ideas • Allow time • Do not critique ideas in this phase! Samaritan Institute Conference, © 2011 Linda La. Ganga 7

Selected Tools: Cause-and-Effect Diagram • Also known as an Ishikawa or fishbone diagram • Selected Tools: Cause-and-Effect Diagram • Also known as an Ishikawa or fishbone diagram • Identify and illustrate the relationships between an effect, an outcome, or a problem and hunches about the possible causes or factors that contribute to it • Articulate theories about root causes and their own inter-relationships Samaritan Institute Conference, © 2011 Linda La. Ganga 8

Steps in a Cause-and-Effect Diagram 1) Summarize your problem statement. 2) Determine the headers Steps in a Cause-and-Effect Diagram 1) Summarize your problem statement. 2) Determine the headers (i. e. , categories to trigger thinking about possible causes). 3) Determine what elements each category are contributing to the effect. 4) Continue to dig for the causes in each branch until you reach the root cause of each bone. 5) Clean out the diagram before testing theories reflected within it. 6) Narrow down your theories. Samaritan Institute Conference, © 2011 Linda La. Ganga 9

Construction of a Cause-and-Effect Diagram 1) Summarize your problem (spine of the fish). 2) Construction of a Cause-and-Effect Diagram 1) Summarize your problem (spine of the fish). 2) Determine headers/categories and draw these as lines attached to the spine (bones/branches). Samaritan Institute Conference, © 2011 Linda La. Ganga Quality & Process 10

Construction of a Cause-and-Effect Diagram 3) Add subsidiary categories/contributing causes (additional branches to the Construction of a Cause-and-Effect Diagram 3) Add subsidiary categories/contributing causes (additional branches to the main category lines). Samaritan Institute Conference, © 2011 Linda La. Ganga Quality & Process 11

Fishbone Suggested Categories Manufacturing Industries (The 6 Ms) • Machines • Methods • Materials Fishbone Suggested Categories Manufacturing Industries (The 6 Ms) • Machines • Methods • Materials • Measurements • Mother Nature (Environment) • Manpower (People) Service Industries (The 4 Ps) • Policies • Procedures • People • Plant/Technology Samaritan Institute Conference, © 2011 Linda La. Ganga 12

Fishbone Diagram Example • Ever had a problem with clinical documentation? • What can Fishbone Diagram Example • Ever had a problem with clinical documentation? • What can we discover through a framework of People, Procedures, Policies, and Plant(Technology)? • Opportunities for improvement? Samaritan Institute Conference, © 2011 Linda La. Ganga 13

Illustration of a Tool: Check Sheet Samaritan Institute Conference, © 2011 Linda La. Ganga Illustration of a Tool: Check Sheet Samaritan Institute Conference, © 2011 Linda La. Ganga 14

Illustration of a Tool: Histogram • Frequency distribution • Number of observations or population Illustration of a Tool: Histogram • Frequency distribution • Number of observations or population members in each category • This example could be number of residents in each age range • Scores on a 50 -point quiz • Weights of domestic pets Samaritan Institute Conference, © 2011 Linda La. Ganga 15

Selected Tools: Pareto Charts • Steps: – Gather data by category – Sort from Selected Tools: Pareto Charts • Steps: – Gather data by category – Sort from high to low – Calculate percentage and cumulative percentage Category of complaint Wait for doctor Ease of appointment Ease of phoning Convenient hours Courtesy of receptionist Number of Percentage Cumulative% complaints 150 26. 79% 112 20. 00% 46. 79% 99 17. 68% 64. 46% 92 16. 43% 80. 89% 35 6. 25% 87. 14% – Only first five categories shown above – Graph to see the “vital few” versus “trivial many” Samaritan Institute Conference, © 2011 Linda La. Ganga 16

of or tf ai W ap doc Ea po tor se intm Fr o of or tf ai W ap doc Ea po tor se intm Fr o ie C en nd Co on f p ur ve ho t lin n es tes ni en ing s of y of th R es ph rec ou po on ep rs ns e t re ion iv c i e ca ep st t C om re v ioni st fo ia ph rta Ph ble one ys wa R e i C Ex sp cia iting on n e fid pla ctfu lis te en na tio l ph ns ce in n o ysic ia ph f tr ys ea n t ic ia me Ti n’s nt m a R e to bili es t pe reg y ct is of ter nu rs es se Ea Percednt Complaint Source 30% 120% 25% 100% 20% 80% 15% 60% 10% 40% 5% 20% 0% 0% Samaritan Institute Conference, © 2011 Linda La. Ganga Cumulative Percent Pareto Chart of Complaints Data with full set of categories Percent of Complaints Cumulative Percent 17

