Chapter 3 – Problem Solving PDF

# MODULE 3 | DEVELOPING PROBLEM-SOLVING AND INNOVATION CAPABILITY ## CHAPTER 3: PROBLEM-SOLVING ### 3.1 INTRODUCTION This chapter deals with key aspects of an environment wherein problem-solving by staff can be done effectively, such as the establishment of Continuous Improvement Teams and a guid...

# MODULE 3 | DEVELOPING PROBLEM-SOLVING AND INNOVATION CAPABILITY ## CHAPTER 3: PROBLEM-SOLVING ### 3.1 INTRODUCTION This chapter deals with key aspects of an environment wherein problem-solving by staff can be done effectively, such as the establishment of Continuous Improvement Teams and a guiding cycle or framework for improvement. The chapter then also introduces different problem-solving tools and techniques. This chapter will focus on a reactive approach to improvement, i.e. solving problems that have occurred. The next chapter will focus on a proactive approach to improvement by discussing innovation and innovation techniques. ### 3.2 CONTINUOUS IMPROVEMENT TEAMS In order to start developing problem-solving and innovation capability and establish a culture of continuous improvement throughout the company, a vehicle must be defined through which continuous improvement activities can function. **IMPORTANT INFORMATION** Continuous Improvement Teams are often referred to as the 'vehicle for improvement'. The vision for a Continuous Improvement Team (CIT) is self-directed improvement, spontaneously initiated by team members. In order to enable teams to move towards such a vision, it must be a priority in the company to create a culture in which it is an acceptable practice to form CITs and also to build capability through all levels to apply the appropriate tools and techniques relevant to CITs. In Module 1: Leading Performance-Driven Teams, the concept of a Performance-Driven Team was introduced. It is important to clearly distinguish between a Performance-Driven Team and a Continuous Improvement Team: - A Performance-Driven Team is a group of people with specific roles and complementary talents and skills, aligned with and committed to a common purpose, who consistently show high levels of collaboration and innovation that produce superior results. - A Continuous Improvement Team is a small group of people that have been called together for a specific period of time to solve a specific problem or to come up with a specific solution. This group can be made up of about three to five people from one Performance-Driven Team, or from different business areas and levels in the company. | Performance-Driven Team | Continuous Improvement Team | |:---|:---| | **Purpose** | Group of people with specific roles and complementary talents and skills, aligned with and committed to a common purpose, who consistently show high levels of collaboration and innovation that produce superior results.| Group of people focusing on solving specific problems or running with projects for improvement. The group is usually defined by the type of problem or improvement theme. | | **Composition** | People who work together every day in the same team or department, as described by the organogram. | Three to five people from one Performance- Driven Team, or from different teams, from different business areas, and from different levels in the organisation. | | **Leadership** | The line management structure as described by the organogram. Usually a team leader or departmental manager. | Group appoints their own leader who acts as leader/facilitator of the group for the duration of the continuous improvement project. | | **Frequency, Time and Place of Meeting** | Regular, ongoing meetings are held, for example start-of-day/morning meetings and weekly meetings (e.g. team 'huddles'). Meetings happen in the Performance-Driven Team area, and usually in front of their visual display. | Decided by the group. The team meets for as long as the project runs, at intervals as set out in the scope of the project and its action plan. The team disbands when its purpose is fulfilled, i.e. when the objectives of the project have been achieved - this could even be after two or three meetings. | | **Activity** | | | ### Activity 3 1. In your own words, describe the difference between a Performance-Driven Team and a Continuous Improvement Team. 2. Indicate the types of problem areas that each team should focus on. | Performance-Driven Team | Continuous Improvement Team | |:---|:---| | | | | | | | | | | | | ### 3.3 The CAPDo Cycle for Continuous Improvement Every team will need to master the CAPDo cycle as it is a fundamental principle of continuous improvement. The CAPDo cycle provides a helpful mental framework for continuous improvement. One of the major reasons for companies not mastering continuous improvement is the fact that teams do not follow the CAPDo cycle.  **IMPORTANT INFORMATION** The Check phase flows naturally out of the implementation of Performance- Driven Teams (Module 1): having an effective visual display and regular team discussions to monitor actual performance against standards, targets and action plans serves as the Check phase. The tools and techniques of Module 3 are then applied during the Analyse phase, where gaps in performance, i.e. problems or improvement opportunities are analysed, root causes are identified and innovation techniques are used to identify improvement suggestions. This is then naturally followed by the Plan and Do phases to ensure the most suitable/impactful improvements are selected, planned and put into action. **CHECK means to:** - Gather information on process, especially the outcomes of the process - Monitor performance against a target/standard/plan to ascertain whether objectives are being achieved - Consider the performance and the process involved from the clients' perspective and needs - Get early readings of the results of the plan and plot the results on achievement graphs - visually - Discuss results (good and bad) and identify reasons for performance gaps - Communicate results to all who need to know **ANALYSE means to:** - Analyse results achieved and reasons for poor (or good) performance - Gather further information on the process, especially the internal mechanics of the process such as the process steps, collect and analyse data and other information, such as qualitative information or pictures. - Identify root causes of problem areas - Generate potential solutions and corrective actions - Select most appropriate solutions and corrective actions in order to plan implementation **PLAN means to:** - Develop the improvement plan with action steps (What?) - Allocate all responsibilities (Who?) - Sequence action steps realistically and add dates (When?) - It also refers to the identification and planning of what needs to be tested or experimented with first, before it is implemented **DO means to:** - Carry out and implement the plan (distinguish between experiments and full implementation of a solution) - Communicate the change to all who need to know - Provide training, wherever necessary - Update standard operating procedures with the new method, if applicable **CELEBRATE SUCCESS** - This is a crucial step in keeping the cycle turning - When people feel that their efforts are not being noticed, they might just start working on something else, which they feel will bring them the recognition - Recognition helps to keep people interested in what they are doing, it will motivate them to try harder and to keep at it **IMPORTANT INFORMATION** Remember you can celebrate effort, but be careful not to celebrate success too soon, as the change must be embedded and sustained first. It is easy to see why the CAPDo cycle is a fundamental principle - it is the very definition of continuous improvement! **IMPORTANT INFORMATION** By ensuring that the cycle rotates us: - CHECK: Gather information about the problem or situation - ANALYSE: Analyse the information to see the situation – root cause analysis - PLAN: Plan an improvement or solution - DO: Implement the action plan - CHECK: Determine whether the improvement or solution has actually improved the situation - ANALYSE: If it wasn't successful, analyse why not - PLAN: How to further improve - DO: Implement the new action plan - CHECK: See if the improvement or solution has actually improved the situation - CELEBRATE SUCCESS: Always celebrate success by recognising the team involved It is important to note that the CAPDo cycle is not an actual tool or methodology to solve a problem, but it rather serves as a framework to guide continuous improvement thinking and often result in the use of specific problem-solving tools such as the methodologies discussed further in this workbook. ### 3.4 PROBLEM IDENTIFICATION Performance-Driven Teams are often not sure where to start with continuous improvement. Initially, all of Mediclinic's Continuous Improvement modules are improvement opportunities that can be used as catalysts to spark the undertaking of improvement action. The different modules will help staff to look for improvement opportunities from different angles and in different areas of this business. **IMPORTANT INFORMATION** A simple definition of a problem: 'A problem exists when there is a gap between what is and what should be.'  A common mistake is to leap into action before understanding a problem well. Understanding a problem well requires that the problem is thoroughly investigated through discussion, analysis and research. 'Our earnest advice to lean firms today is simple: forget about your competitors; compete against perfection by identifying all activities that are "muda” (waste), and eliminating it... this approach has kept Toyota in the lead for more than 40 years... However, you must master the techniques for eliminating "muda"...' - James P. Womach and Daniel T. Jones, Lean Thinking Another way to identify improvement opportunities is to identify waste in the workplace. A simple way of doing that is to ask ‘What makes work difficult?' This is an easy technique and it is effective in getting as many as possible examples of things that prevent us from doing our jobs effectively. To guide the processes, one can typically ask ‘What makes work difficult' in terms of: - Quality (of clinical care and patient experience) (Why do processes fail? What causes people to make mistakes?) - Cost (what causes people to waste time, money, effort, perform rework, etc.?) - Efficiency (what causes people to be delayed or to not achieve agreed time and speed standards?) - Engaged employees (what causes people to feel demotivated or disengaged?) ### Activity 4 Refer back to the problems in your area that you shortlisted as quick-win opportunities in Activity 1. Select one of the shortlisted problems and spend time to carefully think about it. Be prepared to state the problem as specifically as possible and to give some