Glossary of Terms

A3 Problem Solving: A systematic, structured and data-driven method used to write proposals, enable informed decision making, identify and report problems, facilitate problem solving, determine countermeasures to achieve a target condition, communicate status updates, and drive continuous improvement. A3 Problem Solving is based on the principles of Plan-Do-Study-Act (PDSA) Cycle and it helps promote scientific thinking. A3 refers to the international paper size (approximately 11 x 17 inches) that the report is originally produced on.

Acceptance Sampling: A method for evaluating the quality of a large batch of items from a small sample. After inspecting or testing a sample from a lot, an inference is made about whether the entire batch is acceptable or whether it needs to be rejected. There are two types of acceptance sampling. Acceptance sampling by attributes assesses either the number of defects or the number of defective items in a sample. The presence or absence of a characteristic is noted in each of the units inspected. Acceptance sampling by variables is based on quality characteristics that can be measured. This involves reference to a predetermined continuous scale.

Accuracy: The degree of agreement between a measurement result and the true value.

Activity Network Diagram (AND): A project management tool used to graphically display the sequence of tasks and interdependencies between them. It allows a team to identify critical schedule characteristics required to effectively monitor, analyze and adjust a project schedule. See also Critical Path.

Affinity Diagram: A management and planning tool used to gather and organize a large number of ideas into natural groupings. Affinity diagram stimulates creativity, breaks down communication barriers, makes it easier to understand a problem, and allows a team to identify innovative solutions. It is frequently used to create meaningful categories and organize ideas generated by brainstorming.

Alignment: Consistency of plans, processes, information, resource decisions, actions, results, and analyses to support key organization-wide goals. Effective alignment requires a common understanding of purposes and goals. It also requires the use of complementary measures and information for planning, tracking, analysis, and improvement at three levels: the organizational level, the key process level, and the department or work unit level.

Analogous Estimating: A project management technique that involves using expert judgment and historical information on the actual costs of similar, previously completed projects. It is also known as Top-Down Estimating technique. See also Bottom-Up Estimating.

Analysis of Variance (ANOVA): A statistical method for analyzing experimental data that involves dividing the variation in a set of observations into distinct components associated with specific sources of variation in order to test a hypothesis.

Andon: A tool or method used to alert team members and management that a quality or process problem has occurred. Employees are empowered to stop the work and request assistance to promptly address the problem and prevent recurrence. Traditionally, the alert is activated using a physical cord strung above a production line. Contemporary alert systems may incorporate signal lights, audio alarms, wireless buttons, intercom systems, and visual displays. Andon is one of the key elements of Jidoka. Andon board is a visual control device or display that indicates the current status of a process, shows key performance metrics and alerts team members if a quality or process problem is imminent.

Attribute Data: Discrete data that indicate the presence or absence of certain characteristic in each item under test. Attribute data contain a set of discrete values or categories such as pass or fail, yes or no, go or no-go, defective or not defective, low or high, small or large, and so on. See also Variable Data.

Baseline Data: A set of data collected at the beginning of an improvement project which serves as a basis for comparison with the subsequently acquired data on the same system.

Basic Process Equation: The elementary Six Sigma concept indicating that the outputs of any process can be controlled by controlling process inputs. This is expressed mathematically using a simple and elegant equation: Y = f(X), where Y indicates desired outputs or outcomes (dependent variables); X represents inputs required to produce the outcomes (independent variables); and f stands for process or function performed on the inputs to produce the outcomes.

Benchmarks: Processes and results that represent best practices and performance for similar activities, inside or outside an organization’s industry. Organizations engage in benchmarking to understand the current dimensions of world-class performance and to achieve non-incremental or breakthrough improvement.

Bias: A systematic difference between the mean of the measurement results and the true value.

Bottleneck Analysis: The process of identification of factors that restrict the overall capacity, throughput and performance of a production line or service delivery system. See also Theory of Constraints (TOC).

Bottom-Up Estimating: A project management technique that involves estimating the cost of individual tasks or work packages at the lowest level of detail. These cost estimates are added up or “rolled up” to higher levels of the Work Breakdown Structure (WBS) until the cost estimate for the entire project is determined. Bottom-up estimating also takes the most time and effort to complete. See also Analogous Estimating.

Brainstorming: A team problem solving method that involves rapid generation of creative ideas and solutions. The foundation of brainstorming is an atmosphere that is free of criticism and judgment. The brainstorming session can be structured so that each team member participates in turn, or it can be unstructured, with team members given the opportunity to simply contribute ideas as they come to mind.

Brownfield: An established production facility typically managed in accordance with mass-production thinking and systems of social organization. Contrast with Greenfield.

Cellular Operations: A method of designing the physical layout of a production process in a way that improves communication and optimizes space, time, equipment, workstations, inventory, and human resources needed to produce a component, sub-assembly or final product. Since all relevant operations are located in close proximity, it is easier to ensure timely feedback between operations when problems arise.

Chaku-Chaku: A Japanese term that means “load-load.” Chaku-Chaku refers to a single-piece manufacturing flow based on cellular operations in which all the required machines are arranged in the correct sequence and located in close proximity. Machines are loaded by taking the output from one machine and loading it into the next machine in the manufacturing process.

