Big eyes. Big ears. Tiny mouth: Observations of an RPIW newbie


This week I am participating in my first Rapid Process Improvement Workshop (RPIW).

The term RPIW specifically refers to the week when ideas for improvement will be tested through learning cycles, by a team of participants who work within the selected area or unit – and a patient who has received care there. There is, however, a lot of work that goes into an RPIW that is less visible than the actual event week.

Some members of the RPIW “Core Team” begin their work as far out as 6 weeks before the RPIW event week.  The core team is made up of a KPO Support person, a Team Lead, and a Sub team Lead. This trio is responsible for working with the area Sponsor and Process Owner to define the scope of the improvement week, by collecting data, building a value stream map, and setting targets in the three weeks leading up to event week.

Before this week (RPIW week minus three, as it is referred to), I had heard others talk about how much data collection goes on in the weeks leading up to the event.  I often wondered what data needed collecting and really, how much could there be?  Now I know!

In the weeks leading up to the RPIW event week, the goal is to “walk the process” that your team is studying at least 10 times.  While walking the process from the patient’s perspective, you are observing where the patient waits, what questions the patient is being asked, what health care providers are involved, when those health care providers become involved, and how the information is shared between providers or even between units. While walking the process, you are also watching where the patient is taken, by mapping – step by step – how far they are traveling.

After you have observed the process from the patient perspective, the team may choose to walk the process from a provider perspective.  Each time you walk the process, you see new things to learn more about.  Week minus three is really rooted in curiosity. It is imperative to follow that curiosity, because doing so helps take you below the surface to see what is really going on.

During “week minus three” there are several key moments or milestones:

  • The first is the kick off meeting, which starts on Monday at 8am. This is where the core team and the sponsor and process owner first meet. It is at this meeting where everything gets put on the table. Conversations tackled in that meeting cover everything, from the reasons why this particular area or unit was selected for improvement, from what’s working well to the rocks in people’s shoes. It is during this meeting that an initial scope gets set for the work of the event week.
  • The second milestone is data collection. Figuring out what you need, how you are going to get it, who is going to get it, how to make sense of it, what forms you need to use to get it and what calculations you need to do to make sense of it.  This is a milestone that really spans the week, with each day providing more and more clarity.
  • The final milestone of the week is the last daily status meeting which happens Thursday afternoon. This is where the core team, the sponsor, and process owner come together to review everything that has been learned throughout the week.

Week minus three is a busy and fast paced week. The days are long, yet they pass by too quickly. There’s barely enough time to eat. Today is my last day and already Monday feels a distant memory.

A mantra that guided me through this entire week were some wise words shared by Lisa White, Infrastructure Lead within Saskatoon Health Region’s Kaizen Promotion Office.  She told me that week minus three requires  “Big Eyes, Big Ears, Tiny Mouth.” After surviving this week, I would add one more item to that list: Fast Feet. You do an incredible amount of walking, running, and at some times, shuffling, to complete the observations, get forms printed, and meet with providers.

Below is a picture of one our daily status meetings. Team Lead, Crystal McAra is describing the process steps the team had observed after a day of data collection. Also in attendance are Cindy Graham, Sponsor, Deb Leek, Process Owner, Alenka Rudolph, JBA Consultant and Maura Davies, Sub Team Lead.

This month, Saskatoon is preparing for 4 RPIWs; all will run their tests of change from January 28-February 1. Report out on these events is scheduled for February 1 from 1-3pm in the City Hospital Auditorium.  These report outs are open to anyone who is interested.

In the meantime if you are interested to learn how week minus two and week minus one go, follow along on Twitter (#RPIW) as a few of us tweet about our team experiences.

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4 Responses to “Big eyes. Big ears. Tiny mouth: Observations of an RPIW newbie”

  1. Heather Thiessen
    January 11, 2013 at 12:21 pm #

    Great post Debra. I am feeling exhausted just imaging what you are doing. I know us patients and families appreciate all the pre work you do to make the RPIW week go so smoothly and organized. Can’t wait to hear and see all the observations you make. Keep up the great work!!!

    • Debra-Jane Wright
      Debra-Jane Wright
      January 11, 2013 at 12:34 pm #

      Thanks Heather! It really was as mystery to me as to what was all involved in the front end preparation of an RPIW. It has been really interesting to be part of the process and to see how iterative this process really is. Learning is key and while there is a recommended process and structure to follow during the week, what is really important is to not let yourself get too tied to anything too quickly. The more you see, the more you learn and the more you learn the more of the process you really begin to see! I also feel very proud that this province has made a commitment to always involve patients in the RPIW process and if a patient is not involved, an RPIW does not proceed. Pretty darn cool.

  2. Dennis Kendel
    January 11, 2013 at 12:15 pm #

    Thanks for sharing your RPIW expereinces with us.I find it very interesting and informative.
    Dennis Kendel

    • Debra-Jane Wright
      Debra-Jane Wright
      January 11, 2013 at 12:20 pm #

      Thanks Dennis for reading these reflections. It has been an interesting week for sure!! We are literally in the midst of setting our targets for the RPIW, based on what we have seen thus far this week, as I type!

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