QI Essentials Toolkit

Transcription

1 QI Essentials Tlkit Cause and Effect Diagram Driver Diagram Failure Mdes and Effects Analysis (FMEA) Flwchart Histgram Paret Chart PDSA Wrksheet Prject Planning Frm Run Chart & Cntrl Chart Scatter Diagram IHI s QI Essentials Tlkit includes the tls and templates yu need t launch and manage a successful imprvement prject. Each f the nine tls in the tlkit includes a shrt descriptin, instructins, an example, and a blank template. Cpyright 2017 Institute fr Healthcare Imprvement. All rights reserved. Individuals may phtcpy these materials fr educatinal, nt-fr-prfit uses, prvided that the cntents are nt altered in any way and that prper attributin is given t IHI as the surce f the cntent. These materials may nt be reprduced fr cmmercial, fr-prfit use in any frm r by any means, r republished under any circumstances, withut the written permissin f the Institute fr Healthcare Imprvement.

2 IHI ffers a range f prgrams t help yu and yur team develp imprvement skills: IHI Open Schl The IHI Open Schl prvides yu with essential training and tls in an nline, educatinal cmmunity. Eight imprvement capability curses are available. Level: Nvice t Beginner* Frmat: Online, asynchrnus curses that take 1-2 hurs Wh shuld attend: Students, residents, faculty, and prfessinals Imprvement Cach Prfessinal Develpment Prgram If yu are an imprver wh wants t cach and facilitate imprvement teams and supprt the implementatin f imprvement strategies within yur rganizatin, the next step is t becme an Imprvement Cach. Level: Cmpetent t Prficient* Frmat: Twelve-week experiential prgram with a preparatry webinar, tw 3-day in-persn wrkshps, three 3- hur virtual wrkshps in between, and a cncluding webinar. Previus team-based imprvement experience required. Requires an imprvement team with an imprvement prject t cach. Wh shuld attend: Individuals with imprvement experience wh wants t cach and facilitate imprvement teams. Imprvement Advisr Prfessinal Develpment Prgram The Imprvement Advisr (IA) prgram prepares yu t becme a highly effective leader in helping yur rganizatin r system implement strategically vital imprvement initiatives. Level: Prficient t Expert* Frmat: Eleven-mnth experiential prgram with a preparatry webinar, three 4-day wrkshps, and 10 mnthly webinars in between. Previus experience leading imprvement effrts required. Requires an imprvement prject that is strategically imprtant t the spnsring rganizatin. Wh shuld attend: Specialists in imprvement and future imprvement leaders; individuals/prfessinals wh have r expect t have a majr prtin f their wrk fcused n imprvement. Fr mre infrmatin, see ihi.rg/imprvementcapability

3 QI Essentials Tlkit: Cause and Effect Diagram A cmmn challenge fr imprvement teams is determining what changes they can test t imprve a prcess. A cause and effect diagram is an rganizatinal tl that helps teams explre and display the many causes cntributing t a certain effect r utcme. It graphically displays the relatinship f the causes t the effect and t each ther, helping teams identify areas fr imprvement. The cause and effect diagram is als knwn as an Ishikawa diagram, fr its creatr, r a fishbne diagram, fr its resemblance t the bnes f a fish. Teams list and grup causes under the categries f Materials, Methds, Equipment, Envirnment, and Peple. IHI s QI Essentials Tlkit includes the tls and templates yu need t launch and manage a successful imprvement prject. Each f the nine tls in the tlkit includes a shrt descriptin, instructins, an example, and a blank template. NOTE: Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Cause and Effect Diagram Driver Diagram Failure Mdes and Effects Analysis (FMEA) Flwchart Histgram Paret Chart PDSA Wrksheet Prject Planning Frm Run Chart & Cntrl Chart Scatter Diagram Cpyright 2017 Institute fr Healthcare Imprvement. All rights reserved. Individuals may phtcpy these materials fr educatinal, nt-fr-prfit uses, prvided that the cntents are nt altered in any way and that prper attributin is given t IHI as the surce f the cntent. These materials may nt be reprduced fr cmmercial, fr-prfit use in any frm r by any means, r republished under any circumstances, withut the written permissin f the Institute fr Healthcare Imprvement.

4 QI ESSENTIALS TOOLKIT: Cause and Effect Diagram Instructins 1) Write the effect yu wish t influence in a bx n the right-hand side f the page. 2) Draw a hrizntal line acrss the page t the left, starting at the bx yu just drew. 3) Decide n five r six categries f causes fr the effect. The standard categries in a classic cause and effect diagram are Materials, Methds, Equipment, Envirnment, and Peple. 4) Draw diagnal lines abve and belw the hrizntal line t create fishbnes, and label each line at the end with ne f the categries yu have chsen. Draw a bx arund each label. 5) Fr each categry, generate a list f the causes that cntribute t the effect. List the causes by drawing branch bnes. As necessary, draw additinal branch bnes frm the causes t shw sub-causes. Tip: Develp the causes by asking Why? until yu have reached a useful level f detail that is, when the cause is specific enugh t be able t test a change and measure its effects.

5 QI ESSENTIALS TOOLKIT: Cause and Effect Diagram Example: Cause and Effect Diagram

6 QI ESSENTIALS TOOLKIT: Cause and Effect Diagram Befre filling ut this template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Template: Cause and Effect Diagram Peple Envirnment Materials Methds Equipment

7 QI Essentials Tlkit: Driver Diagram A driver diagram is a visual display f a team s thery f what drives, r cntributes t, the achievement f a prject aim. This clear picture f a team s shared view is a useful tl fr cmmunicating t a range f stakehlders where a team is testing and wrking. A driver diagram shws the relatinship between the verall aim f the prject, the primary drivers (smetimes called key drivers ) that cntribute directly t achieving the aim, the secndary drivers that are cmpnents f the primary drivers, and specific change ideas t test fr each secndary driver. Primary drivers are the mst imprtant influencers n the aim, and yu will have nly a few (we recmmend 2 t 5); secndary drivers are influencers n (r natural subsectins f) the primary drivers, and yu may have many. As yu identify each driver, establish a way t measure it. Remember: It s unlikely that a single individual has a clear view f an entire cmplex system. When develping a driver diagram, enlist the help f team members wh are familiar with different aspects f the system under review. IHI s QI Essentials Tlkit includes the tls and templates yu need t launch and manage a successful imprvement prject. Each f the nine tls in the tlkit includes a shrt descriptin, instructins, an example, and a blank template. NOTE: Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Cause and Effect Diagram Driver Diagram Failure Mdes and Effects Analysis (FMEA) Flwchart Histgram Paret Chart PDSA Wrksheet Prject Planning Frm Run Chart & Cntrl Chart Scatter Diagram Cpyright 2017 Institute fr Healthcare Imprvement. All rights reserved. Individuals may phtcpy these materials fr educatinal, nt-fr-prfit uses, prvided that the cntents are nt altered in any way and that prper attributin is given t IHI as the surce f the cntent. These materials may nt be reprduced fr cmmercial, fr-prfit use in any frm r by any means, r republished under any circumstances, withut the written permissin f the Institute fr Healthcare Imprvement.

