This document discusses the use of process behavior charts (PBCs) to evaluate processes, metrics, and improvement efforts. It emphasizes that PBCs help distinguish common cause variation from special cause variation to avoid overreacting to normal fluctuations or missing important signals of change. The document provides examples of how PBCs can be used to evaluate metrics over time, determine if processes are predictable and capable of meeting goals, and identify when improvements have actually resulted in process changes. It argues that PBCs support a more scientific approach to problem solving and help organizations react less and improve more.
12. • One goal is reducing waste
• This includes “management waste”
• Wasted motion
• Overprocessing
A Lean Management System
Looking for a root cause that isn’t there
18. 1. Are we achieving our
target or goal?
2. Are we improving?
3. How do we improve?
Three Key Questions
19. 1. Which of these numbers
(if any) suggests that the
system has changed
significantly?
2. Which of these merit
reaction, investigation, or
explanation?
3. How do we prioritize?
Three More Questions
22. There is VARIATION in Every Metric
• The question is “how much variation is routine?”
• Personal examples:
• Body weight
• Resting heart rate
• Commuting time
60
65
70
75
80
1-Jul
3-Jul
5-Jul
7-Jul
9-Jul
11-Jul
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21-Jul
23-Jul
25-Jul
27-Jul
29-Jul
31-Jul
2-Aug
4-Aug
6-Aug
8-Aug10-Aug12-Aug14-Aug16-Aug
Run Chart (Mark's Resting Heart Rate)
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5/27/16
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6/20/16
6/22/16
6/24/16
6/26/16
6/28/16
6/30/16
7/2/16
7/4/16
Run Chart (Weight)
23. Signals vs. Noise
“While every data set contains noise,
some data sets may contain signals.
Therefore, before you can detect a signal
within any given data set,
you must first filter out the noise."
"Process Behavior Charts"
24. #PlotTheDots — Hospital Covid-19 Dashboard
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2-Apr
3-Apr
4-Apr
5-Apr
6-Apr
7-Apr
8-Apr
9-Apr
10-Apr
11-Apr
X Chart (Number of Employees Out Sick)
Chart Courtesy of Memorial Health System (Marietta OH)
Goal: Avoid Reacting to Every Up & Down
26. Has the System Changed?
(10)
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10
20
30
40
50
3/12/20
0:003/13/20
0:003/14/20
0:003/15/20
0:003/16/20
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0:003/18/20
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0:003/28/20
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0:003/30/20
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0:004/1/200:004/2/200:004/3/200:004/4/200:004/5/200:004/6/200:004/7/200:004/8/200:004/9/200:004/10/20
0:004/11/20
0:00
X Chart (Number of Employees Out Sick)
SIGNAL
“SPECIAL CAUSE”
What changed?
What is the root cause?
Note: The last data point is a hypothetical situation
30. A PBC for the Toyota Way Fieldbook “Trend Chart”
NOISE
“COMMON CAUSE”
There is NO “root cause” for
any of those data points
But we CAN improve the
system systematically
32. We Made Improvements (?) to the System
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10
20
30
40
50
60
70
80
90
100
Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19
Rate this Facility - % of Patients Giving “9” or “10”
33. We Made Improvements (?) to the System
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10
20
30
40
50
60
70
80
90
100
Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19
Rate this Facility - % of Patients Giving “9” or “10”
SIGNAL
34. We Made Improvements (?) to the System
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1.00
2.00
3.00
4.00
5.00
6.00
January-17
February-17M
arch-17
April-17
M
ay-17
June-17
July-17August-17
Septem
ber-17October-17
Novem
ber-17
Decem
ber-17January-18
February-18M
arch-18
April-18
M
ay-18
June-18
July-18August-18
Septem
ber-18October-18
Novem
ber-18
Decem
ber-18January-19
February-19M
arch-19
X Chart -- Pain Score (0-10)
Caudal Epidural Analgesia in 2017 Pudendal Nerve Block in 2018
35. We Made Improvements (?) to the System
-
1.00
2.00
3.00
4.00
5.00
6.00
January-17
February-17M
arch-17
April-17
M
ay-17
June-17
July-17August-17
Septem
ber-17October-17
Novem
ber-17
Decem
ber-17January-18
February-18M
arch-18
April-18
M
ay-18
June-18
July-18August-18
Septem
ber-18October-18
Novem
ber-18
Decem
ber-18January-19
February-19M
arch-19
X Chart -- Pain Score (0-10)
Caudal Epidural Analgesia in 2017 Pudendal Nerve Block in 2018
NO CHANGE
36. We Made Improvements (?) to the System
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20
40
60
80
100
120
January-18 February-18 March-18 April-18 May-18 June-18 July-18 August-18 September-18 October-18 November-18 December-18
X Chart (PACU Minutes)
(Old Protocol) (New Protocol)
NO CHANGE?
37. Evaluating Clinical Process Change (2)
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20
40
60
80
100
120
January-18 February-18 March-18 April-18 May-18 June-18 July-18 August-18 September-18 October-18 November-18 December-18
X Chart (PACU Minutes)
(Old Protocol) (New Protocol)
SIGNAL
38. We Need to Avoid Bad Conclusions
“Look at that positive trend!”
Narrator: It isn’t a trend
42. 1. Are we achieving our
target or goal?
2. Are we improving?
3. How do we improve?
Three Key Questions
43. Bowling Chart as Run Charts - #PlotTheDots
0%
10%
20%
30%
40%
50%
60%
70%
80%
Jan Feb Mar Apr May Jun Jul Aug Sep
Run Chart (Team Engagement)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Jan Feb Mar Apr May Jun Jul Aug Sep
Run Chart (Recommend)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Jan Feb Mar Apr May Jun Jul Aug Sep
Rating
0.0
0.2
0.4
0.6
0.8
1.0
1.2
Jan Feb Mar Apr May Jun Jul Aug Sep
Run Chart (Falls w/ Sev Injury)
0.0
0.5
1.0
1.5
2.0
2.5
Jan Feb Mar Apr May Jun Jul Aug Sep
Run Chart (CLABSI)
0.0
0.2
0.4
0.6
0.8
1.0
1.2
Jan Feb Mar Apr May Jun Jul Aug Sep
Run Chart (CAUTI)
WHEN SHOULD WE REACT?
44. Bowling Chart as PBCs
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (Falls w/ Sev Injury)
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (CLABSI)
0.0
0.2
0.4
0.6
0.8
1.0
1.2
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (CAUTI)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (Team Engagement)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (Recommend)
50%
55%
60%
65%
70%
75%
80%
85%
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (Rating)
SIGNAL
NOISE
SIGNAL
45. Bowling Chart as PBCs with Red/Green
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (Falls w/ Sev Injury)
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (CLABSI)
0.0
0.2
0.4
0.6
0.8
1.0
1.2
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (CAUTI)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (Team Engagement)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (Recommend)
50%
55%
60%
65%
70%
75%
80%
85%
Jan Feb Mar Apr May Jun Jul Aug Sep
X Chart (Rating)
SIGNAL
SIGNAL
NOISE
55. Process Behavior Charts
“A simple tool that helps drive a mindset
change to being more systematic about
the success of improvement work.”
President, Ambulatory Services