Problem Solving

Mindset
Workarounds and Blaming in a hospital

EMR = Electronic Medical Record IS = Information Systems

Toyota’s Practical Problem Solving Method (PPS)
• Steps 1 - 5: Understand the problem and the current situation.
“Don’t jump to solutions”
• Steps 6 - 8: Monitor the processes and results and standardize.
“Initially, not all solutions will be successful.”
If the results are not as expected, go back to a previous PPS process
and try again. If successful, standardize the process.

Step Activity PDSA

Number Phase
1 Clarify the problem Plan
2 Breakdown the problem into manageable parts
3 Set targets
4 Analyze and find the root cause
5 Develop countermeasures
6 Implement countermeasures Do
7 Monitor the processes and results Study
8 Standardize successful countermeasures and processes Adjust
Toyota’s Practical Problem Solving Method (PPS)
• Step 1: Clarify the problem
- Go to the actual site. Do actual site observation and
discussion and data collection.
- Talk to the people working in the process or area in
question.
- Understand the scenario, answering questions of what,
when, who (not whose fault, but who is involved), where,
and how.
- State the problem in a more specific, fact-based way.
- A precise problem statement should define a measurable
gap between actual performance and desired performance.
Toyota’s Practical Problem Solving Method (PPS)
• Step 2: Break Down the Problem into manageable
parts
- Narrow the scope to something that is more
accurate, more understandable, manageable, or
more easy to solve.
- A reported problem might actually only be
occurring in one department within the system.
- When data are available, Pareto charts can be
helpful statistical tools to focus problem-solving
efforts. The “Pareto principle” often means that
80% of complaints or problems are caused by 20%
of the causes
. Pareto principle—20 percent of the
activities yield 80 percent of the results

Prioritize the problem areas

• The first approach uses
the sole criterion of cost
• The second approach
considers the relationship
between the problem
area and operations
strategies
• The third approach
allows for soft factors,
such as the effects of the
problem areas on people
in ways that cannot be
quantified
Pareto Chart
Toyota’s Practical Problem Solving Method (PPS)
• Step 3: Set Targets
- The PPS approach is often not straightforward.
- Example: A short-term goal of reducing to half, instead of to
zero, the defects might be appropriate to entice support and
cooperation. Further improvement would be made through
additional follow up efforts later on.
- Ask questions to understand the situation well.
- Example: In a hospital, an audit team set a target of 100%
scanning of outpatient records as the section in charge
seldom scanned them. Upon further analysis, it turned out
that the records were just computer printouts and need not
be scanned. The target was set to 0% scanning.
Toyota’s Practical Problem Solving (PPS)
• Step 4-5: Analyze the problem, find the true or root
causes, and develop countermeasures
- Go beyond surface problems to the root cause.
- Develop and test countermeasures to prove or
disprove the effect of a suspected cause.
- Go back and review previous steps if necessary
- Use various Quality Control tools to find the true
causes
• 5 WHYS - Problem: The process failed because a piece of equipment has failed

Why did the equipment fail? Because a

circuit board burned out.

Why did the circuit board burn out?

Because it overheated.

Why did the circuit board overheat?

Because the ventilation system wasn’t
working properly.

Why was the ventilation system not

working properly? Because the filters had
not been changed recently.

Why were the filters not changed recently?

Because that was not on the preventive
maintenance schedule.
5 WHYs Too many documents are returned
Because Why?
Almost every time, documents released have many
errors detected
Because Why?
Previous errors detected are not analyzed
Because
Why?
Errors detected in
documents are corrected Quality Control (QC) methods
and are not informed are not being used
Because Why?
No communication
between sections involved Managers do not fully
in documents preparation understand QC methods
Because Why?

No system established to No proper QC Training is

prevent re-occurrence of conducted to managers
mistakes
5 Whys to find the root cause
• Fishbone Diagram / Ishikawa
Diagram / Cause & Effect
Diagram (CE)
4Ms = Man, Machine,
Material, Method
7Ms = 4Ms plus Maintenance,
Measurement, Mother
Nature
4Ps = Place, Procedure,
People, Policies
4Ss = Surroundings, Suppliers,
Systems, Skills
The Seven
Tools of
Quality
Control
Gaps Model of Service Quality
Gap 1: Not knowing what customers expect— the difference
between what customers expect and what managers perceive
they expect
Gap 2: The wrong service quality standards—the difference
between what managers think customers expect and the
actual specifications they establish for service delivery
Gap 3: The service performance gap—The discrepancy
between service specifications and the actual service
delivered
Gap 4: When promises do not match delivery—The
difference between what an organization promises about a
service and what it actually delivers
Gap 5: Expected service—perceived service gap - Gaps 1
through 4 contribute to the emergence of Gap 5, which is the
difference between what the customer expected to receive
from the service and what she believes she actually did
receive
 The 3 T’s : Fail- Safe Service
Example in Car Repair Service
• Task to be done – was the
car fixed properly ?
Task

• Treatment accorded to the

customer – was the service
manager courteous?
Treatment Tangibles
• Tangible features of the
service facility – were the
waiting area and toilet clean
and comfortable?
Toyota’s Practical Problem Solving Method (PPS)
• Steps 6-7: Implement countermeasures & monitor
processes and results
- A countermeasure has to be tested in practice. If fixing a
faulty machine results in better performance, we have
found the correct countermeasure.
- If we could turn off the countermeasure, and the
problem reappears, that would give us further evidence
that our root cause analysis was correct.
- Look across departmental boundaries, across the
value stream or process to assure overall effectiveness
Toyota’s Practical Problem Solving Method (PPS)
• Step 8: Standardize successful countermeasures
and processes
- If the countermeasure is judged as successful,
standardize the new countermeasures made.
- Update the standardized work documents and
methods to ensure sustained performance and
continuous improvement.
- Spread the new practices to related parts of the
organization or process.
- Improve processes before spending money on
additional personnel, machines or on expansion.
5W (What – When – Where – Who – Why) & 2H (How – How Much)
- What is to be done? By when is it to be done? Where will it be done?
- Who is responsible for doing it? Why are we doing it?
- How is it to be done? How much will it cost?
What
When
Where
W

Gantt Chart