8 QI ESSENTIALS TOOLKIT: Driver Diagram Instructins 1) On the left, list the prject aim (what will be imprved, by hw much, fr whm, and by when) and draw a bx arund it. 2) T the right f the aim, list a few primary drivers the mst significant high-level influencers n the aim yu ve identified. Draw a bx arund each f the primary drivers, and draw lines t cnnect the primary drivers t the aim. 3) T the right f each primary driver, list as many secndary drivers that influence the primary driver as yu can think f. Draw a bx arund each secndary driver, and draw lines t cnnect the secndary drivers t the primary drivers. Nte: Secndary drivers can cnnect t mre than ne primary driver. Tip: T shw strng relatinships, use slid lines; t shw weaker relatinships, use dtted lines. 4) T the right f each secndary driver, list specific change ideas yu will test t influence the secndary driver. Nte: Change ideas can cnnect t mre than ne secndary driver.

9 QI ESSENTIALS TOOLKIT: Driver Diagram Example: Driver Diagram

10 QI ESSENTIALS TOOLKIT: Driver Diagram Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Template: Driver Diagram

11 QI Essentials Tlkit: Failure Mdes and Effects Analysis (FMEA) Failure Mdes and Effects Analysis (FMEA) is a tl fr cnducting a systematic, practive analysis f a prcess in which harm may ccur. In an FMEA, a team representing all areas f the prcess under review cnvenes t predict and recrd where, hw, and t what extent the system might fail. Then, team members with apprpriate expertise wrk tgether t devise imprvements t prevent thse failures especially failures that are likely t ccur r wuld cause severe harm t patients r staff. The FMEA tl prmpts teams t review, evaluate, and recrd the fllwing: Steps in the prcess Failure mdes (What culd g wrng?) Failure causes (Why wuld the failure happen?) Failure effects (What wuld be the cnsequences f each failure?) Teams use FMEA t evaluate prcesses fr pssible failures and t prevent them by crrecting the prcesses practively rather than reacting t adverse events after failures have ccurred. This emphasis n preventin may reduce risk f harm t bth patients and staff. FMEA is particularly useful in evaluating a new prcess prir t implementatin and in assessing the impact f a prpsed change t an existing prcess. IHI s QI Essentials Tlkit includes the tls and templates yu need t launch and manage a successful imprvement prject. Each f the nine tls in the tlkit includes a shrt descriptin, instructins, an example, and a blank template. NOTE: Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Cause and Effect Diagram Driver Diagram Failure Mdes and Effects Analysis (FMEA) Flwchart Histgram Paret Chart PDSA Wrksheet Prject Planning Frm Run Chart & Cntrl Chart Scatter Diagram Cpyright 2017 Institute fr Healthcare Imprvement. All rights reserved. Individuals may phtcpy these materials fr educatinal, nt-fr-prfit uses, prvided that the cntents are nt altered in any way and that prper attributin is given t IHI as the surce f the cntent. These materials may nt be reprduced fr cmmercial, fr-prfit use in any frm r by any means, r republished under any circumstances, withut the written permissin f the Institute fr Healthcare Imprvement.

12 QI ESSENTIALS TOOLKIT: Failure Mdes and Effects Analysis (FMEA) Instructins 1) Select a prcess t evaluate with FMEA. Evaluatin using FMEA wrks best n prcesses that d nt have t many sub-prcesses. If yu re hping t evaluate a large and cmplex prcess, such as medicatin management in a hspital, divide it up. Fr example, d separate FMEAs n medicatin rdering, dispensing, and administratin prcesses. 2) Recruit a multidisciplinary team. Be sure t include everyne wh is invlved at any pint in the prcess. Sme peple may nt need t be part f the team thrughut the entire analysis, but they shuld certainly be included in discussins f thse steps in the prcess in which they are invlved. Fr example, a hspital may utilize curiers t transprt medicatins frm the pharmacy t nursing units. It wuld be imprtant t include the curiers in the FMEA f the steps that ccur during the transprt itself, which may nt be knwn t persnnel in the pharmacy r n the nursing unit. 3) Have the team list all f the steps in the prcess. Wrking with a team that represents every pint in the prcess yu re evaluating, establish a mutually agreed upn, rdered list f all the steps in the prcess. Tip: Flwcharting can be a helpful tl fr visualizing a prcess. Learn mre at NOTE: Yu can use the interactive FMEA Tl n IHI s website t cmplete the fllwing steps. [ If yu are nt using the interactive FMEA Tl, draw a nine-clumn table as fllws. Steps in the Prcess Failure Mde Failure Causes Failure Effects Likelihd f Occurrence (1-10) Likelihd f Detectin (1-10) Severity (1-10) Risk Prfile Number (RPN) Actins t Reduce Occurrence f Failure 1 2 3

