1st Edition

Utilizing the 3Ms of Process Improvement
A Step-by-Step Guide to Better Outcomes Leading to Performance Excellence

ISBN 9781439895603
Published June 19, 2012 by Productivity Press
322 Pages 80 B/W Illustrations

USD $74.95

Prices & shipping based on shipping country


Book Description

Why is it that some improvement efforts succeed while others fail despite robust change management programs and the often do-or-die pressure to improve? Quite simply, there are three elements that separate those that succeed from those that fail. They are the 3Ms—Measure, Manage to Measure, and Make-it-Easy.

Complete with forms, templates, and case studies from the aviation and manufacturing industries, Utilizing the 3Ms of Process Improvement supplies step-by-step guidance on how to use the 3Ms to achieve performance excellence that lasts. Suitable for a wide audience—including suppliers, manufacturers, and those who work in service organizations, schools, healthcare, and government—it is as much about the science of process improvement as it is about how to lead process improvement utilizing the 3Ms.

Illustrating applications of the 3Ms across a range of industries, the book weaves stories throughout about role models who have succeeded, as well as those who have failed. It identifies the specific elements that were missing or defective in the failed attempts to provide a clear understanding of how the three elements work together. Arming you with a culture change method based on changing behaviors, it provides a leadership and management guide to achieving your objectives.

The 3Ms have worked for Ben Franklin, Abraham Lincoln, and the author’s teams across the globe. Now, with this book, you can put the power of the 3Ms to work for you in your quest towards improving processes and reducing costs.

The author encourages reader interaction and feedback on his website: www.rpmexec.com. He also provides you with access to the forms and templates described in the book.

Table of Contents

Overview of Process Improvement and the 3Ms
Outcomes Are the Result of Processes
Performance Excellence
3Ms for Process Improvement
     Manage to the Measure
     Make it Easier
Science of Process Improvement
Change Leadership
We Need All Three Ms to Sustain the Improvements
Case Study in Process Improvement
Utilizing the 3Ms for Process Improvement
3Ms, Scientific Methodology, Change Leadership
Key Points

Change Leadership
What Is Change Leadership? Change Management? How Do TheyDiffer?
The Need for Leadership in Change: A Case Study in Healthcare
Too Many Examples of Not Leading Change Well
Management and Leadership: Scientific Management
Perfect Example of Scientific Management
Definition of Manager and Leader
What Happens When There Is no Leader?
Leadership Principles
Abraham Lincoln on Leading Change
Leading Change to a Slave-Free America
Industry’s Change Leaders
Walking the Talk
Definition of Common Terms across Methodologies
Key Points

Resistance to Change and Process Improvement
Forces against Change: Resistance, Time, Natural Laws
A Quick Win against Resistance
Role of the Change Leader
A Policy of Change and Continuous Improvement
     Piloting Changes
     What Can Happen If Change Is Not Piloted First
     Balancing Change and Continuity
The Emancipation Proclamation
What Happens When One or More of the Ms Is Missing?
     Dr. Semmelweis and Washing Hands: The Right Change, but Why Is Change Needed In Healthcare?
     Semmelweis’s Improvement Dies with Him
     Forcing Doesn’t Always Work
The Force of Resistance
Benjamin Franklin, Electricity, and Change Leadership
     Principles of Electricity Explain Resistance to Change
     What You Can’t See Can Hurt You
Using Resistance to Help Lead Change
     Electricity and Forcing Change Can Be Dangerous
     Getting Change to Flow
     Resistance to Change Can Vary within the Same Person
     Resistance between Two Bodies
     Resistance at Home
Key Points
Practicing Change Leadership