Selected Tools: Control Charts for monitoring variation between samples • Elements of a control Selected Tools: Control Charts for monitoring variation between samples • Elements of a control chart – Calculated process average – Calculated control limits – Plotted observations Samaritan Institute Conference, © 2011 Linda La. Ganga

Selected Tools: Process Flow Charts Use a Flowchart? Who, Languish in Pitiful me? Process Selected Tools: Process Flow Charts Use a Flowchart? Who, Languish in Pitiful me? Process Pitfalls No Who wouldn’t? Yes Collect Rewards for Radical Process Improvement Samaritan Institute Conference, © 2011 Linda La. Ganga 19

Flowchart Example: Pharmacy Prescriptions Yes START: New prescription ? Consumer sees psychiatrist. Consumer is Flowchart Example: Pharmacy Prescriptions Yes START: New prescription ? Consumer sees psychiatrist. Consumer is on DH plan? Yes No Consumer requests refill by phone or in person from filling pharmacy. continue MHCD psychiatrist FAXes Rx to DH. DH prescriber receives and signs Rx. Rx filled and consumer picks it up at DH pharmacy. Samaritan Institute Conference, © 2011 Linda La. Ganga Psychiatrist faxes Rx to pharmacy of choice or gives consumer a hardcopy of Rx to take to pharmacy. END 20

Refills remaining in filling pharmacy’s System? No Pharmacy contacts provider. Provider okays refills. Yes Refills remaining in filling pharmacy’s System? No Pharmacy contacts provider. Provider okays refills. Yes Rx filled and consumer picks up medications. END Samaritan Institute Conference, © 2011 Linda La. Ganga 21

Illustration of a Tool: Scatter Diagram • Two-dimensional plot of data • Does there Illustration of a Tool: Scatter Diagram • Two-dimensional plot of data • Does there appear to be relationship? Samaritan Institute Conference, © 2011 Linda La. Ganga 22

Workshop Topics 1. The Tools of Quality 2. Continuous Improvement: The Deming Wheel 3. Workshop Topics 1. The Tools of Quality 2. Continuous Improvement: The Deming Wheel 3. The Six Sigma Cycle 4. Choosing Appropriate Measures 5. Developing a Quality Improvement Plan 6. Resources for Continuous Improvement Samaritan Institute Conference, © 2011 Linda La. Ganga 23

Continuous Improvement: The Deming Wheel • Based on Deming’s concept that continuous improvement is Continuous Improvement: The Deming Wheel • Based on Deming’s concept that continuous improvement is a never-ending cycle • Steps 1. Plan 2. Do 3. Check 4. Act • Who created the Deming Wheel? Samaritan Institute Conference, © 2011 Linda La. Ganga 24

1. Plan Steps in the Deming Wheel: Assess Your QI Process – Define and 1. Plan Steps in the Deming Wheel: Assess Your QI Process – Define and Select a Problem or Process – What is the improvement opportunity? – What can data tell us? • Example using global data • Example of clinic no-show data Samaritan Institute Conference, © 2011 Linda La. Ganga 25

Data from World Health Organization (2004) as reported Conference, Health First Aid Samaritan Institutein Data from World Health Organization (2004) as reported Conference, Health First Aid Samaritan Institutein Mental © 2011 Linda La. Ganga training, © 2007 11

U. S. Adults with a Mental Disorder in Any One Year Type of Mental U. S. Adults with a Mental Disorder in Any One Year Type of Mental Disorder Anxiety disorder % Adults 18. 1 . Major depressive disorder 6. 7 . Substance use disorder 3. 8 . Bipolar disorder 2. 6 . Eating disorders 2. 1 . Schizophrenia 1. 1 . 26. 2 . Any mental disorder Data from World Health Organization (2004) as reported Conference, Health First Aid Samaritan Institutein Mental © 2011 Linda La. Ganga training, © 2007 9