13 QI ESSENTIALS TOOLKIT: Failure Mdes and Effects Analysis (FMEA) 4) Fill ut the table with yur team. In the left-mst clumn, input the numbered list f the steps in the prcess. Then, wrking with the members f the team wh are invlved in specific steps, fill ut the remaining clumns as fllws: Failure Mde [What culd g wrng?]: List anything that culd g wrng during that step in the prcess. Failure Causes [Why wuld the failure happen?]: List all pssible causes fr each f the failure mdes yu ve identified. Failure Effects [What wuld be the cnsequences f the failure?]: List all pssible adverse cnsequences fr each f the failure mdes identified. Likelihd f Occurrence (1 10): On a scale f 1-10, with 10 being the mst likely, what is the likelihd the failure mde will ccur? Likelihd f Detectin (1-10): On a scale f 1-10, with 10 being the mst likely NOT t be detected, what is the likelihd the failure will NOT be detected if it des ccur? Severity (1-10): On a scale f 1-10, with 10 being the mst likely, what is the likelihd that the failure mde, if it des ccur, will cause severe harm? Risk Prfile Number (RPN): Fr each failure mde, multiply tgether the three scres the team identified (i.e., likelihd f ccurrence x likelihd f detectin x severity). The lwest pssible scre will be 1 and the highest 1,000. T calculate the RPN fr the entire prcess, simply add up all f the individual RPNs fr each failure mde. Actins t Reduce Occurrence f Failure: List pssible actins t imprve safety systems, especially fr failure mdes with the highest RPNs. a) Tip: Teams can use FMEA t analyze each actin under cnsideratin. Calculate hw the RPN wuld change if yu intrduced different changes t the system. 5) Use RPNs t plan imprvement effrts. Failure mdes with high RPNs are prbably the mst imprtant parts f the prcess n which t fcus imprvement effrts. Failure mdes with lw RPNs are nt likely t affect the verall prcess much, even if eliminated cmpletely, and they shuld therefre be at the bttm f the list f pririties. Identify the failure mdes with the tp 10 highest RPNs. These are the nes the team shuld cnsider first as imprvement pprtunities. Use FMEA t plan actins t reduce harm frm failure mdes. a) If the failure mde is likely t ccur: - Evaluate the causes and see if any r all f them can be eliminated. - Cnsider adding a frcing functin (that is, a physical cnstraint that makes cmmitting an errr impssible, such as medical gas utlets that are designed t accept nly thse gauges that match). - Add a verificatin step, such as independent duble-checks, bar cding n medicatins, r alert screens. - Mdify ther prcesses that cntribute t causes.

14 QI ESSENTIALS TOOLKIT: Failure Mdes and Effects Analysis (FMEA) b) If the failure is unlikely t be detected: - Identify ther events that may ccur prir t the failure mde and can serve as flags that the failure mde might happen. - Add a step t the prcess that intervenes at the earlier event t prevent the failure mde. Fr example, add pharmacy runds t remve discntinued medicatins frm patient care units within 1 hur f discntinuatin, t decrease the risk that the medicatins will still be available fr use (the failure mde). - Cnsider technlgical alerts such as devices with alarms t alert users when values are appraching unsafe limits. c) If the failure is likely t cause severe harm: - Identify early warning signs that a failure mde has ccurred, and train staff t recgnize them fr early interventin. Fr example, use drills t train staff by simulating events that lead up t failure, t imprve staff ability t recgnize these early warnings. - Prvide infrmatin and resurces, such as reversal agents r antidtes, at pints f care fr events that may require immediate actin. Use FMEA t evaluate the ptential impact f changes under cnsideratin. Teams can use FMEA t discuss and analyze each change under cnsideratin and calculate the change in RPN if the change were implemented. This allws the team t verbally simulate the change and evaluate its impact in a safe envirnment, prir t testing it in a patient care area. Sme ideas that seem like great imprvements can turn ut t be changes that wuld actually increase the estimated RPN. Use FMEA t mnitr and track imprvement ver time. Teams shuld cnsider calculating a ttal RPN fr the prcess as described abve and then set a gal fr imprvement. Fr example, a team may set a gal f decreasing the ttal RPN fr the medicatin rdering prcess by 50% frm the baseline.

15 QI ESSENTIALS TOOLKIT: Failure Mdes and Effects Analysis (FMEA) Example: Failure Mdes and Effects Analysis (FMEA) Medicatin Dispensing Prcess Steps in the Prcess Failure Mde Failure Causes Failure Effects Likelihd f Occurrence (1-10) Likelihd f Detectin (1-10) Severity (1-10) Risk Prfile Number (RPN) Actins t Reduce Occurrence f Failure Orders are written fr new medicatins. The first dse may be given prir t pharmacist review f the rders. Medicatin rdered may be available and easily accessed in the dispensing machine. Patient may receive incrrect medicatin, incrrect dse, r a dse via incrrect rute Assign clinical pharmacists t patient care units s that all medicatin rders can be reviewed as they ccur. Orders are written t discntinue a medicatin r change the existing rder. Orders are written t discntinue a medicatin r change the existing rder. All dses needed fr a 24-hur perid are delivered t the drawer. Drawer is nt changed until next rutine delivery. 24-hur supply f refrigerated medicatins is delivered. Multi-dse vials may be kept in the patientspecific drawer. Medicatins are available in dispensing machine. Patients may receive medicatins that have been discntinued r the incrrect dse f a medicatin that has been changed Schedule pick-ups f discntinued medicatins, including refrigerated medicatins, twice per day. Use dispensing machine screen t verify all infrmatin regarding current and discntinued medicatins prir t each administratin. Orders are written fr a nn-standard dse f a medicatin. Nursing staff may prepare an incrrect dse when manipulating the medicatin. Staff prepare the dse using medicatins frm the dispensing machine and manipulate them t get the dse rdered. Patient may receive an incrrect dse Prepare all nnstandard dses in the pharmacy and dispense each as a patient-specific unit dse.

16 QI ESSENTIALS TOOLKIT: Failure Mdes and Effects Analysis (FMEA) Steps in the Prcess Failure Mde Failure Causes Failure Effects Likelihd f Occurrence (1-10) Likelihd f Detectin (1-10) Severity (1-10) Risk Prfile Number (RPN) Actins t Reduce Occurrence f Failure Pharmacy staff fill dispensing and string devices with medicatins. Errrs may ccur during filling and medicatins may be placed in incrrect bins. Many medicatins are placed in the dispensing machine at ne time. Multiple medicatins and dses are placed in patient-specific drawers. Patient may receive a medicatin that has nt been prescribed Use bar cde scanning fr all medicatins t verify infrmatin prir t administratin. Invlve patients and families in verificatin befre each administratin. Medicatins requiring refrigeratin and intravenus slutins are stred separately. The wrng medicatin may be selected. Medicatins are stred tgether and may nt be in patient-specific bins, s it is easy t select the wrng ne. Patient may receive an incrrect medicatin, incrrect dse, r via incrrect rute Use bar cde scanning fr all medicatins t verify infrmatin prir t administratin. Invlve patients and families in verificatin befre each administratin. Medicatins packaged in multi-dse vials are available. The incrrect dse may be drawn frm the vial. Staff must draw each dse prir t administratin withut a duble-check. Patient may receive an incrrect medicatin, incrrect dse, r via incrrect rute Prepare each dse in pharmacy and dispense each as a single-unit dse. Remve multi-dse vials frm dispensing machines.

