Final Contract Report: Managing and Evaluating Rapid-Cycle Process Improvements as Vehicles for Hospital System Redesign

Appendix B. Pre- and Post-Rapid Improvement Event (RIE) Week Activities

Pre-RIE Week Preparation

3rd week prior to event 2nd week prior to event 1st week prior to event
1: Confirm event area, topic, and steering team direction 1: Determine actual current customer demand, access 1: Review "3 weeks prior" and "2 weeks prior" checklists. Resolve open items.
2: Clarify external team leader, co-leader, and team members. 2: Determine actual throughput for event area over past 4 weeks.

2: Define clearly the boundaries of the event:

  • Who are the customers? What are the outputs? What triggers the area to do something for a customer?
  • Who are the suppliers? What are the inputs?
3: Confirm that at least 1/3 of the team is from the event area. Is IT expertise needed on team? 3: Determine actual total hours worked to create this throughput. (Get the actual time tracking data.) 3: Finalize customer demand and productivity.
4: Define the action deliverables expected from the event team (such as create 1-need flow layout with Standard Work). 4: Calculate actual productivity (use data: actual throughput divided by actual total hours worked). 4: Hold final meeting with area members and supervisor from area. Review measurements, targets, and action deliverables. Ask for feedback, try to address concerns. Reinforce "what's in it for them."
5: Define the measurements and targets for the team. Make sure there are only 3 or fewer key measurements. 5: Review sentinel events/incidents in the past year and member concerns. List top 5 patient safety issues.

5: Arrange for resources the team expects to need:

  • Information technology and facilities (internal/contractors).
  • Materials and any equipment that the teams may need.
6: Review action deliverables, measurements and targets with the external or internal experts. Revise if needed. 6: Review actual customer complaints, audit results. List top 5 quality issues. 6: Brief the experts.

7: Ask a few "hard" questions (then revisit 1, 2 and 3):

  • Will this team improve its value stream?
  • Will it bring the team closer to its desired "future state"?
  • What is the business case for the topic (customer and financial logic)?
  • Will this team improve the area's key measurements (list examples).
 7: Hold a meeting that includes every member of the area. Explain measurements, targets and action deliverables. Address questions and concerns.

7: Prepare supplies and logistics for the team:

  • Locations and schedules (Day 1 briefing, leaders' meetings, team break-out in the area, final presentation),
  • Food (daily morning snacks, lunches, late-night food).
  • Timekeeping (i.e., how hourly paid team members will charge their time and get data submitted daily).
  • Supplies (RIE and standard work forms, transparencies, clipboards, stopwatches, Post-it® notes, markers).
8: Update event charter from value stream analysis, review with site leadership, and send to experts for approval. 8: Put up a blank flipchart in the event area to get suggestions and questions for clarification. 8: Reconfirm schedule commitments with each team member, supervisor, maintenance person, contractor.
  9: Review and confirm event team leader, co-leader and members (reconfirm 1/3 of team from area).  
10: Brief team co-leaders and members: event schedule, measurements, targets and action deliverables.
11: Make sure that each team member understands that they are committed for the whole week!!!
12: Review availability of all necessary training areas and equipment.

Post-RIE Week Activities

1st week after event 2nd week after event 3rd week after event
1: Verify open action items and that appropriate personnel were assigned to work them. 1: Ensure 1st week after activities have been completed. 1: Follow up and report on open action items. Elevate concerns to next level of leadership.
2. Meet with action item owners to ensure they understand the action requirements and due dates. 2: Follow up and report on open action items. Elevate concerns to next level of leadership. 2: Ensure visual management tools (control boards, visual charts, etc.) are being used.
3: Verify that any new standard work sequences and standard processes are being maintained. 3: Ensure visual management tools (control boards, visual charts, etc.) are being used. 3: Participate in transformation rounds with leaders.
4: Insure that all safety and quality issues identified during the event are followed to completion. 4: Participate in transformation rounds with leaders.  
5: Participate in transformation rounds with leaders.    
6: Publicize event results.    

The following additional activities should occur at 30-day, 60-day, and 90-day intervals after the event:

  1. Meet with team leader, process owner, and senior level management to review action plan status.
  2. Provide resources and guidance as necessary to ensure the completion of action items.
  3. Review event metrics and results with process owner and senior leadership.
  4. Calculate return on investment and determine if desired results were achieved.

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