Check Sheet: A simple tool for collecting data in a structured form. The check sheet or tally sheet is used to collect data on the frequency of occurrence of certain events, differentiate between perceptions and facts, identify patterns, highlight problem areas, and provide baseline information for problem solving and quality improvement initiatives.

Change Concepts: A general set of process design ideas, methods and techniques that lead to improvement.

Common Causes of Variation: Predictable causes of variation that are inherent in any given process over time. Common causes are also known as random causes. A process described as stable, predictable or in control generally has only common causes of variation. See also Special Causes of Variation.

Concurrent Engineering: A systematic approach to the simultaneous design of products or services and related processes. Concurrent engineering practices decrease product or service development time and the time to market, leading to improved productivity and reduced operating costs.

Consensus Sampling: One of the commonly used sampling methods when administering a patient satisfaction survey. This type of sampling involves surveying a complete segment of the patient population to gain full understanding of the patient needs in the selected segment. Consensus sampling is used only when the total number of patients in the segment is small. See also Convenience Sampling, Quota Sampling, Random Sampling, and Stratified Random Sampling.

Continuous Flow: Also known as one-piece flow or single-piece flow, continuous flow refers to a production system in which products move continuously through the value stream without separating them into lots or batches for later processing. Continuous flow helps reduce inventory levels and improve overall business performance.

Control Chart: A graphical tool used to analyze, monitor, control, and improve process performance over time. The control chart includes the plotted data points, upper control limit (UCL), lower control limit (LCL), and a center line for the average. If all data points are within the control limits, variations may be due to a common cause and the process is said to be “in control”. If data points fall outside the control limits, variations may be due to a special cause and the process is said to be “out of control”. There are many types of control charts and selection of the appropriate control chart will be made based on the type of data and sample size.

Control Limits: Upper and lower control limits (UCL and LCL) in a control chart that provide statistically determined boundaries for the deviations from the center line. With the exception of acceptance control chart, control limits are based on actual process data, not on specification limits. Control limits are typically set at three standard deviations above and below the process mean and they can be used to detect common or special causes of variation.

Convenience Sampling: One of the commonly used sampling methods when administering a patient satisfaction survey. This convenient and inexpensive method may result in biased responses. Typically, the patients fill out the questionnaire left in the waiting room or registration countertop but only very frustrated or very satisfied patients tend to respond. See also Consensus Sampling, Quota Sampling, Random Sampling, and Stratified Random Sampling.

Correlation Coefficient (r): A statistical measure of the linear relationship between two variables. Correlation coefficients are expressed as values between -1 and +1.

Cost of Poor Quality (COPQ): Combined internal and external failure costs. Internal failure costs result from process inefficiencies, failures to meet performance requirements, and errors that are uncovered and addressed before delivery of services to patients and other customers. External failure costs are associated with problems, process deficiencies and errors that actually reach the patients. See also Total Cost of Quality.

Countermeasures: Actions taken to minimize the effect of process problems or abnormalities in the short term until permanent solution to completely eliminate the problem is identified, tested and implemented.

Critical Path: The series of tasks which add up to the longest duration and ultimately determine the total time it will take to complete the project. In essence, the critical path indicates the shortest time possible to complete the project. If any of the tasks on the critical path is delayed, then the entire project will certainly be delayed unless the project team can make up the time further down the critical path.

Critical to Quality (CTQ) Flow-Down: A technique used to identify critical features of a product or service that have a significant impact on customer experience. CTQ flow-down helps turn customer feedback, perceptions, requirements, and expectations into quantified product or service design specifications.

Customers: Actual and potential consumers or users of products, services or programs. Patients are the primary customers of healthcare organizations. Other customers may include community partners, patients’ families, health care providers, patient advocacy groups, government agencies, educational and research institutions, professional regulatory bodies, students, and many others.

Cycle Time (CT): The total time required to complete one cycle of an operation from the beginning to the end. Cycle time may also refer to the time elapsing between a particular point in one cycle and the same point in the next cycle.

Defect: An output of a process that fails to meet defined specifications, requirements or performance targets within the range of acceptable variation.

Defect per Million Opportunities (DPMO): The number of defects observed during a production run divided by the number of opportunities for defects multiplied by one million.

Deliverables: Defined, measurable and tangible results, outcomes, products, or services required to complete the project.

Deming’s System of Profound Knowledge: A management philosophy, leadership approach and conceptual framework for application of systems thinking to improve team or organizational performance. Profound knowledge consists of four interrelated components: Appreciation for a system, understanding variation, theory of knowledge, and psychology of change.

Design for Six Sigma (DFSS): A robust improvement methodology applied when developing an entirely new product, service or process at six sigma quality levels. It can also be used if a current process requires more than just incremental improvement. DFSS can help reduce the number of design iterations, prevent potential quality, safety and reliability problems, and fully meet stakeholder needs by incorporating an array of tools and techniques into the design process. The most commonly used DFSS models include: DMADV (Define, Measure, Analyze, Design and Verify), DMADOV (Define, Measure, Analyze, Design, Optimize, and Validate), IDOV (Identify, Design, Optimize, and Validate), and DMEDI (Define, Measure, Explore, Develop, and Implement).

Design of Experiments (DOE): A structured method of conducting controlled tests to determine the relationship between input factors impacting process outputs. DOE uses specific design combinations of changes of input factors to observe changes in output responses. Traditional experiments focus on one factor at a time at two or three levels while attempting to hold everything else constant. When properly constructed, DOE involves changing a number of input factors simultaneously so that their individual and combined effects on the outputs can be identified.