17 QI ESSENTIALS TOOLKIT: Failure Mdes and Effects Analysis (FMEA) Steps in the Prcess Failure Mde Failure Causes Failure Effects Likelihd f Occurrence (1-10) Likelihd f Detectin (1-10) Severity (1-10) Risk Prfile Number (RPN) Actins t Reduce Occurrence f Failure Nursing staff access medicatins fr administratin frm strage device. Nursing staff may bypass prper prcedure t access medicatins. Nursing bypass f prcedure may depend n prximity f machines t patient rms, as nurses may want t decrease time traveling back and frth. Patient may receive an incrrect medicatin, incrrect dse, r via incrrect rute Use bar cde scanning fr all medicatins t verify infrmatin prir t administratin. Invlve patients and families in verificatin befre each administratin. Staff access narctics fr administratin. Staff with substance abuse prblems may be diverting narctics. System fr access may allw incrrect infrmatin t be entered (e.g., staff may be able t enter names f ther staff). Clinical staff may be wrking in an impaired state Use individually assigned identificatin cards that must be swiped thrugh a card reader r use thumbprint readers t access narctics.

18 QI ESSENTIALS TOOLKIT: Failure Mdes and Effects Analysis (FMEA) Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Template: Failure Mdes and Effects Analysis (FMEA) Steps in the Prcess Failure Mde Failure Causes Failure Effects Likelihd f Occurrence (1-10) Likelihd f Detectin (1-10) Severity (1-10) Risk Prfile Number (RPN) Actins t Reduce Occurrence f Failure Failure Mde: What culd g wrng? Failure Causes: Why wuld the failure happen? Failure Effects: What wuld be the cnsequences f failure? Likelihd f Occurrence: 1 10 [10 = very likely t ccur] Likelihd f Detectin: 1 10 [10 = very unlikely t detect] Severity: 1 10 [10 = mst severe effect] Risk Pririty Number (RPN): Likelihd f Occurrence Likelihd f Detectin Severity Ttal RPN (sum f all RPNs):

19 QI Essentials Tlkit: Flwchart A flwchart als knwn as a prcess map is a visual representatin f the sequence f steps in a prcess. Understanding the prcess as it currently perates is an imprtant step in develping ideas abut hw t imprve it. This makes flwcharts especially useful in the early phases f imprvement wrk. T create a flwchart, teams brainstrm all the steps in the prcess as it currently exists. Teams write each prcess step in a bx (r n a sticky nte). In additin t the steps themselves, they use a diamnd shape (r sticky nte turned n its crner) t indicate pints in the prcess where a decisin needs t be made. Fr decisin steps, the team writes a yes/n questin. Then they use lines t shw the cnnectins between the bxes and diamnds. Having a shared understanding f the current prcess helps teams identify prblems r bttlenecks, fcus discussins, and identify resurces. Fr example, teams can identify steps in the prcess that d nt add value, such as delays; unnecessary wrk, duplicatin, r expense; and breakdwns in cmmunicatin. It is at these pints where the imprvement wrk can start. IHI s QI Essentials Tlkit includes the tls and templates yu need t launch and manage a successful imprvement prject. Each f the nine tls in the tlkit includes a shrt descriptin, instructins, an example, and a blank template. NOTE: Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Cause and Effect Diagram Driver Diagram Failure Mdes and Effects Analysis (FMEA) Flwchart Histgram Paret Chart PDSA Wrksheet Prject Planning Frm Run Chart & Cntrl Chart Scatter Diagram Cpyright 2017 Institute fr Healthcare Imprvement. All rights reserved. Individuals may phtcpy these materials fr educatinal, nt-fr-prfit uses, prvided that the cntents are nt altered in any way and that prper attributin is given t IHI as the surce f the cntent. These materials may nt be reprduced fr cmmercial, fr-prfit use in any frm r by any means, r republished under any circumstances, withut the written permissin f the Institute fr Healthcare Imprvement.

20 QI ESSENTIALS TOOLKIT: Flwchart Instructins 1) Get the right peple in the rm thse wh knw the prcess best. 2) Start by defining the first and the last step in the prcess s that everyne has a shared understanding f where the prcess yu re wrking n begins and ends. 3) Using the shapes belw, fill in all the steps in the prcess frm first t last. Shw the prcess as it actually wrks (nt as it shuld wrk). Tip: Use sticky ntes (ne fr each step) t create a flwchart. This allws yu t add steps and mve steps arund as yu depict the prcess. Tip: Nte that sme steps are parallel that is, they happen at the same time. 4) Review the flwchart t check fr accuracy and cmpleteness. 5) Assign actin items t team members t fill in unfamiliar steps and verify accuracy. 6) When the flwchart is cmplete and accurate, analyze it, use it, revisit it, and keep it up t date.

21 QI ESSENTIALS TOOLKIT: Flwchart Example: Flwchart

22 QI ESSENTIALS TOOLKIT: Flwchart Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Template: Flwchart Use the symbls n the previus page t map ut yur system.

23 QI Essentials Tlkit: Histgram Often, summary statistics alne d nt give a cmplete and infrmative picture f the perfrmance f a prcess. A histgram is a special type f bar chart used t display the variatin in cntinuus data like time, weight, size, r temperature. A histgram enables a team t recgnize and analyze patterns in data that are nt apparent simply by lking at a table f data, r by finding the average r median. IHI s QI Essentials Tlkit includes the tls and templates yu need t launch and manage a successful imprvement prject. Each f the nine tls in the tlkit includes a shrt descriptin, instructins, an example, and a blank template. NOTE: Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Cause and Effect Diagram Driver Diagram Failure Mdes and Effects Analysis (FMEA) Flwchart Histgram Paret Chart PDSA Wrksheet Prject Planning Frm Run Chart & Cntrl Chart Scatter Diagram Cpyright 2017 Institute fr Healthcare Imprvement. All rights reserved. Individuals may phtcpy these materials fr educatinal, nt-fr-prfit uses, prvided that the cntents are nt altered in any way and that prper attributin is given t IHI as the surce f the cntent. These materials may nt be reprduced fr cmmercial, fr-prfit use in any frm r by any means, r republished under any circumstances, withut the written permissin f the Institute fr Healthcare Imprvement.