background information, such as why it is a problem, how it manifests itself, how it affects your clients and what you have tried to do in the past to solve it. ### 3.1 Define the problem properly. - Remember that it must identify the real issue at hand, and that it is phrased such that you will get responses from people. ### 3.2 Write down your solution to this problem in one sentence: ### 3.5 CONDUCTING PROBLEM-SOLVING Problem-solving is defined as 'the process of finding solutions to difficult or complex issues' and it mainly consists of using generic methods, in a structured manner, for finding solutions. Various generic methods exist to conduct problem-solving and most companies choose the ones that are most applicable to their environment, or that they feel more comfortable with. It is important that when a company starts with problem-solving activities and aims to build capability throughout all levels, a standard customized method and practical tool should be chosen to ensure that everyone is on the same page. As the company matures in problem-solving, the techniques could be adapted, and more freedom can be given to certain teams or specialists to explore alternative methods. In this section, the following are addressed: - Cause-effect relationships before embarking on problem-solving - The A3 method as the foundational framework for problem-solving - The improvement kata as a routine to always challenge for higher performance Establishing understanding of these concepts and the accompanying methodologies will assist Performance-Driven Team leaders and Continuous Improvement Team facilitators to develop problem-solving capability on all levels of the company in a systematic manner. 'The leader's job is to develop people. If the employee hasn't learned, the teacher hasn't taught.' - John Shook, October 2008 ### 3.5.1 Cause-effect relationships During normal day-to-day activities, the Performance-Driven Team will be faced with a variety of problems relating to the achievement of targets. Important decisions will have to be made to solve these problems and to define corrective actions. **IMPORTANT INFORMATION** When you cut a weed off just above the ground, it grows back as you have not pulled the whole root of the plant out. In the same way, when we have problems that keep on recurring, such as incorrect scheduling or incomplete information, you can be assured that you have not pulled the problem out by its root – you need to dig deeper. This is called Root Cause Analysis. When faced with a problem, a common mistake is to leap into action before first doing a sound analysis of the problem. The result is that the solution or decision often generates only short-term improvements. The reason for this is that the symptom was treated, and not the root cause of the problem. **IMPORTANT INFORMATION** In some cases, once a problem has been analysed and potential solutions identified, testing/experimenting with those potential solutions is required before they are simply implemented on a wide scale.  **IMPORTANT INFORMATION** - A symptom is usually something that can be seen or physically observed - The problem must then be clearly defined for each symptom - Root causes can be determined only once the problem has been defined There are different ways to analyse an identified problem in order to determine the root causes that need to be addressed rather than attempting to address the symptoms. Two simple and effective ways are '5 Whys' and 'Ishikawa Diagrams'. These two approaches to root cause analysis will be discussed next. **The 5 Whys** The 5 Whys is an iterative interrogative technique used to explore the cause effect relationships underlying a particular problem. The primary goal of the technique is to determine the root cause of a defect or problem by repeating the question ‘Why?' Each answer forms the basis of the next question. The method provides no hard and fast rules about what lines of questions to explore, or how long to continue the search for additional root causes. Thus, even when the method is closely followed, the outcome still depends upon the knowledge and persistence of the people involved. Observe the example of a problem: The vehicle will not start. - Why will the vehicle not start? (First why) - Because the battery is dead. - Why is the battery dead?(Second why) Because the alternator is not functioning. - Why is the alternator not functioning? (Third why) - Because the alternator belt has broken. - Why did the alternator belt break?(Fourth why) Because the alternator belt was beyond its useful life and not replaced. - Why the alternator was belt beyond its useful life and not replaced? (Fifth why) Because the vehicle was not maintained according to the recommended service schedule. (A root cause) The questioning for this example could be taken further to a sixth, seventh, or higher level, but five iterations of asking why is generally sufficient to get to a root cause. The key is to encourage the trouble-shooter to avoid assumptions and logic traps and instead trace the chain of causality in direct increments from the effect through any layers of abstraction to a root cause that still has some connection to the original problem. Note that, in this example, the fifth why suggests a broken process or an alterable behaviour, which is indicative of reaching the root cause level. **IMPORTANT INFORMATION** A key phrase to keep in mind