DMAIC: A structured, systematic and data-driven problem solving methodology focused on driving breakthrough improvements of existing processes. DMAIC is an acronym for the following five phases of Lean Six Sigma improvement: Define, Measure, Analyze, Improve, and Control.

Effective: The term refers to how well a process or a measure addresses its intended purpose. Determining effectiveness requires (1) the evaluation of how well the process is aligned with the organization’s needs and how well the process is deployed or (2) the evaluation of the outcome of the measure used.

Enterprise Risk Management (ERM): A proactive, structured and systematic approach to managing diverse risks across an entire organization using consistent processes within a comprehensive framework. ERM, also known as Integrated Risk Management (IRM), creates a shared platform to manage risks strategically by integrating risk management into the overall governance, strategic and operational planning processes, organizational policies and procedures, training programs, and performance management.

Failure Mode and Effects Analysis (FMEA): A proactive, systematic and structured technique used to identify, assess and prevent system, process or product failures before they occur. FMEA offers the apparent advantage over Root Cause Analysis (RCA) by preventing failures proactively rather than reacting to adverse events after failures have happened.

FIFO: An acronym for first-in, first-out. FIFO refers to the manufacturing practice of ensuring that the first product component to enter a storage is also the first component to exit. Likewise, materials produced by one process step are consumed in the same sequence by the next process step. By applying FIFO principle, it is less likely that stored product components, materials and supplies will expire or become obsolete.

First Pass Yield (FPY): Also known as quality rate or throughput yield, FPY refers to the percentage of units that complete a process and meet quality guidelines without being scrapped, rerun, retested, reworked, returned, or diverted into an off-line repair area. FPY is calculated by subtracting the defective units from the units entering the process and dividing by the total number of units entering the process.

Fishbone Diagram: A process analysis tool used to explore potential sources of variation in a process and graphically display the relationship between a specific problem or effect and its potential causes. Using a fishbone diagram, also known as a Cause and Effect Diagram or an Ishikawa Diagram, helps the problem solving team be systematic in generating and grouping the various assumptions about the causes of the problem under investigation.

Five S: A simple methodology used to create and maintain organized, neat, safe, and efficient workplace. The term 5S comes from five Japanese words beginning with the letter “S” – Seiri, Seiton, Seiso, Seiketsu, and Shitsuke which can be loosely interpreted as Sort, Set in Order, Shine, Standardize, and Sustain.

Five Whys Analysis: A simple tool used to identify the root cause of a particular problem by repeatedly asking the question “Why”, drilling down through the layers of symptoms and determining the cause-and-effect relationships. The root cause of the problem may be identified after asking the question “Why” only two or three times. In other cases, it may take more than five iterations to uncover the root cause. The Five Whys is most effective when the answers come from people who are closest to the problem being investigated.

Flowchart: A graphical representation of a process that shows all process steps and decision points in sequential order. The flowchart, also known as a process flow diagram, helps quality and process improvement teams examine and understand the actual sequence and interdependencies of process steps required to complete tasks or deliver services.

Force Field Analysis (FFA): A change management and decision making tool used to identify driving forces that support change in the desired direction and restraining forces that that get in the way of change. The tool was developed by German-born American social psychologist Kurt Lewin.

Frequency Distribution: A set of all the distinct values that individual observations may have and the frequency of their occurrence in the sample, population or dataset.

Gemba: A Japanese term referring to “real place”. It has been adapted to indicate the manufacturing shop floor, workplace or other areas where the action is and where value-adding activities take place.

Gemba Walk: A method to gather information through observation and interaction with frontline employees, foster a culture of open communication, recognize abnormal conditions, and identify opportunities for improvement.

Genchi Genbutsu: A Japanese term that means “go and see for yourself.” Genchi Genbutsu is a key principle of the Toyota Production System suggesting that in order to truly understand a problem and recognize implications of any corrective action one needs to go and see the process where the problem exists.

Greenfield: A new service or production facility providing the opportunity to introduce Lean methods, tools and techniques from the beginning. Contrast with Brownfield.

Hansei: A Japanese term that means “self-reflection”. As a significant part of organizational learning, Hansei meetings are often held at the end of key project milestones to capture lessons learned, identify problems, take personal responsibility, develop countermeasures, communicate progress, and drive continuous improvement.

Heijunka: A Japanese term referring to “leveling” or “level loading”. Heijunka helps organizations reduce the variety of items in production, decrease volume fluctuations over a period of time, prevent excessive batching, and consistently meet demands. A perfectly level-loaded system would have the same volumes and employee workloads in every time increment.

Histogram: A classic quality tool that provides a graphical summary of the frequency distribution of the data. Due to the pictorial nature of the histogram, it is easy to identify patterns that are difficult to see when numbers are presented in a table format.

Hoshin Kanri: A closed-loop strategic planning methodology used to visualize the future, focus organizational efforts on issues of strategic importance, maximize opportunities, determine strategic goals, build consensus, and align people, initiatives, projects, metrics, and resources behind the most critical challenges facing the organization. In order to hone objectives and determine realistic means to accomplish them it is essential to use the inter-level negotiation process called catchball where all employees have an opportunity to add value to the strategic plan and provide feedback based on the their knowledge and experience in specific functional areas. Also known as Policy Deployment, Hoshin Planning or Breakthrough Planning, Hoshin Kanri ensures that the vision, mission, values, and established strategic goals drive actions and behaviours at every level within the organization.