24 QI ESSENTIALS TOOLKIT: Histgram Instructins 1) Cllect cntinuus data (time, weight, size, r temperature). 2) Srt and tally individual values in the data set and determine the high and lw values (fr example, 1 and 20 days, in the sample histgram n the next page). 3) Chse a cell width (fr example, 2 days, in the sample histgram) that divides the range int 6 t 12 categries f equal width. Favr narrwer cells, r chices that highlight gaps in the data. 4) Determine the cell bundaries. Chse a cnvenient starting pint at, r belw, the lwest value. Be cnsistent in handling values that fall n the bundaries (put all bundary values in next higher cell). 5) Tally number f bservatins in each cell. Check ttal tally. 6) Draw and prvide clear labels n axes. The vertical axis is frequency; the hrizntal axis is the variable being analyzed. 7) Draw bars t represent number f data values in cell. Adjacent bars shuld tuch. 8) Title the chart, indicate ttal number f data values, and shw any standards and limits. 9) Analyze and develp explanatins fr the pattern.

25 QI ESSENTIALS TOOLKIT: Histgram Example: Histgram One team used histgram analysis t understand the patterns f variatin in electrcardigram (EKG) turnarund time. The team gathered data n EKG turnarund time in days, cllecting 32 data pints (see data table). The average turnarund time was 8.3 days, which revealed relatively little abut the perfrmance f the prcess. T get a better understanding f the data, the team then srted the data, tallying the number f data pints in each f 10 categries: 1-2 days, 3-4 days, and s n. The team then displayed the data in a histgram. The histgram prvided the team valuable new infrmatin abut the distributin f EKG turnarund times: the vast majrity f turnarund times fall in the 1- t 2-day range, with a smaller clump in the 7- t 10-day range, and a third clump in the 13- t 20-day range. Sample Data Table: EKG Turnarund Time EKG Turnarund Time in Days Average = 8.3 Days Sample Histgram: EKG Turnarund Time

26 QI ESSENTIALS TOOLKIT: Histgram Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Template: Data Table & Histgram Data Table Histgram Frequency Variable Yu Are Analyzing

27 QI Essentials Tlkit: Paret Chart Accrding t the Paret principle als knwn as the 80/20 rule in any grup f factrs that cntribute t an verall effect, rughly 80% f the effect cmes frm 20% f the causes. A Paret chart is a type f bar chart in which the varius factrs that cntribute t an verall effect are arranged in rder frm the largest t the smallest cntributin t the effect. This rdering helps identify the vital few (the factrs that have the largest cntributin t the effect and therefre warrant the mst attentin), as distinguished frm the useful many (factrs that, while useful t knw abut, have a relatively smaller cntributin t the effect). Using a Paret chart helps teams cncentrate their imprvement effrts n the factrs that have the greatest impact. It als helps teams explain their ratinale fr fcusing n certain areas and nt thers. IHI s QI Essentials Tlkit includes the tls and templates yu need t launch and manage a successful imprvement prject. Each f the nine tls in the tlkit includes a shrt descriptin, instructins, an example, and a blank template. NOTE: Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Cause and Effect Diagram Driver Diagram Failure Mdes and Effects Analysis (FMEA) Flwchart Histgram Paret Chart PDSA Wrksheet Prject Planning Frm Run Chart & Cntrl Chart Scatter Diagram Cpyright 2017 Institute fr Healthcare Imprvement. All rights reserved. Individuals may phtcpy these materials fr educatinal, nt-fr-prfit uses, prvided that the cntents are nt altered in any way and that prper attributin is given t IHI as the surce f the cntent. These materials may nt be reprduced fr cmmercial, fr-prfit use in any frm r by any means, r republished under any circumstances, withut the written permissin f the Institute fr Healthcare Imprvement.

28 QI ESSENTIALS TOOLKIT: Paret Chart Instructins Cllecting Yur Data 1) Write yur data in a simple table, listing the cntributing factrs t a particular effect (fr example, types f errrs during surgical setup) and the magnitude f each factr (fr example, frequency f each type f errr). 2) Order the factrs accrding t the magnitude f cntributin t the effect, frm largest t smallest. If there are many insignificant factrs, yu can grup them tgether int ne categry labeled Other. 3) Calculate the percentage f the ttal that each factr represents. Fr example, number f times a certain errr ccurred last year divided by the ttal number f errrs last year, multiplied by ) Wrking frm the largest categry t the smallest, calculate the cumulative percentage fr each categry until yu reach 100%. Drawing Yur Paret Chart 1) Draw and label the left vertical axis (Y) with the unit f cmparisn (fr example, Number f Errrs, frm 0 t the ttal). 2) Draw and label the hrizntal axis (X) with the categries (fr example, Type f Errr ), largest t smallest frm left t right. 3) Draw and label the right vertical axis Cumulative Percentage, frm 0% t 100%, with the 100% value at the same height as the ttal mark n the left vertical axis. 4) Draw a bar chart t depict the magnitude f effect. Using the units n the left vertical axis as a guide, draw a slid bar t represent the magnitude f cntributin fr each categry n the hrizntal axis. 5) Draw a line graph f the cumulative percentage, beginning in the lwer left crner f the graph (the 0 pint) and ending at 100% in the upper right. 6) Anntate the diagram t indicate the cumulative percentage assciated with the vital few (fr example, circle r draw an arrw t the first three errr types that accunt fr 75% t 80% f all errrs).

