BUT IT TAKES SO LONG 2

Given these findings, one of the organizations reviewed its history with other types of projects and discovered that these, too, had taken an extremely long time.

These delays resulted from the organization’s limited expertise in basic planning techniques, which carried over to its quality improvement projects.
As a result, team leaders and facilitators were provided with additional training in basic project management techniques.

It is obvious that if team members spend more time each week working on their project, they will complete the project faster; therefore, if the project is important, the team should spend more time on it. The time lost for this category represents the extra weeks that were required to complete the project because team members did not spend a minimum of four hours each week on the project, including time both in and out of team meetings.

Remedies to chronic quality problems often have profound impacts on people, and some will resist proposed changes, no matter how beneficial. Sometimes after a team does all it can to deal with the possible resistance, executive leaders must take action to deal with it.

Many projects are launched without any data to demonstrate the magnitude of the problem.
Without measurement, a team cannot know the magnitude of the problem when the project begins or whether the problem has been eliminated when the project is completed. The absence of a measure does not automatically mean that the project is a poor one, but it does mean that the project team’s first task must be to develop these measures. As organizations mature in quality management, they will routinely develop more appropriate quality measures so later projects can be identified and chartered using reliable data.

If the mission assigned to the team is vague, has several possible meanings, or is not significant, teams will waste a lot of time. Even if the team thinks it understands its mission, it can waste time pursuing one aspect of a problem when another aspect was the intent.

Two typical examples of poor mission statements include:

• “Improve timeliness of proposals”: does this mean reduce the elapsed cycle time? The total number of staff hours consumed? The total amount of time spent on the task?
• “Improve communication in the hospital”: between what people or organizations? On what topic? What is the evidence of poor communication? How will it be measured?

A key to effective quality improvement is identifying and eliminating the vital few root causes of the problem.
When a team becomes distracted with interesting but minor parts of the problem, it takes far longer to solve the problem.

One team with the goal of reducing delays in the delivery of one of its company’s services had many theories about those delays.

One of the theories was that errors in the customer-service data base created delays in scheduling. This theory was widely believed by the team members and was the first one tested.
Errors in the data base turned out to be minuscule and almost never caused service delays. Nevertheless, the team would not let go of that theory. Every time new data were collected to test other theories, additional data were collected about data base errors, always with the same finding that they were not a problem.

Even the proposed remedy had a component to audit and eliminate data base errors. The team ended up wasting at least eight weeks trying to eliminate a source of error that was previously identified as not being a problem.

Flow diagrams are an effective part of many quality improvement projects, but they should not be an end in themselves or be unnecessarily elaborate and complex for the problem they are addressing.

One team was working to speed up a purchasing process. It spent eight weeks drawing exquisitely detailed flow diagrams, with at least 80% of that time spent diagramming work within the purchasing department itself.
When the team finally collected data on the time required for each major step in the process, it discovered that nearly two-thirds of the total time and at least 90% of the waiting time was spent in the approval process before the purchase request reached the purchasing department.

Had the team just collected its initial data based on a high-level flow diagram, it could have saved at least six weeks because nothing in its more detailed chart was needed for that data collection.

Because quality improvement teams are being asked to do something that is often new to them, they typically require two to three days of training.

In some cases, this basic training is received prior to the start of the project, with refresher and supplemental training along the way. In other cases, all or most of the training is provided during the team meetings.

While confining training to team meetings provides a better opportunity to apply skills directly to the project as they are learned, it also makes the project last longer.
Organizations can avoid this delay and still have the immedi acy of applications if they use concentrated team training, which applies what participants have learned to parts of their project during the initial training session and uses a case study for application of all of the process during the training.

If an organization does decide to deliver all the training during the team meetings, it should explicitly identify and allow for the extra time that this choice is adding to the project.

Then the apparent project time really has two components:

• the actual project time
• the training time

If 16 hours of training is delivered during the course of a project and the team meets two hours per week, that can add up to eight weeks to the apparent project time.

If a project team were to implement a remedy before diagnosing the root cause, it might be in for a rude surprise.

If the remedy does not really address the root cause, there will be little or no improvement.
In all the cases in which teams jumped prematurely to solutions, another few weeks of diagnosis would have saved them time and money because, in the end, they had to diagnose the problem further and implement additional solutions.

Several teams concluded that their problems lay with inadequate training or documentation for the individuals operating the process. They then implemented a variety of training and informational efforts that made only the most marginal and ephemeral improvements because the fundamental flaws lay in the way the work was designed.

Another one of the studied project teams concluded that some of its equipment should be replaced with more modern models. The results were disappointing because the old models were fully capable of the tolerances if they were calibrated properly. Inadequate calibration of the new equipment perpetuated the problem.

As previously discussed, one of the more surprising findings was that many teams did a poor job of preparation before they implemented their remedies.

Reasons for the teams’ poor implementation of solutions included:

• The team had no implementation plan at all
• The team failed to provide needed training
• Key procedures, forms, or materials were missing or incomplete
• Key individuals were left out of the implementation plan

Most of the lost time identified in this analysis falls into two general categories:

• Failure to adhere to best quality improvement practices.
  These failures include mission statements that are not specific, specific, observable, and measurable, and neglect of the Pareto principle (to sort the vital few factors from the useful many)
• Mechanical application of tools and process steps without sufficient focus on the reason for the activity or the mission of the team.
  This rigid orthodoxy can lead teams to waste time with excessive flow diagrams, to try solving cultural and organizational problems that senior executives are unwilling to address, or to draw Pareto diagrams but not act on the results

To prevent lost time and gain maximum, rapid impact from quality improvement, senior executives should make sure that:

• They personally know and properly execute their joint responsibilities with respect to quality improvement, especially as they relate to selecting and defining the missions of projects
• Teams are trained in proven methods for quality improvement, using training materials that adhere to the best adult learning principles
• Facilitators and quality managers are properly prepared to spot potential delays in quality improvement projects and intervene if they need to be put back on track

In addition to avoiding the typical project difficulties identified in this study, organizations that are serious about revolutionary rates of quality improvement should conduct similar reviews of their own projects.
Each organization has unique difficulties that reflect its culture, professional development history, and policies.

This article focused primarily on the actions related to an individual quality improvement project. In addition to these, there are a number of other actions needed maintain the infrastructure for successful quality improvement projects, including facilitation support for teams; adequate training; time and support from immediate supervisors of team members; encouragement and recognition from immediate supervisors, upper managers, and peers; and performance management and compensation systems that reinforce quality.

Structured, formal quality improvement is a vital part of a successful quality strategy. If it is adequately supported and rigorously reviewed, the rewards will be substantial.

Cumulative experience with structured quality improvement teams demonstrates that by observing the lessons learned from others, teams can deliver significant breakthroughs in short periods of time.