To truly have a culture of quality, ongoing quality improvement (QI) efforts must be occurring at all levels of the agency, from executive leadership to front-line staff. This article attempts to provide public health practitioners with a step-by-step approach for choosing a QI project.
Practical Strategies for Choosing a QI Project
This three-step approach can assist in choosing a QI project by generating and prioritizing a list of ideas.
Phase 1: Consider Potential Starting Points
To begin, it is important to pay attention to existing agency activities that could reveal the need for improvement. Observing an agency’s operational patterns and addressing the root causes is likely to have a ripple effect—improving multiple processes and growing the culture of quality. Here are some common information sources that can be used to generate topics for a QI project:
- Are there performance measures in your agency’s performance management system that need improvement?
- Do recent customer or employee satisfaction results highlight an area needing improvement?
- Are there opportunities to practice QI while also helping your agency prepare for accreditation or reaccreditation?
- Does your agency’s QI plan contain QI goals or a calendar of QI projects?
- Did any program data, such as an audit or report, reveal an opportunity for improvement?
- Have staff or customers been asked directly for their improvement suggestions?
Whether you’re referring to customer satisfaction data or a review of performance measures, this step helps to ensure that the team has considered these common existing agency activities for potential improvement areas before brainstorming.
Phase 2: Brainstorm Ideas for a QI Project
If you could generate several ideas for a QI project from Step 1, this step may be skipped. However, if you’re looking to generate more ideas, brainstorming is an easy way to cultivate creativity and innovation by allowing participants to build on each other’s ideas, think openly, and challenge the status quo, and it gives all participants an equal voice in the process. This type of creative thinking is important in public health because it gives agencies opportunities to maximize their internal resources and increase their impact on their communities’ health.
Here’s how you can try it yourself:
Supplies: sticky notes, markers, flipchart, or wall
Participants: all members of one program, department, or team
Team Supervisor or Authority Figure (not attending): It helps to ask the team supervisor to not attend the brainstorming session to allow staff the opportunity to share their opinions without perceiving judgement.
Facilitator: It helps to include a neutral party that is not participating in the activity, such as a Quality Council member or someone from a different part of the organization.
Steps for Phase 2
Example: What are some ways the clinic can reduce the amount of time it takes patients to check in and register upon arrival?
Figure 1: Brainstorming and categorizing responses into similar groups
1. Write the main brainstorming question at the top of the flipchart, and ensure that everyone understands the purpose of the brainstorming session
2. Ask each participant to write down one idea per sticky note, ensuring that everyone submits at least one response.
3. Stick ideas on the flipchart under the question, grouping similar ideas together (as shown in Figure 1).
4. Read responses aloud, and ask for clarity if needed.
Responses (grouped in the following categories):
- Ensure that pre-visit preparation steps support efficiency upon patient arrival.
- Standardize the check-in sheet and improve visualization of the check-in window, so patients can easily understand how to check in.
- Standardize registration paperwork to include only necessary information for all visit types.
- Improve communication between check-in staff and registration staff to reduce the time it takes between these steps.
Phase 3: Prioritize Ideas
Now that a list of potential QI projects has been created, it can be prioritized systematically to ensure that the most important issues are fairly addressed. A systematic prioritization, done by a staff team, is transparent and defensible, and it promotes buy-in from participating staff. A prioritization tool, such as a matrix or a Pareto chart, can be used to rank a list of projects in order of importance based on criteria that the agency determines to be significant. If using a matrix, weighted scores can communicate the preference of certain criteria over others. For best results, modify the criteria to your agency’s needs.
Potential criteria to consider include the following:
- Urgency of process improvement (other services depend on it, it affects essential public health service delivery, the state mandates it, etc.)
- Strategic alignment (community health assessment/improvement plan, strategic plan, QI plan, performance management system, workforce development plan, reaccreditation or accreditation, agency policies, etc.)
- Impact on stakeholders (think of impact as the number of additional departments, processes, and/or stakeholders benefiting from this improvement, etc.)
- Resources needed to complete (staff, funding, time, etc.)
Now, it’s your turn! Consider the following:
Supplies: sticky notes of project ideas from the brainstorming activity, marker, flipchart, handout of selected criteria (optional)
Participants: all members of one program, department, or team who participated in brainstorming ideas
Team Supervisor or Authority Figure: It will help to include the team supervisor in the prioritization step because he or she can provide insight into the effort required for the project.
Facilitator: It is helpful to include a Quality Council member or someone with performance management or strategic planning expertise to align efforts with existing QI projects and agency priorities.
Steps for Phase 3
1. Before the prioritization session, determine which prioritization tool and criteria to be used. Print the tool with the criteria for participants’ reference. Also, draw the tool on a flipchart.
2. During the prioritization session, review the tool and criteria to ensure that everyone understands the purpose of the prioritization. Place the sticky notes from the brainstorming session onto the flipchart tool.
3. In small groups, ask participants to evaluate the first project based on how well it fits the criteria on the tool handout. Repeat for all projects and total project rankings.
4. Once everyone has finished, discuss responses for each project as a group and write the final consensus on the flipchart.
5. Focus the first Plan, Do, Study, Act cycle on the highest-scoring project, and once that project is complete, move to the project scoring the second highest, and so on.
Example: What are some ways the clinic can reduce the amount of time it takes patients to check in and register upon arrival?
Prioritized list of projects based on these criteria (urgency of process improvement, strategic alignment, impact on stakeholders, resources needed to complete):
- Standardize the check-in sheet and improve visualization of the check-in window, so patients can easily understand how to check in.
- Improve communication between check-in staff and registration staff to reduce the time it takes between these steps.
- Standardize registration paperwork to include only necessary information for all visit types.
- Ensure that pre-visit preparation steps support efficiency upon patient arrival.
Next Steps
PLAN: Now that you have chosen a QI project, you can begin planning it with the QI framework of your choice.
REVIEW: Keep this documented list of prioritized projects so that after the first project is completed, the team can refer to the list and start on the next QI effort without hesitation.
REVISE: Prioritize projects annually to plan for improvements for the upcoming year. This will encourage sustainability and support the creation of a manageable project plan with a timeline, goals, and objectives for one QI effort at a time.
By systematically prioritizing these improvements, participating staff have a voice in the process and are engaged before the project begins, increasing the likelihood of successful completion.
Citation
Roberts, G. & Kane, T. Choosing a QI Project. Wed, 03/14/2018. Available at https://www.phqix.org/content/choosing-qi-project. Accessed 04/25/2024.