Start with the Work: TQC Souvenir
Dr. Noriaki Kano sketched a pair of linked cycles at a lecture on Total Quality Control (1990 in Tokyo, my hand written notes).
Kano’s picture applies both to service or product, hardware or software. At the heart of the sketch is some value creating system, like a standard sequence of steps to deliver effective health care.
Kano showed the steps of problem-solving the TQC way—the QC Story—like the path of a satellite launched from Earth that conducts a scientific investigation and then returns home after accomplishing its mission. The picture shows an intimate connection between improvement (the outer cycle) and the core value producing system (the inner cycle).
I’ve been thinking about the Kano picture because I am preparing to coach project teams in two healthcare improvement collaboratives next month. (Collaboratives are an action/learning method developed by the Institute for Healthcare Improvement, http://www.ihi.org/Engage/collaboratives/Pages/default.aspx.)
One collaborative involves dental clinics in community health centers that aim to improve oral health of children and adolescents. The other collaborative brings together health care organizations that seek to improve end-of-life planning and care, partnering with their patients.
Both collaboratives start with existing care systems that have opportunities to improve performance.
In past collaboratives, I often have asked teams to think about a pilot population of patients who should experience improved care. However, I haven’t explicitly asked teams to specify a unit, department, service line or value stream that represents Kano’s inner cycle.
While the specification of a pilot population can imply a specific care system—e.g. “all patients served by the Downtown Clinic” –if teams don’t characterize the inner cycle, it is tough to land the improvement project safely. During the project, there isn’t good communication between mission control (management of the inner cycle) and the satellite improvement project. At the end of the project, teams struggle to integrate lessons from their scientific problem-solving into the core care system.
My coaching notes for the two upcoming collaboratives now include a reminder to have my teams describe their care system—the home planet—before launching improvement.
Kano’s Design-Use-Check-Act cycle maps exactly to the Plan-Do-Study-Act in the Model for Improvement.
In TQC short-hand, a problem is the undesirable result of a job—that is, a problem is a gap between what we expect to occur when we use the design and what actually occurs. See e.g. H. Kume Introduction to Statistical Methods for Quality Improvement(1985), AOTS: Tokyo; Chapter 10: QC Story.)