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

• 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

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.”

Voice of the Customer in Defining the Problem

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!

Scope

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.