Process Improvement Methodologies
Overview of the Most Popular Methodologies
Work with Toyota and for Motorola
     Motorola and Toyota Use Lean and Six Sigma Tools
PDSA and PDCA Compared to Six Sigma
     All Good Methods Analyze for Root Causes before Solutions
Case Study of Late Shipments
Cross Reference of PDSA, Six Sigma, Lean, Change Leadership
Human Factors and Ergonomics in Process Improvement
     Case Study: Human Factors Added to Lean Six Sigma
          Hand Hygiene Change Leadership Issue
Failure to Engage Others with the Measure
     Baseball and Managing to the Measure
     Measures for Research Purposes
     Measures for Process Improvement Purposes
     Cedars–Sinai Using Measure and Manage to the Measure
Key Points

Roadmap for Process Improvement
Start the Journey on Main Street
Getting Started on Our Journey
Possible Shortcut
Prepare for Change
     Articulating a Vision
     Elements in a Vision Statement
     Try Out Your Vision Statement
     How Does One Communicate the Vision?
Abraham Lincoln’s Vision
     Advocate a Vision and Continually Reaffirm It
     For Whom the Bell Tolls
     Quality Circles
          Enabling during the Recession of the Early 1980s
     Assumptions and Decisions
Key Points

Chartering the Process Improvement Work
The Charter
No Charter? Big Problem
     Sharing Findings before Departing
     Clear Definition of the Issue and What Was to Be Measured Are Key
     The Final Report and Surprise
The Issue Statement
     The Measures or Metrics
     Outcome and Process Measures
     Progressive Goals and Successive Successful Approximations
Measures and Goals to Build a Safer Culture
Hold Off on Financial Metrics Until
Scope the Work
Charter "Signatories"
     Chartering Is Iterative
     Sign the Charter
Key Points
Practicing Skills: Chartering

Stakeholder Analysis
Purpose of Stakeholder Analysis
Case Study in Stakeholder Analysis
Mission and Values of the Organization
Overview of the SHA
     Measuring the Gap: The Level of Resistance
     Three SHA Scenarios to Know Your Strategy Upfront
     Designing the "Circuit" to Achieve Flow and Manage Resistance
Difficult to Be Perfect
Them Is Us Eventually
Let’s Learn Stakeholder Analysis by Doing
     Using the SHA Template
     Time to Assess Each Stakeholder’s Buy-In
Key Points

Finding the Root Causes, Improving, and Controlling
Explore Together
     Doctor Livingstone
     Explore Together with Empathy and Patience
     Building the Team
Case Study
     Poor Service for a Major Customer and Its Customers
     Work-Arounds in the "Factory of Hidden Defects"
     Exploring Using the "Five Whys"
     Explore: Builds on Experimentation
     Build Consensus
     Train, Enable, Empower, Hold Accountable
          Training in the Improvements
Hold Accountable
Key Points

Utilizing the 3Ms: Measure, Manage to the Measure, and Make It Easier
     Practicing Measure
Manage to the Measure
Make It Easier
Visual Management
Measuring Example
Managing to the Measure Example
Make It Easier Example
     Takt Time: A Measure of the Pace Needed to Meet Customer Demand
Measuring: The Most Important M
Apply the First of the Three Ms and See the Value
     Setting Up Your Experiment
     Measuring the Baseline
Statistical Process Control Charting: Turning Data into Information
     Sample Size
     Hand Hygiene and the 3Ms
     Ready to Observe
     Alternative Experiment
The Hawthorne Effect
     Desire to Increase Productivity
Utilizing the 3Ms by Changing the Measure
     Incentive Piecework as a Measure
     More on the Perverse Incentive Measure
French Restaurant Dining
The Hawthorne Effect Revisited
     Case Study in Timeliness in Sharing the Measure
Key Points

What to Measure
Hidden Factory of Rework and Swiss Cheese
Getting Started: Preparing for Change, Chartering, and Stakeholder Analysis (SHA)
     Case Study: 3Ms Improving Surgical Safety
     The Measure Is Invented
     Measuring the Errors to Reduce the Risk of Wrong-Site Surgery
Measuring the Quality of a Decision
Practicing Measuring
A Change In One Area May Affect Other Areas
     Inventory Management
Measure What the Customer Measures
Base the Measure on Correlation with the Outcome
High Reliability Organizations: What Do They Measure?
A Safety Culture and How to Measure
Measuring the Inputs versus Just the Outcomes
Measuring the Culture
President Franklin D. Roosevelt’s First Inaugural Address
Key Points