Appointment Data Samaritan Institute Conference, © 2011 Linda La. Ganga 28 Appointment Data Samaritan Institute Conference, © 2011 Linda La. Ganga 28

Step 1: Plan (continued) – Describe the current process: • What are the steps Step 1: Plan (continued) – Describe the current process: • What are the steps and decision points? • Where can the process proceed differently? – Possible causes of problems: • What are the root causes? • Addressing the problems or the symptoms? – Determine a solution • Workable? • Action Plan with clear target objectives Samaritan Institute Conference, © 2011 Linda La. Ganga 29

The Deming Wheel: Step 2 Assess your performance of this step 2. Do • The Deming Wheel: Step 2 Assess your performance of this step 2. Do • Pilot or small-scale initial implementation • Following the plan? – Milestones – Measures – Timing • How to gauge your progress? Samaritan Institute Conference, © 2011 Linda La. Ganga 30

The Deming Wheel: Step 3 Assess your performance of this step 3. Check • The Deming Wheel: Step 3 Assess your performance of this step 3. Check • Measure progress and success • Working as planned? • Unexpected/unintended consequences? • How to measure success? Samaritan Institute Conference, © 2011 Linda La. Ganga 31

The Deming Wheel: Step 4 Assess your performance of this step 4. Act • The Deming Wheel: Step 4 Assess your performance of this step 4. Act • Assess results • Recommend changes • Continue improvement where needed • Standardize changes • Celebrate results! Samaritan Institute Conference, © 2011 Linda La. Ganga 32

How’s Your Process Working? Plan Act Continuous Improvement Check Do 33 Samaritan Institute Conference, How’s Your Process Working? Plan Act Continuous Improvement Check Do 33 Samaritan Institute Conference, © 2011 Linda La. Ganga

Workshop Topics 1. The Tools of Quality 2. Continuous Improvement: The Deming Wheel 3. Workshop Topics 1. The Tools of Quality 2. Continuous Improvement: The Deming Wheel 3. The Six Sigma Cycle 4. Choosing Appropriate Measures 5. Developing a Quality Improvement Plan 6. Resources for Continuous Improvement Samaritan Institute Conference, © 2011 Linda La. Ganga 34

The Six Sigma Cycle • Steps – Define – Measure – Analyze – Improve The Six Sigma Cycle • Steps – Define – Measure – Analyze – Improve – Control • Where was it invented? • What was its initial focus? – Industry – Meaning of Six Sigma = 6σ Samaritan Institute Conference, © 2011 Linda La. Ganga 35

Six-Sigma Quality 3. 4 defects per million opportunities Most observations are at the Target Six-Sigma Quality 3. 4 defects per million opportunities Most observations are at the Target Value F R E Q U E N C Y Variance = σ, which is so small that 6σ fit between Target and Tolerance Limits Samaritan Institute Conference, © 2011 Linda La. Ganga Quality & Process 36

Comparison: Deming Wheel and Six Sigma Deming Wheel Six Sigma Elements PDCA DMAIC Philosophy Comparison: Deming Wheel and Six Sigma Deming Wheel Six Sigma Elements PDCA DMAIC Philosophy Incremental Continuous Improvement Quantifiable Value, High Financial Return Approach Repeat the cycle Monitor and applied to the control to sustain same process improvements, move on to next project Tools Emphasized Tools of Quality Samaritan Institute Conference, © 2011 Linda La. Ganga Advanced Statistics 37

Workshop Topics 1. The Tools of Quality 2. Continuous Improvement: The Deming Wheel 3. Workshop Topics 1. The Tools of Quality 2. Continuous Improvement: The Deming Wheel 3. The Six Sigma Cycle 4. Choosing Appropriate Measures 5. Developing a Quality Improvement Plan 6. Resources for Continuous Improvement Samaritan Institute Conference, © 2011 Linda La. Ganga 38

Choosing Appropriate Measures • • • What’s important? Why is it important? To whom Choosing Appropriate Measures • • • What’s important? Why is it important? To whom is it important? What are the problems? How do we know how we’re doing? Samaritan Institute Conference, © 2011 Linda La. Ganga 39