29 QI ESSENTIALS TOOLKIT: Paret Chart Example: Data Table and Paret Chart Errrs During Surgical Set-up One team used Paret analysis t identify the vital few factrs that cntributed t errrs during surgical setup. The team identified eight types f surgical set-up errrs, and cllected data n the frequency f each type (see table). They calculated the percentage f the ttal effect fr each errr type, then listed errr types in rder frm largest t smallest effect. Finally, they calculated the cumulative percentage f effect. When the team displayed this data in a Paret chart, they discvered that three types f errrs accunted fr 75% f all errrs. Instead f wrking n all errr types, the team decided t fcus its effrts n these three vital few errr types Wrng Supplier, Excess Cunt, and T Few Cunt because tgether they accunt fr rughly 80% f the prblem. Data Table: Types f Errrs Discvered During Surgical Set-up Errr Type Frequency Percent Cumulative % Wrng Supplier Excess Cunt T Few Cunt Wrng Size Wrng Sterile Instrument Set Missing Item Damaged Item Other TOTAL

30 QI ESSENTIALS TOOLKIT: Paret Chart Paret Chart: Types f Errrs Discvered During Surgical Set-up

31 QI ESSENTIALS TOOLKIT: Paret Chart Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Template: Data Table and Paret Chart Cntributing Factr Frequency Percent Cumulative % TOTAL

32

33 QI Essentials Tlkit: PDSA Wrksheet The Plan-D-Study-Act (PDSA) cycle is a useful tl fr dcumenting a test f change. Running a PDSA cycle is anther way f saying testing a change yu develp a plan t test the change (Plan), carry ut the test (D), bserve, analyze, and learn frm the test (Study), and determine what mdificatins, if any, t make fr the next cycle (Act). Fill ut ne PDSA wrksheet fr each change yu test. In mst imprvement prjects, teams will test several different changes, and each change may g thrugh several PDSA cycles as yu cntinue t learn. Keep a file (either electrnic r hard cpy) f all PDSA cycles fr all the changes yur team tests. IHI s QI Essentials Tlkit includes the tls and templates yu need t launch and manage a successful imprvement prject. Each f the nine tls in the tlkit includes a shrt descriptin, instructins, an example, and a blank template. NOTE: Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Cause and Effect Diagram Driver Diagram Failure Mdes and Effects Analysis (FMEA) Flwchart Histgram Paret Chart PDSA Wrksheet Prject Planning Frm Run Chart & Cntrl Chart Scatter Diagram Cpyright 2017 Institute fr Healthcare Imprvement. All rights reserved. Individuals may phtcpy these materials fr educatinal, nt-fr-prfit uses, prvided that the cntents are nt altered in any way and that prper attributin is given t IHI as the surce f the cntent. These materials may nt be reprduced fr cmmercial, fr-prfit use in any frm r by any means, r republished under any circumstances, withut the written permissin f the Institute fr Healthcare Imprvement.

34 QI ESSENTIALS TOOLKIT: PDSA Wrksheet Instructins Plan: Plan the test, including a plan fr cllecting data. State the questin yu want t answer and make a predictin abut what yu think will happen. Develp a plan t test the change. (Wh? What? When? Where?) Identify what data yu will need t cllect. D: Run the test n a small scale. Carry ut the test. Dcument prblems and unexpected bservatins. Cllect and begin t analyze the data. Study: Analyze the results and cmpare them t yur predictins. Cmplete, as a team, if pssible, yur analysis f the data. Cmpare the data t yur predictin. Summarize and reflect n what yu learned. Act: Based n what yu learned frm the test, make a plan fr yur next step. Adapt (make mdificatins and run anther test), adpt (test the change n a larger scale), r abandn (dn t d anther test n this change idea). Prepare a plan fr the next PDSA.

35 QI ESSENTIALS TOOLKIT: PDSA Wrksheet Example: PDSA Wrksheet Objective: Test using Teach-Back (a clsed-lp cmmunicatin mdel, in which the recipient f infrmatin repeats the infrmatin back t the speaker) with a small grup f patients, in hpes f imprving patients understanding f their care plans. 1. Plan: Plan the test, including a plan fr cllecting data. Questins and predictins: Hw much mre time will it take t use Teach-Back with patients? It will take mre time at first (5 t 10 minutes per patient), but we will start t learn better cmmunicatin skills and get mre efficient. Will it be wrthwhile? The extra time will feel wrthwhile (and pssibly prevent future rewrk). What will we d if the act f teaching back reveals a patient didn t understand the care plan? If a patient is nt able t explain his r her care plan, we will need t explain it again, perhaps in a different way. Wh, what, where, when: On Mnday, each resident will test using Teach-Back with the last patient f the day. Plan fr cllecting data: Each resident will write a brief paragraph abut their experience using Teach-Back with the last patient. 2. D: Run the test n a small scale. Describe what happened. What data did yu cllect? What bservatins did yu make? Three residents attempted Teach-Back at the end f the day n Mnday. Tw residents did nt find anything they needed t ask patients t Teach-Back. Jane fund that her patient did nt understand the medicatin schedule fr her child. They were able t review it again and, at the end, Jane was cnfident the mther was ging t be able t give the medicatin as indicated.

36 QI ESSENTIALS TOOLKIT: PDSA Wrksheet 3. Study: Analyze the results and cmpare them t yur predictins. Summarize and reflect n what yu learned: Predictin: It will take mre time at first (5 t 10 minutes per patient), but we will start t learn better cmmunicatin skills and get mre efficient. Result: Using Teach-Back tk abut 5 minutes per patient. Predictin: The extra time will feel wrthwhile (and pssibly prevent future rewrk). Result: Jane felt the time she invested in using Teach-Back significantly imprved the care experience. Predictin: If a patient is nt able t explain his r her care plan, we will need t explain it again, perhaps in a different way. Result: After a secnd review f the medicatin rders, the patient was able t Teach-Back the instructins successfully. In additin t the team cnfirming all three predictins, Jane realized the medicatin infrmatin sheets she had been handing ut t parents weren t as clear as she thught. She realized these shuld be re-written maybe with the input f sme parents. 4. Act: Based n what yu learned frm the test, make a plan fr yur next step. Determine what mdificatins yu shuld make adapt, adpt, r abandn: Jane is planning t use Teach-Back any time she prescribes medicatin. Althugh it may take mre time, she nw understands the imprtance. The ther residents are ging t wrk n using Teach-Back specifically fr medicatins fr the next week. They wuld like t pull tgether a team t wrk n sme f the medicatin infrmatin sheets with parent input, but they are first ging t gather mre infrmatin thrugh mre interactins in the cming days.

37 QI ESSENTIALS TOOLKIT: PDSA Wrksheet Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Template: PDSA Wrksheet Objective: 1. Plan: Plan the test, including a plan fr cllecting data. Questins and predictins: Wh, what, where, when: Plan fr cllecting data: 2. D: Run the test n a small scale. Describe what happened. What data did yu cllect? What bservatins did yu make?