Measure Risk to Achieve High Reliability
Measuring Risk
The FMEA Form
     The Process Step or Design Function
     Input, Failure Modes, Effects, Causes, and Scoring of Risk
     Existing Controls
     Risk Priority Number (RPN)
     Data Can Be a Component In Today’s High Tech Equipment
FMEAs Don’t Always Prevent Catastrophic Failure
3Ms Lesson: Must Manage to the Measure, Not Just Measure
Facilitating a FMEA
Key Points

Measurement as a System
Measurement as a System
Measurement System Analysis (MSA) Critical in Utilizing the 3Ms
Analyzing a Measurement System
Qualities of an Acceptable Measurement System
Attributes of a Measurement System
Designing a Measurement System
Performing a Measurement System Analysis (MSA)
     MSAs Can Be Really Easy
     Inaccurate Measurement Systems Can Lose Customers
     A Measurement System Using Actual Data by Surgeon and by Procedure
     Measurement Systems That Add No Value to the Client
     Calibrating a Measurement System
Statistical MSA Methods
     Categories and Types of Data
     Checklists as Measurement Systems
     Overview of Performing a Gage R&R
     MSA for Blood Pressure Reading
MSA for Attribute Data
     Attribute Agreement Analysis
          Moderate Risk of Harm
     The Soft Drink Challenge with AAA
Overview of MSA for Continuous Data and High Granularity
     Gage Repeatability and Reproducibility (Gage R&R)
     Precision to Tolerance: (%P/T)
          Knowing Good from Bad
          Percent to Total Variation %P/TV
          % Contribution
     Using Minitab in Measurement System Analysis for Gage R&R
     Should I Measure 100% or Sample?
     Sampling Quality
Key Points

How to Share and Communicate Measurements
Pareto Charts
     Pareto to Reduce Resistance
Statistical Process Control Charts (SPC)
     First SPC Chart: May 1924
     High Reliability Organizations (HROs) and SPC
     The "Swiss Army Knife" for Process Improvement
     Components of the SPC Control Chart
     Control and Out of Control
     Case Study
          Call Center Wait Times
     Using a Simple Histogram to Create SPC Chart Parameters
     Reliability and SPC
     SPC Is Often Preferred in Managing to the Measure
     Prove Change Really Occurred
     Change Management without SPC?
     Frontline Workers Have Been Using SPC Since the 1920s
Run Charts
Key Points

3Ms: Manage to the Measure
The Scoreboard
Visual Management
What to Expect Short Term and Long Term from Measuring
     Instructing and Coaching
     Training within Industry
          Job Instructions
          Job Methods
          Job Relations
          Program Development
Standard Work to Manage to the Measure
Coaching is Key in Managing to the Measure
     Coach’s Playbook
Key Points

3Ms: Make It Easier
Performance Improvement in Making It Easier to Change
Case Study
     Store Staff Spending Time with Customers
     Job Satisfaction
Making Change Easier Is What We Need to Do
Prepare Stakeholders for the Change
     Explore Together
Satisfaction and Loyalty Measurement
     Experiment, Explore, Build Consensus
Choosing the Best Countermeasures
Piloting and Choosing the Best Countermeasures
Piloting to See if the Measure Moves
     Train, Enable, Empower, and Hold Accountable
Mindfulness and Control
Commitment to Resilience
Case Study
     University of Pennsylvania, Penn Medicine Utilizing the 3Ms
SPC Making It Easier
The 3Ms Are the Most Important Tool for Leadership and Process
Improvement Leaders Including Change Leaders to Sustain the Gains
Key Points

