QI Tools
Improvement Facilitator Training
Session 2
1
Primary Care Practices
are 2.76 times more
likely to adopt evidencebased guidelines through
improvement facilitation.
- Baskerville, Liddy and Hogg, 2012
Be curious about
how things really work!
• Map Your Process
• Check for Defects
• Diagram Cause Effect
• Ask 5 Whys
2
Analyse your System;
Choose the Tools to Serve your Curiosity!
1.Why
2.Why
3.Why
4.Why
5.Why
3
The 5 “WHYs”:
• Sometimes a barrier or challenge is identified
that has a root cause that is not readily
apparent.
• By asking “WHY” 5 times you can usually drill
down to uncover that root cause.
Example:
• Dr. Doe chose CV Risk Assessment as part of
his ASaP screening bundle. One of the required
measures for the calculation is weight.
• Rooming staff were concerned that they could
not reasonably perform this measure
opportunistically to all patients of Dr. Doe.
• The 5 Whys are applied…..
Measuring weight opportunistically not
“doable”:
1st. WHY: Not enough time to weigh each patient before
rooming.
2nd. WHY: There would be a wait at the weigh scale.
3rd. WHY: There are only 2 scales in the entire clinic.
4th. WHY: More providers added over the years but no
more weigh scales added.
5th. WHY: Before ASaP, weight not done on many patients
per day so the 2 scales were adequate.
So, what was thought to be a time barrier is actually an
equipment barrier.
Run Chart Rules
• There are 4 basic rules to help interpret Run
Charts
• We will review the two that will likely be the
most useful to you
Run Chart Rules - a SHIFT in the process is
signaled by 6 or more consecutive data points
all either above or below the median.
Measurement
Note: Skip all values that fall on the median and continue counting.
Time
Run Chart Rules: A TREND is signaled by 5 or
more consecutive data points all going up or
going down, can span the median.
Note: If two data consecutive points are the exact same, you only count the first one
and ignore the repeating value; “like” values do not make or break a trend.
8
7
Measurement
5
3
4
2
1
Time
6
#6 is same
value as #5
so would not
be counted.
Fishbone, Cause & Effect or Ishikawa
Diagram
Blue Meadow Clinic Improvement Board
for Screening
What have we learned about the way
we currently do things?

Insert ‘cause & effect diagram’ OR ‘process
map’ OR ‘pareto diagram’ OR ‘5 whys’
Provider/Staff
Policies
Person/Patients
Effect



What changes are we making that
will lead to an improvement?
Patient Awareness :Placing posters in
rooms promoting pharmacist reviews for
patients on 5 or more medications.
Provider Reminders: Each day, attaching a
pharmacist brochure to charts of patients
on 5 or more medications who are
scheduled.
Place/Equipment
Procedures
25
20
15
Series 1
10
Target
5
0
1
2
3
4
5
6
7
8