in any 5 Whys exercise is 'people do not fail, processes do'. It is interesting to note that the last answer points to a process. This is one of the most important aspects in the 5 Whys approach - the real root cause should point toward a process that is not working well or does not exist. Untrained facilitators will often observe that answers seem to point towards classical answers such as not enough time, not enough investments, or not enough manpower. These answers may be true, but they are out of our control. Therefore, instead of asking the question 'Why?' ask 'Why did the process fail?' **IMPORTANT INFORMATION** When dealing with cause-effect relationships, many reasons will be given why a certain problem exists or an issue was observed. In order to steer clear of the obvious reasons, always ask the following questions: 1. Can it happen? The reason must be possible in theory. 2. Did it happen? It can be proven with practical investigation and facts. If you can answer yes to both questions, you can continue with the questioning. Not all problems have a single root cause. If one wishes to uncover multiple root causes, the method must be repeated asking a different sequence of questions each time. It is here where the Ishikawa Diagram can assist. **Ishikawa Diagrams** Ishikawa Diagrams (also called fishbone diagrams or cause-effect diagrams) were created by Kaoru Ishikawa (1968) and it shows all the causes of a specific event. Common uses of the Ishikawa Diagram are to identify potential factors causing an overall effect or symptom. Causes are usually grouped into major categories and can typically include: • **People:** Anyone involved with the process • **Method:** How the process is performed and the specific requirements for doing it, such as policies, procedures, rules, regulations and laws • **Equipment:** Any equipment, computers, tools, instruments etc. required to accomplish the task • **Material:** Raw materials, gases, medication, parts, pens, paper, information, etc. used in the process • **Measurement:** Data generated from the process that are used to evaluate its performance • **Environment:** The conditions, such as location, time, temperature and culture in which the process operates  **Variations on the Ishikawa Diagram include the following:** • The 5 Ms (used in manufacturing industry): Machine, Method, Material, Manpower, Management • The 8 Ps (used in marketing industry): Product, Price, Place, Promotion, People, Process, Physical Evidence, Packaging • The 5 S's (used in service industry): Surroundings, Suppliers, Systems, Standard documentation skills, Scope of work. ### Activity 5 1. Identify a recurring problem in your team, and practice using the Ishikawa Diagram to find a root cause(s). When stating the problem, consider how it affects your client(s) and aim to let your wording reflect the client perspective.  ### 3.5.2 The A3 method A3 is a structured problem-solving approach. It provides a simple approach that systematically leads towards problem-solving. The process is based on the principles of the CAPDo cycle, as explained earlier. There are various benefits at different levels of a company if the A3 method is applied: | Company | Manager | Employee | |:---|:---|:---| | Creates common language | A tool to see thinking and evidence of problem-solving | Creates seriousness to work, not just once-off problem solvers| | Cultivates discussion | Creates effective countermeasures based on facts and data | Engages the people touching the problem and the client | | Aligns the work at all levels | Promotes team understanding and consensus | Develops problem solvers | | Creates trust at all levels | A tool for coaching | Creates leadership and leaders | The A3 method derives its name from the central idea to collate and capture all information related to a specific problem as concisely, yet as complete as possible, on a single A3 size paper. The problem-solving process followed in the method is indicated on the A3 page and typically includes the steps as displayed in the example on the next page:  Consider the following explanation and questions that can be asked in each section of the A3: 1. **Title:** - The title is a short description of what the specific A3 is about. 2. **Background:** - The background should sufficiently explain why this is an important topic. This section can include factual information, graphs, reference to data sets, etc. - 'Why are you talking about this specific title?' - What is the business reason for choosing this problem? - How does it tie into your company's goals and objectives? - What are the client's real needs in this situation? - What is the impact on other team members? **IMPORTANT INFORMATION** To ensure that you understand what a problem is about before you start solving it, you can apply the 5W1H technique to ensure that you gather all the necessary information needed. This will help you to not make any assumptions that might send you down the wrong track! The 5W1H stands for: - What happened/was done? - When did it happen/does it usually happen? - Why did it happen? (Here the 5 Whys can be used)? - Who was involved/was responsible? - Where did it happen? - How did it happen/is it done/much does it cost? 3. **Current conditions:** - Explain the current condition by highlighting what is currently happening in the performance. The story should be told with facts via charts, maps, process flows, graphs, etc. - What is the process flow? Can we see the bottleneck, risk-points, timing issues? - Where is the client in this process and how is the client affected by the current process? - Are there standards in place? Are they being followed? - What is the current target achievement? - Are averages a good basis for having the conversation? 