Getting Started in QI Project Work:
Organizing Your Project Work (A3 Roadmap)
Defining Your Problem (Problem Statement
How do I Start?
How do I Get to Where I’m Going?
Framework – A3
• A3 – Tells a story
Framework – A3
• A3 – Tells a story
• Provides a STEPWISE Framework
Framework – A3
• A3 – Tells a story
• Provides a STEPWISE Framework
• Prevents Jumping from Problem to Solution
Framework – A3
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•
•
•
A3 – Tells a story
Provides a STEPWISE Framework
Prevents Jumping from Problem to Solution
Easily Shared with Team, Leaders, Colleagues
Picking a Problem
• Best Done by the person/people
DOING THE WORK
• Ask “What would be better about that?”
• Don’t include your SOLUTION as a part of your
PROBLEM.
– “We are leaving side-rails of beds down and patients
are falling and injuring themselves”
– Instead “The fall and injury rate for patients in the
PACU is 8%. The opportunity for improvement would
be a 50% reduction in falls.”
The Problem/Opportunity Statement
Problem/Opportunity statement should answer these questions:
• What is occurring or What are we missing?
• When did the problem start?
• Where is the occurrence?
• Extent (Gap) of the problem or opportunity
Example:
• In fiscal 2008 (When), the State Medicaid Group overpaid (What) a total of $5
Million/BJillion(Extent) in supplemental rebates to the 50 US states (Where).
Or
The Problem statement should be very specific and customer-focused:
Example:
• Mr. J received ten times the dose of pain killer ordered and required transfer to the
ICU and intubation for 24 hours.
• a
Voice of the Customer in Defining the
Problem
Ask the customers in the process:
1. What works well?
2. What does not work well?
3. If you could change one thing, what would it be and
why?
Tip: Don’t jump to solutions – capture them, but focus on issues in
“What are we trying to accomplish.”
Scope
The scope assists in defining the work and consists of two questions:
1.
What is the earliest step in the process and the last step in the process that falls
into this improvement cycle?
– Example: Is it the entire peri-operative experience or only from patient registration
through to hand-off in PACU?
– This bounds the work for the team and speeds success
2.
What is included and excluded in the work?
– All services or just Pediatrics?
– All floors or just 2 South?
Tip:
 Scope small to gain progress quickly
 Beware of Scope Creep!
The problem statement is the most
important stage of a project. It is critical to
properly define what is wrong with the
process, from the customer’s viewpoint.