I have sat through hundreds of unproductive meetings over my many work years and I would say that the great majority of team “wheel-spinning” could have been avoided using one simple tool: The Critical-to-Quality Tree which I now call the Critical-to-Success Tree because I think that name resonates better with most people. I know I’m preaching to the choir in explaining this to my lean-six-sigma trained brethren but for those not familiar with the tool I can only say this; LEARN IT TODAY! It’s critical to any improvement project and should be the first tool you use before you go out and purchase any software or information system.
In essence this is a tool used to take a "Big Goal" and convert it into sub-goals and the related metrics, which in turn can be converted into action items that will help you achieve your "Big Goal" . It’s on my top 5 must-use process improvement tool list.
Take a look at my simplified example below:
We can say our "Big Goal" is to arrive at work on time but until we layout what that entails it is not going to happen. In this example we take this rather simple goal of "getting to work on time" and work through the specific actions that will make that happen. For this goal many people could figure out the requirements and specifications by trial and error but using the tool eliminates that need. The tool is completed from left to right with the left side showing a broad need or want and as you move to the right you get more and more specific about how to drive that goal. When complete it becomes clear that unless you are successful in meeting the specifications (far right) you will not accomplish the broader goal (far left). Note that the specifications may require more detailed action items.
Consider a much more complex issue. Rather than getting to work on time consider a more complex problem that you think you can solve by installing a certain expensive software program or by completing a Lean project. Maybe you want to improve patient flow, reduce the cost of a surgical process, or increase MRI utilization. Do you think you would understand the drivers and specifications of these complex processes without going through this exercise?
Lets use a complex “real life” problem that every Hospital is facing: How will the Hospital reduce Congestive Heart Failure 30 day readmissions? This is critical because starting in 2012 they will not be paid for additional services within 30 days of the first admission and related discharge. Before you read further why don’t you grab a piece of paper and jot down what you believe are the drivers and specifications for such a project. If you get all of the drivers and specifications you see below I submit to your genius however my experience is that few individuals and almost no teams can layout the critical success factors without using this tool. Now, with your “guess” by your side take a look at a recent Critical-to-Success diagram a team of ours is using for that specific goal.
While some may disagree on the exact format to complete this exercise and while there might be some minor quibbling about the exact drivers it is clear that the tool allows any team to bring much more focus to large and complex issues. Before we did this exercise our team was trying to solve the problem in a semi-accurate (most people understood the basic issues) but random manner and we were not making very good progress. After allowing the team to struggle for a few meetings I intervened (with the facilitator), explaining the tool and its benefit. The facilitator was also frustrated with the team’s progress and being a very smart person he immediately gleaned the value of this tool and we worked on it together and then later with the team. Once the team created this CTS diagram the dynamics within the team changed dramatically. Armed with clear objectives the team members and the facilitator could spend their time accomplishing specific actions that will drive success. The team is making good progress and the wheel spinning has stopped.
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