Measurement • Examples from Clinical Peer Review • Required for community mental health centers Measurement • Examples from Clinical Peer Review • Required for community mental health centers in Colorado – Conduct peer reviews – Use results to improve quality – Broadly defined • Measure: – Compliance = % of records in conformance with requirements – Treatment plans signed by consumers? – Treatment plan uses at least 2 consumer strengths? Samaritan Institute Conference, © 2011 Linda La. Ganga 40

Measurement: Examples from Peer Review (years past) What are opportunities to improve measurement? T Measurement: Examples from Peer Review (years past) What are opportunities to improve measurement? T 1 II. ISP T 2 1. Did the consumer/parent/guardian participate in the ISP? 82% 79% 2. Are the consumer’s strengths that are listed in the Intake integrated into the ISP? 3. Does the ISP effectively capture all MHCD and external services (i. e. coordination with PCP) 4. Are Objectives and Methods measurable and specific? 75% 78% 5. Is the ISP up to date? 88% 91% 6. Is the 6 -month case review up-to-date? 76% 71% III. Progress Notes 82% 80% 88% 91% 1. Does treatment in notes match ISP objectives? 93% 2. Are the consumer’s strengths, listed in the Intake and ISP integrated into the service delivery and Progress Notes? 3. Do notes follow the approved format with all sections completely filled out? 77% 79% Samaritan Institute Conference, © 2011 Linda La. Ganga 91% 94% 41

Measurement: Examples from Lean Process Improvement 1. Event data: Appointments and their status 2. Measurement: Examples from Lean Process Improvement 1. Event data: Appointments and their status 2. Process data: Steps and time to complete a process Samaritan Institute Conference, © 2011 Linda La. Ganga 42

Appointments scheduled and no-show rates before and after lean improvement Samaritan Institute Conference, © Appointments scheduled and no-show rates before and after lean improvement Samaritan Institute Conference, © 2011 Linda La. Ganga

Lean Process Improvement: One Year After Rapid Improvement Capacity Expansion RICE Results • Analysis Lean Process Improvement: One Year After Rapid Improvement Capacity Expansion RICE Results • Analysis of the 1, 726 intake appointments for the one year before and the full year after the lean project • 27% increase in service capacity – from 703 to 890 kept appointments) to intake new consumers • 12% reduction in the no-show rate – from 14% to 2% no-show • Capacity increase of 187 additional people who were able to access needed services, without increasing staff or other expenses for these services • 93 fewer no-shows for intake appointments during the first full year of RICE improved operations. • Annual cost savings (expense avoidance): $90, 000 - $100, 000 for staffing Samaritan Institute Conference, © 2011 Linda La. Ganga 44

 • Before: Comparing process steps: Before and After • Total steps with recurrent • Before: Comparing process steps: Before and After • Total steps with recurrent steps (worst case with 3 instances of steps 4 and 5) = 3 x 3 + 5 = 14 • After • Total steps with recurrent steps (worst case with 2 instances of steps 4 and 5) = 2 x 3 + 6 = 12 • Eliminates 2 steps Samaritan Institute Conference, © 2011 Linda La. Ganga

Comparing process time and lag time: • Before: • Total time (minimum possible) = Comparing process time and lag time: • Before: • Total time (minimum possible) = (30+50+60 minutes) + 2 days = 2 days 2 hours and 20 minutes • Total time (maximum if consumer is admitted on 4 th call) • = 5 weeks 4 hours and 5 minutes • After: • Total time (minimum possible) = Same as above • Total time (maximum if consumer is admitted on 3 rd call) • = 1 week 3 hours and 10 minutes • Process and lag time reduction of worst case: • > 4 weeks Samaritan Institute Conference, © 2011 Linda La. Ganga

Process Improvement • Accomplished by involving clinicians and consumers • Reconfiguration for timely and Process Improvement • Accomplished by involving clinicians and consumers • Reconfiguration for timely and consumer-friendly access • Measured – Increased intakes – Decreased no-show rates – Decreased delays to access La. Ganga, L. R. (2011). Lean service operations: Reflections and new directions for capacity expansion in outpatient clinics. Journal of Operations Management, 29(5), 422 -433. Samaritan Institute Conference, © 2011 Linda La. Ganga

