Tools for QI Prioritization?

The Michigan "Embracing Quality Improvement in Public Health: A Practitioner's Quality Improvement Guidebook is helpful in many ways. For example, it's helpful in selecting a QI tool and deciding where to start. The Guidebook has a tool selector chart to help choose a tool based on the task or situation, user experience with QI and corresponding steps in the PDSA cycle. Tool selection basics and the tool selector chart is on pages 70-71. The Guidebook pdf can be found here:
http://www.accreditation.localhealth.net/guidebook.htm

For a QI project, I find that that the most successful projects have a well defined problem. At our health department the most successful QI project had the problem of "too much of the waste sent to a landfill has recyclable content." We observed our impact on this problem by doing weekly measurements on waste & recycling volume.

Other projects with problem statements such as "Form A is too complex" have fared less well. I believe it is because there is no obvious way to measure complexity for a form.

The National Network for Public Health Institutes has a few items in their online Public Health Improvement toolkit (http://nnphi.org/tools/public-health-performance-improvement-toolkit-2?v...) that are very helpful for these purposes. "Selecting Improvement Areas to Address" is a powerpoint presentation that includes a prioritization matrix and a control/influence chart. "Identifying a QI Project at your Health Department" is a template from the Minnesota Department of health that helps with the selection of a QI effort by posing a series of questions. "Screening Criteria to Identify a QI Topic" also provides guidance in the form of a series of questions. When using these tools with a team, it may also be helpful to use brain storming and affinity diagrams to generate and synthesize numerous ideas. A decision-making tool such as nominal group technique can also be an effective way to generate consensus. See the Institute for Healthcare Improvement's guide, which can be found at http://nciph.sph.unc.edu/mlc/presentations/perf_imp/BrainstormAffinityMu....

I also like the "Selecting Improvement Areas to Address" presentation on the NNPHI site that Grace mentioned. It gives a couple of approaches and a few different tools to use to identify a good QI project as a starting point.

It sounds like you are already familiar with the concept of starting small and going after low hanging fruit that has the potential for a big pay-off. You also might want to consider if there is a manager or supervisor who you want to convert into a QI champion and start with a project in that person's program. Many times, going through a QI process turns protesters into advocates!

In regard to your other question about when to move to bigger projects, I don't think there is one set answer. It really depends on your agency's organizational culture and how quickly people adopt the quality culture principles/methods/tools you introduce in their daily work. We conducted two or three smaller, program-specific QI projects before diving into a more complex cross-divisional QI project. You also might want to find a potential QI project that would benefit from applying a different method at some point (e.g., if you use PDSA for the first couple of projects and then move to a lean or Kaizen approach).

Hope this is helpful.

Cindan Gizzi
Community Assessment Manager
Tacoma-Pierce County Health Dept.
cgizzi@tpchd.org

There are so many guidebooks to take advantage of. That's probably your best place to start!