Starting Small with QI-some observations from some QI trainings!

Just wanted to share observations from the last few Quality Improvement Trainings that I have conducted. These have been both a mix of small, rural HDs and district or larger ones as well. Here is what I have learned.
Most are frustrated with QI and PM and don't know where to begin. (Specifically PM)
Most have senior leadership on ALL committees, thus not giving front line employees the chance to engage, increase buy-in, etc.
Most want to start with large project or PM metrics-which is hard to begin and leave staff feeling inadequate.

Some tips that we have tried to incorporate in training materials:
Start Small! With QI and PM, we try to have people start small. For QI, pick a small project that is in a specific division or dept for those "small wins" to get people used to the terminology and tools. For PM, start small with a metric that is internal (may be a process measure rather than health outcome--but this is OK as it teaches your staff how to begin the process-then you can build from there.
When teaching the tools for QI, I only have been focusing on Brainstorming, Flowcharting, Fishbone/Cause and Effect, and Solution and Effect! There are many other tools that are great, but honestly, if we can have everyone just doing these few tools, they can accomplish great things! Trying to teach someone about prioritization matrix, etc. has a time and place, but I don't even mention this when doing these first trainings. Just that there are other tools that you can use and are more appropriate at times, but just get the right people in the room at the right time and talk it out---this is what I say a million times during the trainings and it has resonated with the staff.

I don't even mention the words "fishbone" when doing a project anymore to avoid glassy eyes and clammy hands--just say "lets list all the things that we are frustrated with regarding the ____ process" then have them categorize them after the fact---look what you all did! :-) when you say fishbone or flowchart and expect them to jump up and down with joy then you have established that QI culture....I hope you are there....we aren't! LOL