Human Factors Engineering (HFE): The scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance. HFE, often used interchangeably with human factors and ergonomics, has evolved as a unique and independent discipline focused on design of products, systems, processes, tasks, jobs, and work environments while taking into consideration the needs, abilities and limitations of people.

Indicators: Numerical information that quantifies input, output, and performance dimensions of processes, programs, projects, services, and the overall outcomes.

Integration: The harmonization of plans, processes, information, resource decisions, actions, results, and analyses to support key organization-wide goals. Effective integration goes beyond alignment and is achieved when the individual components of a performance management system operate as a fully interconnected unit.

Jidoka: A Japanese term that means “autonomation”, “automation with human intelligence” or “quality at the source”. Jidoka leads to operational efficiency and significant productivity gains by combining automation and mistake-proofing. Equipment and processes are designed and operated so that work is stopped immediately if a defect or abnormal condition is detected.

Jishuken: A Japanese term that means “self-learning” or “self-study”. Jishuken is a management-driven kaizen activity that involves identifying specific areas in need of continuous improvement, training of employees involved, spreading information, and stimulating other kaizen activities.

Just-in-Time (JIT): A highly efficient production or inventory management system in which materials, supplies or product components are delivered immediately before they are required in the production process resulting in reduced waste and inventory costs.

Kaikaku: A Japanese term referring to “radical change”, “radical improvement”, “innovation”, “reformation”, or “transformational change”. Kaikaku, also called Breakthrough Kaizen, aims to eliminate waste across an entire organization and create greater value by redesigning the entire system, products or processes.

Kaizen: A Japanese term that means “continuous improvement” or “change for the better”. Kaizen philosophy is applied to drive small incremental improvements of systems, products and processes and promote a culture of innovation and continuous quality improvement.

Kaizen Event: Also called Kaizen Blitz or Rapid Kaizen, Kaizen Event is a focused, intense, structured, and team-based problem solving approach to produce results and improve performance within a short period of time.

Kanban: A Japanese term that means “signal”, “card” or “sign board”. Kanban refers to a wide variety of systems used to visually communicate the need to replenish stock, optimize the workflow and manage, control and streamline the movement of materials in a value stream. Kanban systems and methods do not have to be elaborate or sophisticated to effectively visualize and enable Pull System.

Lateral Thinking: A process for solving problems by changing the frame of reference, looking at things in novel ways, using reasoning that is not immediately obvious, and generating ideas that may not be obtainable through conventional thinking. The term was coined by Dr. Edward de Bono who is regarded by many as the leading authority in conceptual and creative thinking.

Leadership System: A term that refers to how leadership is exercised, formally and informally, throughout the organization; it is the basis for and the way key decisions are made, communicated, and carried out.

Lean: A management philosophy, business strategy, methodology, and integrated system of tools and techniques designed to continually improve efficiency and effectiveness of processes, optimize the use of resources and minimize wasteful activities while creating value from the viewpoint of patients and other stakeholders.

Lean Six Sigma: A management philosophy, business strategy and integrated approach to organizational performance improvement that combines Lean and Six Sigma methodologies and provides a powerful set of tools and techniques to achieve operational excellence and create value. There is a great deal of overlap between Lean and Six Sigma but generally speaking, Lean is associated with efficiency, speed and elimination of waste, whereas Six Sigma is focused on improving quality, reducing process variation and elimination of defects.

Learning: New knowledge or skills acquired through evaluation, study, experience, and innovation. Organizational learning is achieved through research and development; evaluation and improvement cycles; workforce, patients, other customers, and other stakeholder ideas and input; best-practice sharing; and benchmarking. Personal learning is achieved through education, training, and developmental opportunities that further individual growth.

LIFO: An acronym for last-in, first-out. LIFO means that the most recently produced or purchased items are the ones used or sold first.

Linearity: The consistency of bias across the range of measurements.

Macro Process: A broad, largescale process that generally crosses functional and departmental boundaries. See also Micro Process.

Mass Customization: Service and manufacturing processes that combine the low costs associated with mass production with the flexibility, personalization and variable outputs required to meet individual client needs.

Material Requirements Planning (MRP): A computerized production planning, scheduling, and inventory control system.

Matrix Diagram: A tool used to systematically identify, rate and analyze the presence and strength of relationships between two or more variables.

Micro Process: A narrowly defined process consisting of detailed steps that can often be performed by a single operator. See also Macro Process.

Mind Map: A graphical technique for creating a visual, hierarchical and structured representation of connections between interrelated ideas and concepts. It is often created around a single idea or concept drawn in the center of a blank page. Mind maps are used to analyze, synthesize, classify, and generate new ideas needed to solve problems and make informed decisions.

Mean: The arithmetic average of all measurements in a data set.

Mean Time Between Failures (MTBF): The average time interval between product or component failures. MTBF is one of the important indicators of expected performance and reliability of a system.