Lean Process Improvement: Express Intake: Fast Track Project La. Ganga, L. R. , & Lean Process Improvement: Express Intake: Fast Track Project La. Ganga, L. R. , & Lawrence, S. R. (2009). POMS Proceedings and Presentation, May 2, 1: 30 p. m. , Knave. 48 Samaritan Institute Conference, © 2011 Linda La. Ganga

Measures of Perceptions • Customers • Consumers/Clients/Patients • Employees Samaritan Institute Conference, © 2011 Measures of Perceptions • Customers • Consumers/Clients/Patients • Employees Samaritan Institute Conference, © 2011 Linda La. Ganga 49

Clinical Outcomes and Recovery Data (1) Recovery Marker Inventory (RMI) (Staff rating of member Clinical Outcomes and Recovery Data (1) Recovery Marker Inventory (RMI) (Staff rating of member progress in recovery on eight dimensions. Used to inform clinical & program decisions - every 2 mo. ) (4) Recovery Needs Level (RNL) (Suggests best level of services for stage of recovery) To what degree is RECOVERY happening? w Multiple perspectives w Multiple dimensions w Change over time (2) Promoting Recovery in Organizations (PRO) (Consumer evaluation of how specific programs and staff are promoting recovery - random sample 1 x per yr. ) Samaritan Institute Conference, © 2011 Linda La. Ganga (3) Recovery Measure by Consumer (RMC) (Consumer’s rating of their own recovery on five dimensions – all members every 6 months) 50

Recovery Marker Indicators Samaritan Institute Conference, © 2011 Linda La. Ganga 51 Recovery Marker Indicators Samaritan Institute Conference, © 2011 Linda La. Ganga 51

Samaritan Institute Conference, © 2011 Reaching Recovery, © 2011 Linda La. Ganga Samaritan Institute Conference, © 2011 Reaching Recovery, © 2011 Linda La. Ganga

Specialized Control Charts Helps Us to Understand a Consumer’s Recovery Changes and Variability Compared Specialized Control Charts Helps Us to Understand a Consumer’s Recovery Changes and Variability Compared to All Other Consumers: Recovery Measures Change Slope 0. 3 0. 2 0. 1 0 Average Moderate Outlier Extreme Outlier -0. 1 -0. 2 -0. 3 1 3 5 Recovery Measures Intercept Samaritan Institute Conference, © 2011 Linda La. Ganga 7 53

Employee Perceptions • Annual Staff Satisfaction Survey – Common HR Items – Organization-specific initiatives Employee Perceptions • Annual Staff Satisfaction Survey – Common HR Items – Organization-specific initiatives – Numeric Scoring – Open-ended Comments • Gallup Q 12: Three x yearly – 5 -point scale • 5 = Strongly Agree, 1 = Strongly Disagree – “I know what’s expected of me at work” – “I have the materials and equipment to do my job” – “In the last seven days I have received recognition or praise for doing good work” – “This last year, I’ve had opportunities to learn and grow” Samaritan Institute Conference, © 2011 Linda La. Ganga 54

Workshop Topics 1. The Tools of Quality 2. Continuous Improvement: The Deming Wheel 3. Workshop Topics 1. The Tools of Quality 2. Continuous Improvement: The Deming Wheel 3. The Six Sigma Cycle 4. Choosing Appropriate Measures 5. Developing a Quality Improvement Plan 6. Resources for Continuous Improvement Samaritan Institute Conference, © 2011 Linda La. Ganga 55

Developing a Quality Improvement Plan • Samaritan Accreditation Standards • The Center shall develop Developing a Quality Improvement Plan • Samaritan Accreditation Standards • The Center shall develop a Quality / Performance Improvement Program that includes: A. a written description of the QI/PI program B. compiling and analyzing data on at least one clinical and at least one administrative function annually C. accountability to the Center board of directors D. at least annual public reporting of QI/PI results Samaritan Institute Conference, © 2011 Linda La. Ganga 56

