The objective of Mechanism 1 is to optimize the development process required to turn a PICO question into a clinical practice recommendation, making the recommendation available for use as quickly as possible. The development process has been optimized when work “flows” through it as smoothly and quickly as possible, with minimal interruptions, waiting, or repeating tasks, and without compromising quality or reliability. Perfect flow (in which work never stops and the development process happens as fast as resources allow) is a theoretical ideal; guideline programs should aim for continuous improvements in flow.
Establish “flow” in the development process
Below are descriptions of the components of this mechanism.
1.1 Make ongoing work visible
Framing Question: Where are your PICOs in the development process?
Making work visible facilitates managing the amount of ongoing work. Using tools like Kanban boards turns the “invisible” work of spreadsheets, statistical files, and manuscript revisions into visible representations of how work is progressing. Monitoring how work progresses through the guideline development process facilitates many of the other components that contribute to establishing flow.
1.2 Limit the amount of ongoing work
Framing Question: Do you have capacity for the PICOs being actively worked on?
Limiting the amount of ongoing work to match the capacity of the program is necessary to enable the flow of work. Actively working on more PICOs than your program has capacity for inevitably results in pauses in work. When work is paused it loses value; when work is paused for too long, it becomes obsolete and must be redone to ensure quality and currency. Limiting and prioritizing the number and order of PICOs that are actively being worked on will allow the work to flow more continuously and ensure work is completed in a timely fashion.
1.3 Minimize the “size” of ongoing works
Framing Question: How large in scope are your PICOs?
Minimizing the scope of PICO questions reduces the volume of work associated with each PICO. PICOs requiring larger volumes of work typically move more slowly through the guideline development process, which can have similar effects as pauses in the work, and/or require larger proportions of capacity to maintain a faster pace. By narrowing the scope of PICO questions, both flow and capacity can be increased. (Read Single PICO Flow for more)
1.4 Increase continuity in the work
Framing Question: Is there a consistent thread of context and information-sharing between everyone working on the PICOs?
Increasing continuity in the documentation and knowledge associated with a PICO promotes quality and reliability in the work. Decision-making is an integral component of guideline development. Decisions are often based on (or related to) past decisions; therefore, failing to document all decisions associated with the work reduces the quality and reliability of the work. Furthermore, the context in which each decision is made is an important component of the knowledge associated with each PICO. Maintaining continuity of this knowledge, either through an entire team or a selected individual, is important for optimizing flow.
1.5 Find and mitigate limiting factors in the development process
Framing Question: Which steps are slowing flow, and how can you mitigate those limitations to increase flow?
Identifying and mitigating the limiting factors in the development process increase the flow of work and capacity of the teams. Each step in the development process requires resources; unless these steps can be automated or the resource requirements are insubstantial, they can limit the flow and capacity of the development process. Limiting factors can range from labor-intensive procedures to highly-trained technical workers that must be heavily involved in certain steps. Identifying ways to mitigate these limiting factors, while maintaining quality and reliability, will increase the flow and capacity of the development process.
1.6 Eliminate unnecessary hurdles and wasteful work in the development process
Framing Question: Are there steps in the development process that can be consolidated, reduced, or eliminated to improve flow without negatively impacting quality or reliability?
Identifying and eliminating unnecessary hurdles and wasteful work in the development process increases the flow of work and capacity of the teams. Some hurdles and additional work, such as performing controls and checks, and proper documentation to maintain continuity of knowledge, are integral to maintaining quality and reliability of work. Unnecessary hurdles and wasteful work are those steps that delay completion of ongoing work and reduce flow without increasing the quality or reliability of the work. Eliminating these steps will help optimize the flow of the development process.
Σχόλια