Measurement System Analysis (MSA): An experimental and mathematical method of determining how much the variation within the measurement system contributes to overall process variability. MSA is performed to evaluate capability of the measurement system, identify sources of measurement variation, quantify measurement variance, and take necessary steps to ensure the accuracy and precision of measurement methods. A number of analytical methods are used to investigate key characteristics that contribute to the effectiveness of a measurement system including bias, linearity, stability, repeatability and reproducibility. Resolution or discrimination is another important parameter that shows ability of the measurement system to detect small differences or changes in the characteristic measured.

Median: The middle value in a set of values that have been arranged in ascending order. If there is no middle value, the median is the average of the middle two values. 50% of the plotted measurements will fall below the median and 50% will fall above.

Mode: The value that occurs most frequently in a data set. If no value is repeated, then there is no mode for the data set.

Model for Improvement: A simple and effective framework for making meaningful changes and accelerating improvement. Developed by Associates in Process Improvement and successfully used by the Institute for Healthcare Improvement (IHI), the Model for Improvement consists of two parts. The first part includes the three fundamental questions: What are we trying to accomplish; How will we know that a change is an improvement; and What changes can we make that will result in improvement? Answers to these questions form the basis of improvement. The Plan-Do-Study-Act (PDSA) Cycle represents the second part of the Model for Improvement.

Muda: A Japanese term that means “waste”. Muda or waste is any activity that consumes resources but does not add value to the products or services. The terms waste and non-value added activity are often used interchangeably. The types of waste that exist in most organizational work systems and processes include unnecessary waiting, transport, inventory, motion, overproduction, overprocessing, defects, and wasted talent.

Mura: A Japanese term that means “unevenness”, “lack of uniformity”, “irregularity”, or “variability”. Eliminating fluctuations, unevenness or irregularities in any process or operation is one of the main pillars of the Toyota Production System.

Muri: A Japanese term that means either physical or mental “strain” or “overburden”. Muri refers to straining, overstressing and pushing systems, people, processes, or equipment beyond the normal or designed limits. Muri often results in employee injuries or illnesses, higher number of defects and unplanned equipment downtime.

Nemawashi: A Japanese term referring to “laying the groundwork”. It is literally translated as “”going around the roots” in the sense of preparing a tree for transplant. Nemawashi is often the first step in the decision making process and involves sharing of information, engaging employees in the process, seeking feedback, and building consensus before making changes.

Network Diagram: A project management technique used to display the logical sequence and relationships among the tasks as well as identify project milestones that signify important events in the project such as completing the major project deliverables.

Nominal Group Technique (NGT): A structured method for brainstorming that allows a team to quickly reach consensus on relative importance of issues or solutions. NGT allows all team members to participate in the process, generate ideas and prioritize potentially sensitive issues without being influenced by more dominant individuals.

Operation: An activity or activities performed on a component, sub-assembly or product by a single machine.

Organizational System: A set of interdependent, interactive and interconnected components forming a complex whole and working together to accomplish specific goals and objectives. Complex sociotechnical systems often consist of numerous subsystems that tend to be organized in some form of hierarchical structure.

Pareto Chart: A vertical bar graph which ranks the frequency or impact of causes in decreasing order of occurrence. The Pareto chart, named after a 19th century Italian economist Vilfredo Pareto, is used to separate the most significant problems from the trivial ones by displaying the relative importance of problems in a simple, visual format. The Pareto principle suggests that most effects or problems result from relatively few causes.  In other words, 80% of the effects or problems typically result from 20% of the possible causes.

Partners: Key organizations or individuals who are working in concert with the organization to achieve a common goal or to improve performance. Typically, partnerships are formal arrangements for a specific aim or purpose, such as to achieve a strategic objective or to deliver a specific product or service.

Performance: Outputs and their outcomes obtained from processes and services that permit evaluation and comparison relative to goals, standards, past results, and other organizations. Performance can be expressed in nonfinancial and financial terms.

Performance Excellence: An integrated approach to organizational performance management that results in (1) delivery of ever-improving value to patients, other customers, and stakeholders, contributing to improved health care quality and organizational sustainability; (2) improvement of overall organizational effectiveness and capabilities as a healthcare provider; and (3) organizational and personal learning.

Pie Chart: A graph in the form of a circle divided into sectors or “pie slices”, where each sector shows the relative size of each value. Pie charts are typically used to compare up to 6 sets of data but they do not show changes over time.

Plan-Do-Study-Act (PDSA) Cycle: An iterative, four-step scientific method for solving problems, improving processes and implementing change. The steps in the PDSA cycle include: 1. Plan – Develop a plan to test the change; 2. Do – Carry out the plan preferably on a small scale; 3. Study – Analyze the data and study the results; 4. Act – Refine the change based on lessons learned. PDSA cycle is also known as the Plan-Do-Check-Act (PDCA) cycle, Deming cycle or Shewhart cycle. The original PDCA cycle was developed by Walter A. Shewhart and later adapted by W. Edwards Deming, replacing “Check” with “Study”.

Point-of-Use Storage or (POUS): The practice of storing materials, parts, tools, and any other inventory items at the location where they will be used.

Poka Yoke: A Japanese term that means “inadvertent error prevention”. Poka Yoke, also known as mistake-proofing or error-proofing, refers to a wide variety of system safeguards, tools and techniques that make human errors improbable or even impossible. Poka Yoke can completely eliminate the possibility of human errors, make complex tasks easier to perform, detect errors or defects before proceeding to the next step in the process, or minimize the impact of errors.