4. **Goals/Targets:** - In this section, outline the future state that must be achieved, i.e. set the challenge: - What performance standard would you like to reach within a certain amount of time? - What does the client want us to achieve by a certain time? - What are the metrics that you will measure to know if you achieve your target condition? - Are there any other supportive metrics you want to monitor or maintain to ensure that the correct results have been achieved? **Always ensure that all targets comply toSMART criteria.** **IMPORTANT INFORMATION** - Specific - Measurable - Achievable - Realistic - Time-oriented Not SMART: See if we can improve the flow of 'green patients' in the Emergency Centre next time. SMART: Decrease the two-week rolling median door-to-discharge time of 'green patients' in the Emergency Centre from 108 minutes to 60 minutes over the next six months. 5. **Analysis:** - Break down the problem into its specific root causes. In this section, depending on the complexity of the problem, you can use the 5 Whys, Ishikawa Diagrams or other cause-effect diagrams to determine what the actual root causes are. **IMPORTANT INFORMATION** Remember all root causes must have actually happened and can be supported by facts from practical investigations. 6. **Proposed countermeasures:** - Once the root causes are clear, potential countermeasures (solutions) need to be generated, evaluated and prioritised. This requires a description of what can be done to address the root causes and obstacles sufficiently. - First generate a list of all possible countermeasures without evaluating them as this will restrict generative thought and creative problem-solving. You can use the PMI method described in the next chapter as a guide. - When the list is exhausted, eliminate those that are not possible (regulatory, budget, resource availability, system constraints, capability, etc.). - Combine those that are similar. - Determine which countermeasures need to be tested first before other countermeasures can start, or before implementation starts on a wide scale. - Order the countermeasures in terms of priority, based on ease of implementation and expected benefits. 7. **Plan:** - The plan describes which activities will be required for implementation and who will be responsible and by when. Ensure that all the countermeasures are addressed in the plan and that all root causes are covered. - Action plans were explained in detail in Module 1. - Ensure that actions are clear and that a responsible person is allocated along with a due date. **ACTION PLAN** | Date | Issue/Problem | Action | Who | When | Status | |:---|:---|:---|:---|:---|:---| | | | | | | | 8. **Follow-up actions:** - In this section, list which issues can be anticipated and how each should be addressed. Also, note how and when follow-up checks must be conducted to ensure that the desired results are achieved. Some other aspects to consider: - How should the learning from the A3 be captured and shared with others? - Are there specific processes, procedures or standard methods that must be updated? - Are there similar departments, problems or processes that will benefit from this analysis? - Which metrics will be monitored to ensure ongoing improvement? - Communicate the results across the company and teach others. **IMPORTANT INFORMATION** What makes an A3 good? - It tells a story - It contains objective facts and data - It resolves a problem - It is concise and visual However, being technically 'right' is only half the battle - A good A3 engages and aligns the organisation. What really makes an A3 a 'good one' is not the specific collection of facts and data that set up a perfect problem-solve. A good A3 is a reflection of the dialogue that created it. ### Activity 6 Practice the A3 method by going through an actual example.  ### 3.5.3 Rapid improvement events Continuous improvement projects are generally conducted over a period of time, whereas rapid improvement events happen between three to five days. Rapid improvement works well when: - An obvious waste has been identified - Implementation of changes has a low risk - Immediate results are required - Demonstrating the power of continuous improvement to gain senior management buy-in There a several variations on running rapid improvement events. For this training module, the DMAIC method (Define, Measure, Analyse, Improve, and Control) was selected as the framework to use.  **STEP 1: Define Stage (Preparation)** While the actual event only takes three to five days, preparation time is still required prior to the event. The Define stage will focus on the preparation, which can take from a few weeks to a couple of months, depending on the improvement. In this stage, an event leader must be appointed. The leader will also be involved in clearly defining the objective of the event. It is important that the leader is not on management level, however the leader does need to be close to the process. Additionally, select a team of people to help with the rapid improvement event. The team should be between six and eight people consisting of individuals from within the process, some who are upstream and downstream of the process, some outside the process (who support the process) and finally some completely outside the process. This is will ensure a diverse team, which will help create stronger improvements. The team will need to be made aware that they will be focusing on the event for the entire week. Ensure that there is good communication links with everyone and provide them with all the information about the event along with any logistical information. During the Define stage, prepare and tailor any training material that is needed. Gather any existing data or spend time collecting new data. Organise and analyse the data to a degree that it is useful for group work during the event. Take the time to walk through the process in advance to ensure the improvement leader has a clear understanding of what the process involved is actually about. **STEP 2: Measure Stage (Monday)** On the first day, the improvement leader should brief the team and give an overview of the five days. On this day, the team creates a high-level map such as a Value Stream Map. If this is a new concept to everyone, training needs to be provided for the team. During this stage, all relevant information is discussed, collected data is presented and information is shared about the problem and the process. The output is that the team fully understand the problem area, along with all the constraints, performance measures and actual results. **STEP 3: Analyse Stage (Tuesday)** When the Measure stage is completed, move on to analysing the root causes. Process maps can be used to identify waste and non-value-added activities. The techniques of Root Cause Analysis can be applied (see section 3.4). Use cause-effect diagrams (5 Whys and Ishikawa diagram) to identify root causes to problems. **STEP 4: Improve Stage (Wednesday - Thursday)** Once the analysis has been sufficiently done, start working on solutions. Ensure improvements are suitable, prioritise them and then improve them further. Next, implement the improvements and provide any training necessary. **STEP 5: Control Stage (Friday)** In the Control stage, create any needed Standard Operating Procedures (SOPs) or update existing ones. Implement any plans that were developed to ensure further improvements in the future will happen, communicate changes to any necessary stakeholders and present outcomes to the management team. Tools such as a control plan or performance measurements also need to be implemented to ensure the improvements are working and sustainable. **IMPORTANT INFORMATION** Tips for rapid improvement events: - This is no silver bullet - it's not for every improvement. Complicated cross functional processes require more in-depth projects. - If you're not familiar with facilitating Rapid Improvement Events, then use an experienced expert. - Use the right tools for the job. Remember you have less time to work with. - Don't forget to celebrate the success of the team. - Plan each day with set goals, then review with your sponsor/manager. ### Activity 7 In which situations, or for which existing problems, can you apply the Rapid Improvement Event technique? Compile a list: ### 3.5.4 The improvement kata The improvement kata was developed by Mike Rother (2009), and outlines the scientific method of goal setting and achievement. The word Kata is a Japanese term, referring to a system of individual training exercises, that once mastered delivers a holistic approach to improvement through learning. It is a routine that is practiced so that it becomes an automatic habit. The improvement kata can be graphically shown as follows:  1. **Get the direction or challenge** - There are often new challenges to face in business - A challenge often even gives a useful sense of direction - Challenges usually lead towards the strategic goal of the business 2. **Grasp the current condition** - It is important to understand where you currently are, before you set your next goal - Do not pull goals randomly out of the air. A team should consider its goals to be meaningful 3. **Establish your next target condition** - Break a big challenge down into smaller goals - Set an easier and closer goal that is on the way to the challenge. - When the goal is reached, you can set the next goal 4. **Conduct experiments to get to the next target condition**  When experimenting is done right, small failures often provide new insight that advances the process. - You never know in advance exactly how you will achieve a goal. - We need to test the ideas we have. A good way to reach a goal is to experiment rapidly. Try something, see what happens, and then adjust based on what you learn. Refer to Chapter 3.5.3 - Rapid Improvement Events. - To learn from an experiment, you should write down what you 'expect and what actually happens,' so you can compare those two things afterwards. - After each experiment, ask the following questions: - What is your Target Condition? - What have you achieved up to now? - What did you plan to try in your last step? - What was the result? - What did you learn from your result? - What is your next experiment? The improvement kata, along with the guidelines and questions is a great tool for Performance-Driven Team leaders and Continuous Improvement Team facilitators to enhance their coaching skill during improvement events.