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Contents

Foreword xi Preface xv Acknowledgments xviii The Authors xix Introduction: The Improvement Guide, Second Edition 01 PART ONE: INTRODUCTION TO IMPROVEMENT 13 Chapter One: Changes That Result in Improvement 15 Principles of Improvement 15 The Model for Improvement 23 Key Points from Chapter One 25 Chapter Two: Skills to Support Improvement 27 Supporting Change with Data 28 Developing a Change 35 Testing a Change 41 Implementing a Change 43 Spreading Improvements 44 The Human Side of Change 45 Key Points from Chapter Two 46 Chapter Three: Improvement Case Studies 49 Case Study 1: Improving the Morning Meeting 49 Case Study 2: Improving Service in a Dental Office 54 Case Study 3: Improving Methods for Teaching Biology 60 Case Study 4: Contamination in Shipping Drums 63 Case Study 5: Reducing Energy Use in School 66 Key Points from Chapter Three 71 PART TWO: METHODS FOR IMPROVEMENT 73 Chapter Four: The Science of Improvement 75 Profound Knowledge 76 Milestones in the Development of Profound Knowledge 85 Key Points from Chapter Four 88 Chapter Five: Using the Model for Improvement 89 What Are We Trying to Accomplish? 89 How Will We Know That a Change is an Improvement? 93 What Changes Can We Make That Will Result in Improvement? 96 The Plan-Do-Study-Act Cycle 97 Using the Cycle to Build Knowledge 100 Key Points from Chapter Five 106 Chapter Six: Developing a Change 109 Some Typical Problems in Developing Changes 110 Reactive Versus Fundamental Change 111 Theory for Change 116 Methods for Developing Fundamental Change 120 Key Points from Chapter Six 136 Chapter Seven: Testing a Change 139 Applying the Science of Improvement to Testing 140 Principles for Testing a Change 144 Designs for Testing a Change 153 Strategies for Testing 168 Key Points from Chapter Seven 170 Chapter Eight: Implementing a Change 173 Testing a Change 174 Implementing a Change 174 Implementation as a Series of Cycles 175 Implementing Changes to Achieve and Maintain Improvement 179 The Social Aspects of Implementing a Change 186 Key Points from Chapter Eight 193 Chapter Nine: Spreading Improvements 195 A Framework for Spread 196 Phase for Organizational Readiness for Spread 197 Phase for Developing an Initial Spread Plan 205 Phase for Executing and Refining the Spread Plan 210 Key Points from Chapter Nine 216 Chapter Ten: Integrating Methods for the Improvement of Value 217 Eliminating Quality Problems 218 Reducing Costs While Maintaining or Improving Quality 224 Expanding the Expectations of Customers to Increase Demand 230 Developing an Environment Conducive to the Improvement of Value 235 Key Points from Chapter Ten 236 Chapter Eleven: Improving Large or Complex Systems 237 Project Setup and Management 239 Understanding the System and Developing High-Impact Changes 243 Testing and Learning Systems 250 Key Points from Chapter Eleven 262 Chapter Twelve: Case Studies of Improvement Efforts 263 Case Study 1: Reducing the Occurrence of No-Fault-Found Components 264 Case Study 2: Improving the Drill Process 269 Case Study 3: Reducing Infection and Mortality Rates in a Pediatric Intensive Care Unit 276 Case Study 4: Improving Safety at a Manufacturing Plant 285 Case Study 5: Improving the Credentialing Process at CareOregon 291 Case Study 6: Improving Sales at a Specialty Chemical Company 292 Key Points from Chapter Twelve 305 PART THREE: IMPROVING VALUE AS A BUSINESS STRATEGY 307 Chapter Thirteen: Making the Improvement of Value a Business Strategy 309 Building the System of Improvement 312 Key Points from Chapter Thirteen 328 Chapter Fourteen: Developing Improvement Capability 331 Developing Improvement Capability in the Workforce 333 Organization to Support the Focus on Improvement 340 Development of Other Capabilities 343 Key Points from Chapter Fourteen 346 Sample Agendas for Getting Started, Sponsors, and Improvement Advisors 348 Development of Internal Improvement Advisors: Topical Agenda 352 APPENDIXES 355 Appendix A: A Resource Guide to Change Concepts 357 How to Use Change Concepts 358 The Change Concepts 363 Appendix B: Tools and Methods to Support Improvement 409 Methods and Tools for Viewing Systems and Processes 410 Methods and Tools for Gathering Information 417 Methods and Tools for Organizing Information 423 Methods and Tools for Understanding Variation 433 Methods and Tools for Understanding Relationships 440 Methods and Tools for Project Management 442 Standard Forms for Improvement Projects 445 Appendix C: The Model for Improvement and Other Roadmaps 453 Fundamental Questions for Improvement 454 Alternative Roadmaps for Improvement Projects 456 Summary 464 Notes 465 Index 479

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