Portfolio: Projects and programs grouped together to balance investments, examine the value of proposed projects, and maximize effective management of projects, programs and other related work. The projects and programs within a portfolio may or may not be directly related but they all contribute to achievement of strategic goals.

Precision: The degree to which repeated measurements will produce the same results under unchanged conditions.

Process: A set of interdependent operations or defined series of steps that transform inputs into outputs with the purpose of producing a product or providing a service. Generally, processes involve specified combinations of people, information, equipment, tools, methods, techniques, and materials used to achieve a particular end.

Process Capability: The degree to which a process, with its inherent variability, is capable of meeting established customer specifications and requirements. The concept of process capability is meaningful only for processes that are in a state of statistical control.

Process Controls: Existing policies, procedures, practices, standards, inspections, internal audits, employee training, technology, equipment, and other mechanisms designed to prevent failures from reaching the patient, reduce severity of failures, reduce likelihood of occurrence, or increase likelihood of detection.

Process Decision Program Chart (PDPC): A management and planning tool used to systematically identify what may go wrong in a plan under development. Countermeasures are developed to prevent or mitigate potential failures.

Process Village: The practice of grouping activities by type of operation performed rather than in the sequence required to design or manufacture a product.

Product Family: A group of related products derived from a common product platform. Typically, these products can be produced interchangeably in a production cell using common equipment and following a series of similar process steps.

Production Board: A visual management board located at a prominent point in the workplace and used to display hourly production targets along with the actual production achieved. It is also known as “60-minute board”.

Productivity: The term refers to measures of the efficiency of resource use. Although the term often is applied to single factors, such as the workforce or labor productivity, machines, materials, energy, and capital, the productivity concept applies as well to the total resources used in producing outputs.

Program: Similar, interdependent and related projects grouped together to ensure efficient use of resources, improve coordination and enable more centralized management of projects within an organization.

Progressive Elaboration: A project management technique that allows a project team to continuously update, improve and refine the project plan as more detailed and specific information become available during the course of the project.

Pull System: A lean system in which the provision of services or production is based on actual demand. The upstream departments or suppliers do not initiate services or produce items until a signal is received from the downstream processes or departments.

Push System: A traditional system in which the provision of services or production is not based on actual demand. The upstream departments or suppliers initiate services or produce items whether the downstream processes or departments are ready or not.

Quality: The quality of products is typically defined in terms of conformance to specifications, freedom from deficiencies, fitness for use, performance to standards, meeting customer expectations, reliability, durability, serviceability, aesthetics, safety, and value for the price paid. The quality of services is often defined in terms of responsiveness to customer needs, competency and courtesy of staff, consistency, communication, availability, timeliness, promptness in resolving issues, accuracy, and many other factors. There are also many definitions, domains or dimensions used to define quality in healthcare. For example, the Institute of Medicine (IOM) defines quality as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. The World Health Organization (WHO) defines six areas or dimensions of quality in healthcare suggesting that healthcare must be effective, efficient, accessible, patient-centered, equitable, and safe.

Quality Assurance (QA): All the planned and systematic activities implemented within the quality management system focused on providing confidence that a product or service will fulfill requirements for quality. The terms “quality assurance” and “quality control” are used interchangeably, referring to the activities and actions performed to ensure the quality of products, services or processes.

Quality Audit: A systematic, critical analysis of the quality of patient care and resulting outcomes as well as planned, independent and documented assessment of a process, product, or quality management system to determine whether requirements are being met. Quality audits enable organizations to systematically review their activities, practices and results referenced against accepted standards of practice, government regulations, guidelines, quality management system requirements, or organizational policies and procedures.

Quality Control (QC): The operational techniques and activities implemented within the quality management system focused on fulfilling quality requirements. The terms “quality control” and “quality assurance” are used interchangeably, referring to the activities and actions performed to ensure the quality of products, services or processes.

Quality Function Deployment (QFD): Also known as the house of quality, QFD is a method used to translate customer needs, priorities and requirements into product or service design features and technical characteristics.

Quality Management System (QMS): A network of interdependent processes and procedures, organizational structure, and resources required to plan, implement, control, sustain, and continually improve quality. The QMS provides a framework for seamless integration of quality planning, quality assurance (QA), quality control (QC), and a number of other structured, systemic and planned activities designed to ensure quality and patient safety.

Quality Trilogy: A universal approach aimed at managing and improving quality of products and services that is attributed to the celebrated management consultant and engineer Joseph M. Juran. Also known as the Juran Trilogy, this approach involves three interconnected managerial processes including quality planning, quality control and quality improvement.

Quota Sampling: One of the commonly used sampling methods when administering a patient satisfaction survey. This method is used when specific number of patients is needed from each segment. For example, the specific number or quota of male or female patients may be required for the sample. See also Consensus Sampling, Convenience Sampling, Random Sampling, and Stratified Random Sampling.

Radar Chart: A graphical method of displaying the magnitude of gaps between current organizational performance and ideal performance targets. Three or more quantitative variables are typically represented on axes starting from the same point and the resulting chart resembles a radar screen or a spider’s web. The radar chart, also known as a spider chart or web chart, makes organizational strengths and weaknesses visible by clearly showing key categories of performance.

Random Sampling: One of the commonly used sampling methods when administering a patient satisfaction survey. Random sampling involves random selection of patients from a known patient population so that each patient in the population has an equal chance of being included. See also Consensus Sampling, Convenience Sampling, Quota Sampling, and Stratified Random Sampling.