Developing a Quality Improvement Plan: Tips from MHCD’s Experience since 1995 A. A written Developing a Quality Improvement Plan: Tips from MHCD’s Experience since 1995 A. A written description § What processes are important to improve? § How will you measure them? Who and how often? § Framework or philosophy § § § PDCA DMAIC CQI/TQM Principles § § Customer focus Data-driven Employee involvement Cross-functional / interdisciplinary teams Samaritan Institute Conference, © 2011 Linda La. Ganga 57

Developing a Quality Improvement Plan: Tips from MHCD’s Experience since 1995, Applied to Samaritan Developing a Quality Improvement Plan: Tips from MHCD’s Experience since 1995, Applied to Samaritan Accreditation Standards B. Compiling and Analyzing Data – Choose clinical and administrative functions • Examples – – – Adult Outpatient Children and Families Intake Process Grants Management Employee Satisfaction/Engagement/Retention – Select meaningful measures – Apply Tools of Quality Samaritan Institute Conference, © 2011 Linda La. Ganga 58

Developing a Quality Improvement Plan: Tips from MHCD’s Experience since 1995, Applied to Samaritan Developing a Quality Improvement Plan: Tips from MHCD’s Experience since 1995, Applied to Samaritan Accreditation Standards C. Accountability to the Center board of directors – Consider board priorities, backgrounds, interests – Measure baseline and change over time – Analyze change – Other projects and milestone completion D. At least annual public reporting of QI/PI results – Annual plan and report Samaritan Institute Conference, © 2011 Linda La. Ganga 59

Developing a Quality Improvement Plan: Tips from MHCD’s Experience since 1995, Applied to Samaritan Developing a Quality Improvement Plan: Tips from MHCD’s Experience since 1995, Applied to Samaritan Accreditation Standards Balance Comprehensiveness with Conciseness! – Elicit input – Edit for consistency and conciseness – Present with illustrations of importance and results! Samaritan Institute Conference, © 2011 Linda La. Ganga 60

Workshop Topics 1. The Tools of Quality 2. Continuous Improvement: The Deming Wheel 3. Workshop Topics 1. The Tools of Quality 2. Continuous Improvement: The Deming Wheel 3. The Six Sigma Cycle 4. Choosing Appropriate Measures 5. Developing a Quality Improvement Plan 6. Resources for Continuous Improvement Samaritan Institute Conference, © 2011 Linda La. Ganga 61

Resources for Continuous Improvement • Books and Printed Materials – The Memory Jogger 2: Resources for Continuous Improvement • Books and Printed Materials – The Memory Jogger 2: Tools for Continuous Improvement and Effective Planning, ISBN 978 -1 -57681 -113 -9 or see www. Memory. Jogger. org – Evans, James R. and William M. Lindsay, Managing for Quality and Performance Excellence, 8 th edition, South-Western, 2010, ISBN-13: 978 -324 -783 -205 -4, ISBN 10: 0 -324 -783205 – Foster, Thomas. Managing Quality, 4 th Edition, Prentice-Hall, 2010, ISBN-10: 0136088503 ISBN-13: 9780136088509 – Harry, Michel and Richard Schroeder, Six Sigma: The Breakthrough Management Strategy Revolutionizing the World's Top Corporations, Random House, 2005, ISBN 0 -385 -49438 -6 Samaritan Institute Conference, © 2011 Linda La. Ganga 62

 Resources for Continuous Improvement • Web sites – The American Society for Quality: Resources for Continuous Improvement • Web sites – The American Society for Quality: www. asq. org – Tools of Quality: http: //asq. org/learn-aboutquality/seven-basic-qualitytools/overview. html – www. isixsigma. com Tools and Templates Samaritan Institute Conference, © 2011 Linda La. Ganga 63

Quality and Performance Improvement Samaritan Institute Annual Conference, August 5, 2011 Linda La. Ganga, Quality and Performance Improvement Samaritan Institute Annual Conference, August 5, 2011 Linda La. Ganga, Ph. D. , LPC, NCC Director of Quality Systems & Operational Excellence Mental Health Center of Denver, CO, USA Linda. [email protected] org Websites for Publications and Presentations: https: //secure. smhcd. org/Outcomes. Pubs. aspx http: //leeds-faculty. colorado. edu/lawrence/apptsched/ Samaritan Institute Conference, © 2011 Linda La. Ganga 64