While all changes do not lead to improvement, all improvement requires change. The ability to develop, test, and implement changes is essential for any individual, group, or organization that wants to continuously improve. There are many kinds of changes that will lead to improvement, but these specific changes are developed from a limited number of change concepts.
A change concept is a general notion or approach to change that has been found to be useful in developing specific ideas for changes that lead to improvement. Creatively combining these change concepts with knowledge about specific subjects can help generate ideas for tests of change. After generating ideas, run Plan-Do-Study-Act (PDSA) cycles to test a change or group of changes on a small scale to see if they result in improvement. If they do, expand the tests and gradually incorporate larger and larger samples until you are confident that the changes should be adopted more widely.
The change concepts included here were developed by Associates in Process Improvement. See The Improvement Guide
(Langley GJ, Nolan KM, Nolan TW, Norman CL, Provost LP. San Francisco, California: Jossey-Bass Publishers, Inc.; 2009) for a list of hundreds of change concepts, as well as examples of how they were applied in process improvement, both inside and outside of health care.
In a broad sense, waste can be considered as any activity or resource in an organization that does not add value to an external customer. Some possible examples of waste are materials that are thrown away, rework of materials and documents, movement of items from one place to another, inventories, time spent waiting in line, people working in processes that are not important to the customer, extra steps or motion in a process, repeating work that has previously been done by others, over-specification of materials and requirements, and more staff than required to match the demand for products and services.
Toyota is famous for focusing improvement on the following "seven wastes":
Waste of overproduction
Waste of waiting
Waste of transportation
Waste of processing itself
Waste of inventory (stock)
Waste of motion
Waste of producing defective parts or products
Improve Work Flow
Products and services are produced by processes. How does work flow in these processes? What is the plan to get work through a process? Are the various steps in the process arranged and prioritized to obtain quality outcomes at low costs? How can we change the work flow so that the process is less reactive and more planned?
Inventory of all types is a possible source of waste in organizations. Inventory requires capital investment, storage space, and people to handle and keep track of it. In manufacturing organizations, inventory includes raw material waiting to be processed, in-process inventory, and finished goods inventory. For service organizations, the number of skilled workers available is often the key inventory issue. Extra inventory can result in higher costs with no improvement in performance for an organization. How can we reduce costs associated with the maintenance of inventory? Understanding where inventory is stored in a system is the first step in finding opportunities for improvement. The use of inventory pull systems such as "just-in-time" is one philosophy of operating an organization to minimize the waste from inventory.
Change the Work Environment
Changes to the environments in which we work, study, and live can often provide leverage for improvements in performance. Production of products and services takes place in some type of work environment. As we try to improve quality, reduce costs, or increase value of these products and services, technical changes are developed, tested, and implemented. But many of these technical changes do not lead to improvement because the work environment is not ready to accept or support the changes. Changing the work environment itself can be a high-leverage opportunity for making other changes more effective.
To benefit from improvements in quality of products and services, the customer must recognize and appreciate the improvements. Many ideas for improvement can come directly from a supplier or from the producer's customers. Many problems in organizations occur because the producer does not understand the important aspects of the customers’ needs or customers are not clear about their expectations from suppliers. The interface between producer/provider and their customers presents opportunities to learn and develop changes that will lead to improvement.
This age-old concept provides an opportunity to make time a focal point for improving any organization. An organization can gain a competitive advantage by reducing the time to develop new products, waiting times for services, lead times for orders and deliveries, and cycle times for all functions in the organization. Many organizations have estimated that less than five percent of the time needed to manufacture and deliver a product to a customer is actually dedicated to producing the product. The rest of the time is spent starting up or waiting.
Focus on Variation
Everything varies! But how does knowing this help us to develop changes that will lead to improvement? Many quality and cost problems in a process or product are due to variation. The same process that produces 95 percent on-time delivery or good product is the same process that produces the other 5 percent of late deliveries or bad product. Reduction of variation in such cases will improve the predictability of outcomes (may actually exceed customer expectations) and help to reduce the frequency of poor results.
There are three basic approaches to dealing with variation:
- Reduce the variation
- Compensate (deal with the variation)
- Exploit the variation
The benefits of reducing variation have been well documented during the last ten years:
A manufacturer of heat exchangers was having problems sealing tubes in their exchanger. Variation in the air pressure system contributed to most leaking tubes. The air pressure system was updated and the stability of 80 psi maintained. This resulted in a dramatic decrease of leaking tubes. This problem had previously been viewed as the fault of workers assembling the heat exchangers.
An automotive company has learned to manufacture engine and transmission parts with minimum variation. The superb fit of the parts has allowed them to reduce the normal lubrication and servicing required of most cars. The also expect to have better engine reliability and less repair and replacement warranty costs.
Errors occur when our actions do not agree with our intentions even though we are capable of carrying out the task. Often, we have to act quickly in a given situation or are required to accomplish a number of tasks sequentially or even simultaneously. Making these slips is part of being human. We might do such things as:
Forget to enter information or enter it incorrectly
Leave out a step in a process or do them in the wrong sequence
Include the wrong merchandise in a shipment
Try to use something in the wrong way
Put something together wrong
Although these errors or slips are the result of human actions, they occur because of the interaction of people with a system. Some systems are more prone to error than others. We can reduce errors by redesigning the system to make it less likely for people in the system to make errors. This type of system design or redesign is called error proofing.
The frequency of errors is a function of the number of opportunities to make errors and the probability of making an error given we have the opportunity. For example, if the same information is entered in the computer on three separate occasions, we would expect three times more errors than if the information were only entered once.
We should always be looking for ways to reduce the number of steps in a process or the number of parts in a product. This will allow for the opportunities for errors to be reduced. Error proofing is then used to reduce the probability of making an error for a given opportunity. We can error proof by using technology (e.g., adding equipment to automate repetitive tasks), by using methods to make it more difficult to do something wrong, or by the integration of these methods with technology. Methods for error proofing are not directed at changing people's behavior, but rather at changing the system to prevent slips. The methods are directed at reducing errors from actions that are done almost subconsciously when performing a process or using a product.
Focus on the Product or Service
Although most change concepts address the way that a process is performed, many also apply to improvements to a product or service. This section contains eight change concepts that are particularly useful for developing changes to products or services that do not naturally fit into any of the other groupings.