Range: The difference between the largest and smallest values in a data set.

Rapid Changeover: A series of methods and techniques introduced by Shigeo Shingo for minimizing waste in a process by reducing the time it takes to change a production line or equipment from running one product to the next. It is also known as a Single Minute Exchange of Die (SMED), setup reduction or quick changeover. The ultimate goal is to achieve instantaneous changeovers and enable continuous flow. Additional benefits include increased production capacity, flexibility and responsiveness, improved quality of services, and reduced inventory, operating costs and equipment downtime. Rapid changeover within the context of healthcare often refers to changing or resetting a process, room or medical equipment for the next patient.

Relationship Diagram: A management and planning tool that shows the relationship between factors in a complex system. Also known as an interrelationship digraph, this tool is used to explore and determine logical cause-and-effect relationships between various ideas.

Repeatability: Within-system variation that occurs when successive measurements are taken under the identical conditions by a single operator.

Reproducibility: The average between-systems variation when multiple measurement results are obtained by different operators in a stable environment.

Risk Priority Number (RPN): The product of the severity (S), occurrence (O), and detection (D) ratings (RPN = S x O x D). As part of Failure Mode and Effects Analysis (FMEA), the RPN is essentially a numeric, quantitative value of the process risk. It helps the team focus on key areas of risk and prioritize improvement opportunities. The RPN for the entire process is obtained by adding up all the individual RPNs calculated for each failure mode.

Root Cause Analysis (RCA): A structured process used to perform a comprehensive, system-based investigation of any unexpected or undesirable event, uncover the underlying management, organizational and environmental contributing factors, identify the systemic flaws that lead to errors and failures, and subsequently develop effective solutions to prevent recurrence. The RCA helps determine what happened, why it happened, and what systemic changes need to be made to prevent it from happening again.

Run Chart: A visual representation of observed data or process performance indicators over time that allows improvement teams to observe trends, patterns or vital changes in a process. The run chart, also known as a run-sequence plot, helps the teams formulate process improvement goals and evaluate the value and impact of the specific changes on the process performance over time.

Scatter Diagram: A graphical tool to analyze the relationship between two variables. The values of two variables are plotted along two axes and the pattern of the resulting points reveals any correlation present. The scatter diagram is also known as scatter plot, scatter graph and correlation chart.

Sensei: A Japanese term that means “a teacher”. In the context of Lean, it refers to the master teacher of lean methods, tools and techniques.

SIPOC Diagram: A visual tool for documenting and mapping a process from beginning to end. The acronym SIPOC stands for suppliers, inputs, process, outputs, and customers. The SIPOC diagram is typically developed during the “Define” phase of Lean Six Sigma DMAIC (Define, Measure, Analyze, Improve, and Control) methodology.

Six Sigma: A management philosophy, business strategy, methodology, metric, and integrated set of tools and techniques for reducing undesirable process variation, eliminating defects and achieving breakthrough performance improvements. The term sigma (σ) is a Greek letter that refers to the standard deviation or measure of variation in a process. Processes with minimal variation or higher sigma quality levels are less likely to produce defects. If a process operates at the six sigma level it means that this distinctly capable process is almost perfect and 99.99966% of resulting products and services are free of defects. This world-class performance equates to only 3.4 defects per million opportunities (DPMO).

SMART Objectives: A set of organizational, team or individual objectives that are characterized by being Specific, Measurable, Actionable, Realistic, and Time-based (SMART). The SMART objectives help mobilize the organizational resources, build commitment to change, capitalize on specific opportunities, drive individual accountability, and monitor progress against targets.

Spaghetti Diagram: A visual representation of movement of people, products, information, and materials through a physical area or process. Spaghetti diagram, also known as spaghetti chart, uses a continuous line to trace the path, determine the distance traveled, identify redundancies in the work flow, and uncover the waste of excessive motion and unnecessary transportation.

Special Causes of Variation: Unpredictable causes of process variation that occur due to unexpected special events or unusual circumstances. Special or assignable causes of variation are not normally an inherent part of a process.

Stability: Performance of the measurement system over time.

Standard Work: Documented and agreed upon work instructions that precisely describe the best known methods, required resources and sequence of tasks to achieve desired outcomes consistently, efficiently and safely. By documenting the current best practice, standard work or standardized work creates the baseline for continuous improvement.

Statistical Process Control (SPC): The application of statistical techniques to monitor process behavior, reduce variation and steer the process in the desired direction.

Statistical Quality Control (SQC): The application of statistical techniques to monitor and control the quality of products and services. The term Statistical Quality Control (SQC) is often used interchangeably with Statistical Process Control (SPC). However, SQC includes Acceptance Sampling as well as SPC.

Storyboard: A method for highlighting key aspects of a Lean Six Sigma or quality improvement project using creative, graphical and engaging formats. Storyboards are typically posted in the area where the improvement activities occur but they are becoming increasingly virtual.

Stratified Random Sampling: One of the commonly used sampling methods when administering a patient satisfaction survey. This type of sampling is useful when the patient population is not homogeneous and it ensures that various subgroups of the patient population are represented in the sample. See also Consensus Sampling, Convenience Sampling, Quota Sampling, and Random Sampling.