38 QI ESSENTIALS TOOLKIT: PDSA Wrksheet 3. Study: Analyze the results and cmpare them t yur predictins. Summarize and reflect n what yu learned: 4. Act: Based n what yu learned frm the test, make a plan fr yur next step. Determine what mdificatins yu shuld make adapt, adpt, r abandn:

39 QI Essentials Tlkit: Prject Planning Frm The Prject Planning Frm is a useful tl t help teams think systematically abut their imprvement prject. By tracking a list f the changes that the team is testing including all f the Plan-D-Study-Act (PDSA) cycles, the persn respnsible fr different aspects f each test, and the timeframe fr each phase f the wrk the frm allws a team t see at a glance the full picture f a prject. IHI s QI Essentials Tlkit includes the tls and templates yu need t launch and manage a successful imprvement prject. Each f the nine tls in the tlkit includes a shrt descriptin, instructins, an example, and a blank template. NOTE: Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Cause and Effect Diagram Driver Diagram Failure Mdes and Effects Analysis (FMEA) Flwchart Histgram Paret Chart PDSA Wrksheet Prject Planning Frm Run Chart & Cntrl Chart Scatter Diagram Cpyright 2017 Institute fr Healthcare Imprvement. All rights reserved. Individuals may phtcpy these materials fr educatinal, nt-fr-prfit uses, prvided that the cntents are nt altered in any way and that prper attributin is given t IHI as the surce f the cntent. These materials may nt be reprduced fr cmmercial, fr-prfit use in any frm r by any means, r republished under any circumstances, withut the written permissin f the Institute fr Healthcare Imprvement.

40 QI ESSENTIALS TOOLKIT: Prject Planning Frm Instructins 1) Use the frm at the beginning f an imprvement prject t initiate planning. 2) In the tp left crner, create a numbered list f the drivers n which the team will fcus. Drivers are key leverage pints in the system that are yur pprtunities t influence the utcme and achieve yur aim. Tip: We recmmend using a tl called a driver diagram (ne f the tls in the QI Essentials Tlkit) t establish primary and secndary drivers with yur team. 3) Next t each driver, identify a prcess measure and gal as fllws: Prcess measure: Define in specific terms hw yu will measure the driver, t evaluate the results f yur tests f change. Gal: State a measureable gal fr that driver (i.e., define in specific terms what yu want the results t be after yur changes). 4) Fill ut the grid fr each driver using the fllwing questins t prmpt yu: Change Idea: What idea fr imprvement will yu test? Tasks t Prepare fr Tests: What tasks will yu need t perfrm t set up and run the test? Persn Respnsible: Wh is respnsible fr each task yu ve identified? PDSA: What are the details f yur test? Timeline: Hw many weeks d yu expect t need fr each phase f the imprvement cycle (Testing, Implementatin, and Spread)? Indicate where each phase will end with the letter T, I, r S. 5) As the prject cntinues, update the Prject Planning Frm regularly with yur nging tests f change.

41 QI ESSENTIALS TOOLKIT: Prject Planning Frm Example: Prject Planning Frm Team: Jhn, Sally, Mark, Dave, Laura, and Beth Prject: Lwering Depressin Scres: Achieve a 15-pint decrease in PHQ-9 scres fr 50% f depressed patients by May 1. Driver list the drivers yu ll be wrking n Prcess Measure Gal 1. Patient educatin % f patients in depressed ppulatin receiving educatin materials befre leaving ffice will have dcumented use f educatin materials 90% f patients in depressed ppulatin will have dcumented use f educatinal materials befre leaving ffice 2. Fllw-up assessment % f patients in depressed ppulatin that have a fllw-up assessment within the first eight weeks f their initial diagnsis % f patients in depressed ppulatin have a fllw-up assessment within the first eight weeks f their initial diagnsis Driver Number (frm abve) Change Idea Tasks t Prepare fr Tests PDSA Persn Respnsible Week Timeline (T = Test; I = Implement; S = Spread) Prvide pamphlet and link t shrt vide at time f patient discharge Need t make sure we have enugh pamphlets n site; need t ensure link t vide wrks Nurse will hand materials t patient befre leaving the exam rm with all patients scring high n the PHQ-9 Beth and Mark T T 2 Patients will cme back t the ffice fr a fllw-up assessment within eight weeks f depressin diagnsis Need t schedule appintments within timeframe and get patients t attend fllw-up appintment; need t make sure secretaries are aware f this test Have secretaries write dwn the date and time f the fllw-up appintment n the back f the clinic s business card Laura T T

42 QI ESSENTIALS TOOLKIT: Prject Planning Frm Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Template: Prject Planning Frm Team: Prject: Driver list the drivers yu ll be wrking n Prcess Measure Gal Driver Number (frm abve) Change Idea Tasks t Prepare fr Tests PDSA Persn Respnsible Week Timeline (T = Test; I = Implement; S = Spread)

43 QI Essentials Tlkit: Run Chart & Cntrl Chart A run chart is a graph f data ver time. It is a simple and effective tl t help yu determine whether the changes yu are making are leading t imprvement. Run charts help imprvement teams frmulate aims by depicting hw well (r prly) a prcess is perfrming, understand the value f a particular change, and begin t distinguish between cmmn and special causes f variatin. Cmmn-cause variatin is the natural r expected variatin inherent in a prcess. Special-cause variatin arises because f specific circumstances that are nt inherent in the prcess. A cntrl chart, which includes an upper cntrl limit (UCL) and a lwer cntrl limit (LCL), ges further t help teams distinguish between cmmn and special causes f variatin within a prcess. Use a cntrl chart when yu have mre than 15 data pints and want mre insight int yur data. Cntrl charts help imprvement teams identify special-cause variatin in a prcess, identify early signs f success in an imprvement prject, and mnitr a prcess t ensure it is hlding the gains frm a quality imprvement effrt. IHI s QI Essentials Tlkit includes the tls and templates yu need t launch and manage a successful imprvement prject. Each f the nine tls in the tlkit includes a shrt descriptin, instructins, an example, and a blank template. NOTE: Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Cause and Effect Diagram Driver Diagram Failure Mdes and Effects Analysis (FMEA) Flwchart Histgram Paret Chart PDSA Wrksheet Prject Planning Frm Run Chart & Cntrl Chart Scatter Diagram Cpyright 2017 Institute fr Healthcare Imprvement. All rights reserved. Individuals may phtcpy these materials fr educatinal, nt-fr-prfit uses, prvided that the cntents are nt altered in any way and that prper attributin is given t IHI as the surce f the cntent. These materials may nt be reprduced fr cmmercial, fr-prfit use in any frm r by any means, r republished under any circumstances, withut the written permissin f the Institute fr Healthcare Imprvement.