High Reliability
Case Study: SKF
     High Reliability Program Number 1
     High Reliability Program Number 2
     The Products Surrounding the Variation
     Scrapping versus Inspecting
     Utilizing the 3Ms in Zero Defects and SWOC
     High Reliability Program Number 3: Building a Safety Culture
     A Story of a Seal and Its Grease
Change Isn’t Always Easy, Except
Stakeholder Analysis Revisited for Making It Easier
Designing an Experiment Should Start with the People Doing the Work
Key Points

Mistake-Proofing Promotes Defect Prevention versus Detection
     Types and Levels of Mistake-Proofing Devices
Human Error Drives Need for Mistake-Proofing
Mistake-Proof Approaches
Train, Engage, Enable, and Empower the People Doing the Work
Reinforcing Continuous Process Improvement
Key Points


Roadmap for Performance Excellence™
Process Improvement Foundational Tools
The Emancipation Proclamation
Charter Template
Stakeholder Analysis Template
Hand Hygiene Data Collection Sheet
Hand Hygiene Compliance Chart for Posting
Measure: Data Collection Tool
FMEA Severity, Occurrence, Detection Tables
Gage Repeatability and Reproducibility Measurement System Analysis


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Rick Morrow is a consultant with more than 25 years of senior leadership experience in healthcare, aviation, construction, automotive and high tech. Morrow leads Healthcare Performance Partners’ Quality, Safety, and High Reliability unit, a MedAssets company. He has authored Lean Six Sigma performance excellence courses and taught and deployed programs internationally for Eaton Corporation, SKF, Motorola, United Airlines, The Joint Commission, and Healthcare Performance Partners.

Morrow is the author and leader of HPP’s Six Sigma consulting and wrote and leads the Belmont University Lean Healthcare Certification Program for Supply Chain Professionals, which is a blend of The Toyota Production System, Six Sigma, and Change Leadership. Morrow also wrote and taught The University of Penn’s Penn Medicine Leadership and Performance Improvement courses. He authored the Lean Six Sigma Program at The Joint Commission and led its Center for Transforming Healthcare, where he and his team led collaborations improving patient care and safety with major academic medical centers including Cedars-Sinai, Johns Hopkins, Mayo Clinic, Intermountain Healthcare, North Shore Long Island Jewish, and Stanford University.

Morrow earned his MBA from the University of Illinois’ Executive Program and has a B.S. in Business from Illinois State University. Certifications include Motorola Master Black Belt and Lean Enterprise from the University of Tennessee. He is an international speaker on Lean Six Sigma, Quality, and Safety at conferences including NPSF, ASC and ASQ.

Morrow is also the author of the companion book, Utilizing the 3Ms in Process Improvement in Healthcare, and is a contributing editor on performance improvement, quality and safety publications. He is as proud in his work coaching his son and daughter in baseball and soccer and leading as President of Holy Family Commission of Education.

Featured Author Profiles

Author - Richard  Morrow

Richard Morrow

Executive Director, Quality, Safety, Reliability, Patient Satisfaction, Healthcare Performance Partners
Nashville, TN, USA

Learn more about Richard Morrow »


In this book, Rick Morrow provides a clear, structured, and disciplined approach to improving processes and systems in any industry or organization in need of improvement. He gives readers great insight into how all the tools of improvement can indeed be used in an integrated approach to improve service or product reliability, quality, safety, utilization, and efficiency. He wraps this around straightforward steps and the management systems required to sustain improvements. A must read for all looking to improve an organization and delivery system.
—Charles Hagood, Founder & Past President of The Access Group, International Industrial and Business Services Consulting

As an international expert in quality and safety, Utilizing the 3Ms of Process Improvement is my go-to-guide for practical applications in process improvement. This is a must read for all professionals looking to create sustainable processes and improve outcomes.
—David Jaimovich, MD, President of Quality Resources International