How Do Visual Tools Help Improvement? Lloyd Provost, MS; Statistician, Associates for Process Improvement If we’re going to try to do systems thinking — so, appreciation of a system is a fundamental part of the science of improvement — and if I am helping somebody, I need to appreciate the system. Well, I have to be able to see that system. I remember when I would do work in auto organizations. They actually designed the big production plants so that you could go up to the top of it and stand in the scaffolding and actually see the system working and how it was flowing. So you could do that. In health care it’s sometimes very difficult to see the system. “Hey, the systems the problem here.” Well, where’s the system? I can’t see it. Where do we look at it? What tools do we have, then? Tools like flow process mapping that allow us to see the system — it’s a pretty important tool. On the other hand, if I tell people they need to have a flowchart, they get bogged down in that tool. So doing flowcharting, drawing systems maps, is not improvement. It allows us to see the system to make that happen. So I’m always careful about overemphasizing any tool there to that. Probably if there’s one [tool] that I wouldn’t do without on any improvement work or projects, it’s a time series chart — a run chart, Shewhart chart, or control chart over time. I always want to see that improvement is temporal. We have a past; we have a current; we have a future. And I have a picture that helps everybody see that the same way. A run chart, a Shewhart chart — I’ll always have that on an improvement project.