44 QI ESSENTIALS TOOLKIT: Run Chart & Cntrl Chart Instructins 1) Obtain a set f data pints in their natural time sequence. 2) Draw the vertical and hrizntal axes, leaving rm n all sides t title and label the graph. 3) Label the vertical (Y) axis with the name f the value being measured (e.g., Percent f Births by C-sectin, Number f Days t Third Next Available Appintment, etc.). 4) Label the hrizntal (X) axis with the unit f time r sequence in which the numbers were cllected (e.g., April, May, June, etc., r Quarter 1, Quarter 2, etc.). 5) Determine the scale f the vertical axis. The scale shuld extend frm a number 20 percent larger than the largest value t a number 20 percent smaller than the smallest value. Label the axis in equal intervals between these tw numbers. 6) Plt the data values in the sequence in which they ccurred. 7) Draw lines t cnnect the data pints n the graph. 8) Calculate the median (the data pint half way between the highest and the lwest data pint) f the pltted numbers and draw the line n the graph. Nte: Fr a cntrl chart, cmplete these tw steps: a) Instead f calculating the median, calculate the mean r cntrl limit (the average) f the pltted numbers and draw the line n the graph. b) Calculate and then draw upper and lwer cntrl limits that crrespnd t +/- 3 sigma limits frm the mean. (We recmmend ding this in Micrsft Excel r anther sftware prgram.) 9) Title the chart, and nte the gal line and the sample size. 10) Anntate the chart, indicating when tests f change were initiated, s that it is easy t see the effect f changes n the measure. Als indicate any external events that may have affected the perfrmance f the prcess.

45 QI ESSENTIALS TOOLKIT: Run Chart & Cntrl Chart Example: Run Chart Example: Cntrl Chart

46 QI ESSENTIALS TOOLKIT: Run Chart & Cntrl Chart Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Template: Run Chart r Cntrl Chart Value Being Measured Time

47 QI Essentials Tlkit: Scatter Diagram A scatter diagram als knwn as a scatter plt is a graphic representatin f the relatinship between tw variables. Teams use scatter diagrams t help them identify cause-and-effect relatinships between tw variables. Fr example, after brainstrming multiple causes and effects using a fishbne (cause and effect) diagram, yur team might use a scatter diagram t determine whether a particular cause and effect are related. A scatter diagram graphs ne variable n the X-axis and the ther variable n the Y-axis. If the tw variables are related, the data pints will fall alng a diagnal line r curve that is, values fr variable X will be assciated with values fr variable Y. This culd shw either a psitive crrelatin (values fr bth variables increase r decrease) r a negative crrelatin (values fr ne variable increase while thse fr the ther decrease). Nte: A scatter diagram shws a crrelatin between tw variables; it des nt prve causatin. IHI s QI Essentials Tlkit includes the tls and templates yu need t launch and manage a successful imprvement prject. Each f the nine tls in the tlkit includes a shrt descriptin, instructins, an example, and a blank template. NOTE: Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Cause and Effect Diagram Driver Diagram Failure Mdes and Effects Analysis (FMEA) Flwchart Histgram Paret Chart PDSA Wrksheet Prject Planning Frm Run Chart & Cntrl Chart Scatter Diagram Cpyright 2017 Institute fr Healthcare Imprvement. All rights reserved. Individuals may phtcpy these materials fr educatinal, nt-fr-prfit uses, prvided that the cntents are nt altered in any way and that prper attributin is given t IHI as the surce f the cntent. These materials may nt be reprduced fr cmmercial, fr-prfit use in any frm r by any means, r republished under any circumstances, withut the written permissin f the Institute fr Healthcare Imprvement.

48 QI ESSENTIALS TOOLKIT: Scatter Diagram Instructins 1) Gather the data fr yur tw variables. On the data cllectin sheet, put each data pair in their respective clumns. Ensure the data remain paired. 2) Decide which factr yu will plt n which axis. Put the suspected cause n the hrizntal (X) axis, and the suspected effect n the vertical (Y) axis. 3) Draw and label the axes clearly. Make the axes rughly the same length, creating a square pltting area. Label each axis with increasing values frm left t right, and frm bttm t tp. Label each axis t match the full range f values fr that factr. In ther wrds, make the lwest numerical label slightly less than the lwest data value, and the highest label slightly greater than the highest value. The data shuld fill the whle pltting area. 4) Plt the X and Y data pairs n the diagram; place a pint n the graph where the tw values intersect. 5) Include a title at the tp f the diagram and prvide necessary anntatins t describe what it shws. 6) Study the pattern that the pltted data pints create t identify what yu have learned and decide n yur next steps. If there is an assciatin between the tw variables, the pattern will resemble an elliptical shape r a straight line. If the pints fr bth values are increasing (line slants frm lwer left t upper right): The crrelatin is psitive. If ne variable increases while the ther decreases (line slants frm upper left t lwer right): The crrelatin is negative. If the pints frm a circular shape: There is little r n crrelatin.

49 QI ESSENTIALS TOOLKIT: Scatter Diagram Example: Scatter Diagram This example scatter diagram shws the relatinship between median incme (X-axis) and Metr Health Index, a measure f peple wh smke r are bese (Y-axis). The researcher wanted t see if there was crrelatin between incme and health utcmes. Indeed, the scatter diagram indicates that cities with a lwer median incme tend t have a lwer Metr Health Index (indicating much higher levels f smking and besity). As the incme level increases, s des the Metr Health Index. The scatter diagram shws a strng psitive crrelatin between incme and Metr Health Index. Crrelatin Between Median Incme (in US $) and Metr Health Index Surce: Flrida R. Why Sme Cities Are Healthier Than Others. The Atlantic CityLab. January 5,

50 QI ESSENTIALS TOOLKIT: Scatter Diagram Befre filling ut the template, first save the file n yur cmputer. Then pen and use that versin f the tl. Otherwise, yur changes will nt be saved. Template: Data Cllectin Sheet Variable 1 Variable 2 Template: Scatter Diagram Variable 1 Variable 2