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Return to Newsletters Table of Contents What's New in Quality? FMEA (Failure Modes and Effects Analysis) Summary: FMEA is a tool developed outside of health care but now is being used by hundreds of hospitals and clinics o assess risk of failure and harm in processes. An interactive tool is available from QualityHealthCare at: www.qualityhealthcare.org/QHC/workspace/tools/fmea/. Overview: Failure Modes and Effects Analysis (FMEA) is a systematic, proactive method used to evaluate a process to identify where and how it might fail, to assign a failure risk number to error-prone steps, and identify by prioritizing the steps in a process most in need of change. This methodology is particularly helpful in evaluating new processes prior to implementation and in assessing the impact of a proposed change to an existing process. Steps in using the tool: • Select a process to evaluate with FMEA • Recruit a multidisciplinary team • Have the team meet together to list all of the steps of the process • Have the team list failure modes and causes • For each failure mode, have the team assign a numerical value (known as the Risk Priority Number, or RPN) for likelihood of occurrence, likelihood of detection, and severity • Evaluate the results • Use RPNs to plan improvement FMEA can be used to: • Reduce harm from failure modes • Evaluate the potential impact of changes under consideration • To monitor and track improvement over time A great analytical tool to add to your quality tool kit!   Thoughts and excerpts from: The Tipping Point by Malcom Gladwell, (2000) ISBN 0-316-1696-2 This is a very readable book as well as a useful book for anyone involved in making change. Mr. Gladwell explores how change happens and why some changes are successful while others are not. He explores trends to identify why some become widely accepted and others die out without being embraced by the majority. This phenomenon is described as the "tipping point". The analogy of an infectious disease epidemic is used to talk about change processes in a social setting. He outlines three basic principles involved in the mechanics of what makes something "tip" into an epidemic as opposed to dying out without the epidemic developing. Those three principles are: 1. The Law of the Few 2. The Stickiness Factor 3. The Power of Context "The success of any kind of social epidemic is heavily dependent on people with a particular set of rare social gifts." The Law of the Few: One critical factor in epidemics is the nature of the messenger. A. Connectors: These are people with a wide network of other connected people. For example, Paul Revere was very social and outgoing, suggesting that if were a quiet and introverted person, his midnight ride may not have had the same impact. The '"connector" concept is based on research that suggests there are "six degrees of separation doesn't mean that everyone is linked to everyone else in just six steps. It means that a very small number of people are linked to everyone else in a few steps, and the rest of us are linked to the world through those special few." B. Mavens: Maven comes from a Jewish word meaning "one who accumulates knowledge". This person is a teacher and information broker, sharing and trading what they know. C. Salesman: This is based on research about interactional synchronization that suggests emotion is contagious and there is a strong tendency to mimicry that happens during conversation. What the research shows about this is that: • Little things can be as important as big things • NON-verbal cues are MORE important than verbal • Persuasion often works in ways we don't appreciate The Stickiness Factor: "There are specific ways of making a message memorable; there are relatively simple changes in presentation and structuring of information that can make a big difference in how much of an impact it makes." Example: "Winston tastes good, like a cigarette should." Stickiness is a critical component of tipping. Ideas have to be memorable to move us to action. We need to know how it fits into our lives once it becomes personal and practical, it becomes memorable. "The lesson of stickiness - there is a simple way to package information that, under the right circumstances, can make it irresistible. All you have to do is find it." The Power of Context: "Epidemics are sensitive to the conditions and circumstances of the time and places in which they occur." We are exquisitely sensitive to changes in context. Paul Revere's ride would not have had the same impact mid afternoon."Our character and behaviors are definitely influenced by context." (Situation ethics, the show "Survivor" had modern Americans eating rats.) When people are asked to consider evidence or make decisions in a group, they come to very different conclusions than when they are asked the same questions by themselves. Once we are part of a group, we're all subject to peer pressure and social norms and any other kind of influence than can play a critical role, sweeping us up in the beginnings of an epidemic. "We have to keep groups below the 150 (participant) tipping point. Above that point there begins to be structural impediments to the ability of the group to agree and act as one voice."   Quality Line and Between the Lines are designed to provide members information on vital issues in Minnesota healthcare, trends, CQI methodologies, legislation and news about our organization. Published quarterly in Spring, Summer, Fall, Winter. Editor: Patricia Beilke Beilke.Patricia@mayo.edu