Supermarket: The storage location of the parts and materials used to supply downstream production processes. Supermarket is characterized by predetermined maximum and minimum inventory levels.

Takt Time: The available production time divided by the rate of customer demand. The term originates from the German word “takt” which refers to a beat, pulse or rhythm. As the heartbeat of any Lean system, Takt Time sets the pace of production to match the rate of customer demand. For example, if a customer needs 120 units per day and the production line is set up to run 480 minutes per day, then Takt Time is 4 minutes (480/120=4). In other words, to optimize capacity, minimize inventory and successfully meet customer demand one unit has to be completed every 4 minutes.

Theory of Constraints (TOC): A management philosophy and set of tools and techniques introduced by Eliyahu M. Goldratt for improving processes by identifying and eliminating the barriers or constraints in a process. The constraint is often referred to as a process bottleneck. One of the key principles in the Theory of Constraints is that the system is only as strong as its weakest link. In order to drive continual improvement, achieve optimum performance and sustain effectiveness of the system, it is essential to methodically address the constraint until it is no longer the limiting factor.

Total Cost of Quality: The sum of various quality costs across the four categories that include appraisal costs, prevention costs, internal failure costs, and external failure costs. Appraisal costs are associated with measuring and evaluating the quality of medical care, delivery of services, compliance with standards of practice, and conformance to performance requirements. Prevention costs arise from systematic efforts throughout the entire organization to prevent or minimize internal and external failures. Internal failure costs result from process inefficiencies, failures to meet performance requirements, and errors that are uncovered and addressed before delivery of services to patients and other customers. External failure costs are associated with problems, process deficiencies and errors that actually reach the patients. Combined internal and external failure costs are also known as the Cost of Poor Quality (COPQ).

Total Productive Maintenance (TPM): A system designed to maintain the integrity of production and improve quality, efficiency and safety by increasing equipment reliability, availability and performance. TPM is focused on keeping equipment in excellent working condition to eliminate or minimize breakdowns, setup and adjustment losses, idling, minor stoppages, reduced speed, product rework, defects, and delays in production processes.

Tree Diagram: A management and planning tool that systematically breaks down and maps out the tasks, subtasks or conditions required to achieve an objective. The completed diagram resembles a tree.

Trends: Numerical information that shows the direction and rate of change for an organization’s results. Trends provide a time sequence of organizational performance. A minimum of three historical (not projected) data points generally is needed to begin to ascertain a trend. More data points are needed to define a statistically valid trend. The time period for a trend is determined by the cycle time of the process being measured. Shorter cycle times demand more frequent measurement, while longer cycle times might require longer time periods before meaningful trends can be determined.

Type I Error: The error of rejecting a null hypothesis when it is actually true. Type I error is also known as a false positive, alpha (α) error or error of the first kind.

Type II Error: The error of failing to reject a null hypothesis when it is actually false. Type II error is also known as a false negative, beta (β) error or error of the second kind.

Validation: Confirmation by examination of evidence that a product or service meets the requirements, satisfies the operational needs of the user and achieves its intended purpose.

Value Stream Mapping (VSM): One of the essential Lean tools used to document, analyze and improve the flow of information, materials or people required to provide services and create value for patients and other stakeholders. By incorporating fundamental Lean concepts, VSM helps identify the sources of waste in a value stream, differentiate between valued-added and non-value-added activities, optimize decision making, provide common language, and streamline critical processes across organizational or departmental boundaries.

Variable Data: Continuous data resulting from the measurements recorded on a continuous scale. See also Attribute Data.

Verification: The act of determining whether products or services conform to design specifications.

Visual Management: A method to visually and succinctly communicate process performance, expectations, standards, and warnings so that key stakeholders can easily understand the status of the system at a glance.

Visual Management Board: A visual aid designed to engage and inform employees, organizational leaders and other people visiting the work area. The board may have a number of customized headings including quality, safety, cost, process, delivery, people, environment, and innovation.

Voice of the Customer (VOC): A term used to describe the process of capturing customer needs, expectations, preferences, and requirements. Some of the typical data collection methods may include written surveys, telephone surveys, in-person interviews, technical specifications, direct observations, complaint logs, market research, data mining, Kano analysis, quality audits, and comment cards.

Voice of the Process (VOP): A term used to describe process measures indicating the actual process performance against customer requirements.

Work Breakdown Structure (WBS): Hierarchical outline of the total project work that must be completed by the project team in order to achieve project objectives and produce project deliverables.

Work Systems: The term refers to how the work of your organization is accomplished. Work systems involve your workforce, your key suppliers and partners, your contractors, your collaborators, and other components of the supply chain needed to produce and deliver your health care services and business and support processes.

Workforce Capability: The organization’s ability to accomplish its work processes through the knowledge, skills, abilities, and competencies of its people.

Workforce Capacity: The organization’s ability to ensure sufficient staffing levels to accomplish its work processes and successfully deliver your health care services to your patients and other customers, including the ability to meet varying demand levels.

Work-in-Process (WIP): Partially completed products, parts, subassemblies, or services that are awaiting further processing prior to being forwarded to the customers as finished products or completed services.

Yokoten: A Japanese term that roughly means “horizontal deployment”. Yokoten is a process for sharing information, knowledge, innovative ideas, and lessons learned laterally across an organization. It often involves copying and improving on Kaizen ideas and adapting them to address the local problems.