Over the past few years, I have been involved in training and facilitating many quality improvement (QI) teams in public health and have noted the following major problems that they have encountered:
1. AIM Statement - This important goal statement was often too large; the scope of the initial project was so large – “Solve World Hunger” – that the team floundered for many meetings trying to figure out what they were going to work on. AIM Statements should be discrete, measureable, and time-bound.
2. Team Charter – Many teams were simply started by management with no formal direction and were left to find their own way – “We think this is what management wanted” was a familiar statement. A detailed
Team Charter provides the start-up direction a team needs to be successful in tackling the task it has been assigned. Too often teams spend a considerable amount of their valuable resources trying to figure out what it is they are supposed to do. A well-developed Team Charter helps increase a team’s maturity since it answers a number of issues that usually arise in the start-up phase of a team.
3. Team Members – Team members were selected on the basis of who was available rather than who was needed. Starting off with the wrong team is a key ingredient in the recipe for disaster. Get the right people at the start, not those who are available.
4. Problem-Solving Process – Teams began their journey by not following a defined problem-solving process like
Plan-Do-Check/Study-Act (PDC/SA), or they skipped steps since the solution seemed obvious. If there is no defined process, the team wanders aimlessly.
5.
Rapid Cycle – Teams took too long to go through the PDC/SA cycle. Meeting for one hour every other week or once a month with many meetings cancelled soon left those remaining with the feeling that this was an endless cycle. Instead, have a limited AIM Statement, go through the PDC/SA cycle quickly, and get a quick win. Then move on to something more complex and keep repeating the PDC/SA cycle.
6. Team Maturity – Teams go through a growth cycle; too often we miss the fact that in every team meeting we need to focus on behavior as well as the problem- solving process. If the behaviors are not maturing, it can derail the problem- solving process.
7. Base-Line Data – Teams never collected any data on where they were starting from and never knew if they made an improvement.
8.
Training – Lack of training is a problem. People think, “This QI stuff seemed so obvious we just jumped right in and started solving problems.” Team members were never sure what was going on or what the next steps were.
9. Root Cause Analysis (RCA) – Treating the symptom instead of doing an RCA is a common problem. Root Cause Analysis is a structured investigation that aims to identify the true cause of a problem and the actions necessary to eliminate it with a permanent fix rather than continuing to deal with the symptoms on an ongoing basis. In Root Cause Analysis we need to determine what happened, why it happened, and how to eliminate it so it will not happen again. Treating the symptom may provide a temporary fix, but it just masks the real cause until it reappears.
10. Pilot Testing – Many teams like to jump to solutions and not identify potential improvements that could address the root cause, agreeing on which one to test. We need to pilot test a potential solution to determine how the solution will impact the problem. This step provides an opportunity to collect data, to alter the improvement if it is not achieving our goal, and/or develop countermeasures as needed to address any potential unintended consequences.
Remember - “To solve a problem or to reach a goal, you don't need to know all the answers in advance. But you must have a clear idea of the problem or the goal you want to reach.” - W. Clement Stone