The Quality Improvement Challenge. Richard J. Banchs
resources.
By developing a tentative project schedule and updating it as new information becomes available, you will be able to estimate and manage project resources more efficiently and effectively.
CHAPTER 4 Frame Your Challenge : The Problem Statement and Charter
STORIES FROM THE FRONT LINES OF HEALTHCARE: MARTHA SANCHEZ, THE HEAD OF HOUSEKEEPING
“I think the problem is that we don’t have enough people in the morning shift to clean the rooms so we can keep patients moving,” said Martha Sanchez, the head of housekeeping. “If we are to decrease the time patients have to wait to be seen, we need to clean the rooms faster after the doctor sees the patient. I am going to speak to the director of the clinic; I said it many times: we need more staff!”
Describe the situation. How is the problem defined? Why is the way Martha Sanchez “sees the problem” a problem?
THE PROBLEM STATEMENT
What Is a Problem Statement?
You should start every improvement effort by creating a clear and concise statement of: what problem you are trying to address, why you are launching a project, and what your overall objectives are.
The problem statement is a clear, concise, and specific explanation of the problem that does not include any causes of the problem.
What’s not working? What is wrong? How is performance falling short of customers’ expectations? What is the magnitude of the problem, and who does it affect? What’s the challenge? The problem statement frames the issues and is critical to the success of your improvement efforts. The time spent defining the problem is not a waste: it’s time well spent!
The primary purpose of a problem statement is to focus the efforts and attention of the QI team. A good problem statement should
Be clear.
Use precise language without unnecessary medical or technical jargon.
Describe the problem to the level where the root cause is not yet known.
Incorporate data, if any is available.
Include the undesirable results and outcomes from the patient, providers, or staff’s perspective.
Be agreed upon and fully supported by all core team members.
Why Do We Need a Problem Statement?
When people describe a problem, they often describe it in vague terms and use what they think is the cause to define it. Defining the problem by the cause creates a narrow‐minded focus that, at best, restricts creativity and, at worst, sets in motion a process that culminates in rolling‐out solutions that do not address the true nature of the problem. By simply and properly defining the problem, you will create a better solution. The most apparent problem is often the tip of the iceberg, which upon further investigation reveals a multitude of underlying problems that leads to what at first glance seems obvious.
To describe a problem, put yourself “in the shoes” of the customer and try and describe it from the perspective of the people affected by the problem. Properly defining a problem is the most commonly overlooked step for many QI teams, and yet it is the step that provides the greatest return on investment. Healthcare providers and QI teams often jump to searching for solutions without having clearly defined and agreed on the actual problem. Teams spend a great deal of time debating the “best” solution but seldomly ask themselves: do we clearly and fully understand the problem?
Quotable quote: “Without changing our patterns of thought, we will not be able to solve the problems that we created with our current patterns of thought.” Albert Einstein
How to Write a Focused Problem Statement
Problem statement investigation efforts should include
The reasons why we should address the problem,
The consequences of not addressing the problem,
The “why now?” are we addressing the problem, and
How the project is linked to the organizational priorities.
Remember, the problem statement should not include any potential causes of the problem or possible solutions to resolve it. One way to create a problem statement is to divided it in three parts: define what we consider the “ideal state” (or standard); define the current state; and identify the gap between the current state and the ideal state. Write a short paragraph addressing each one while answering the relevant questions:
Ideal state. What would be the ideal performance? What would success look like? What is the standard?
Current state. What’s the failure? What is the rate of failure (how often is it happening)? How long has it been going on? What’s the background? Who does it affect? What is the patient or customer’s perspective? What is the stakeholder’s perspective? What metrics are currently used to measure the problem? Where is the data coming from? What is the current performance? What is the key output metric that needs to be improved?
Gap. What is the gap between our current state and the ideal state? What needs to happen?
A problem statement is often supported by a goal statement. The goal statement should be brief and specific, use the same metrics as the problem statement, and include a specific date by which the project should be completed successfully. A goal statement often accompanies the problem statement and defines the targets of the QI project.
THE PROBLEM STATEMENT IS YOUR “ELEVATOR SPEECH”
Imagine you walk into an elevator and the CEO of the hospital comes in right after you. He politely greets you and then asks you about your project. He has heard from your chair that you want to launch a QI project to improve the current situation in the cath lab. What are you going to say? Well, here are some of the questions you may want to address: What’s the problem? How is the problem affecting your patients? Why is it important? Why address the problem now? What are your goals? You may have a clear idea of what you want to improve, but you should be able to articulate it in a succinct and clear fashion.
Quotable Quotes: “A problem that is poorly defined has an infinite number of solutions but a problem well defined is a problem half solved.” Wally Davis
A Problem Statement May Include a “Burning Platform”
The problem statement may include a “burning platform” or statement that provides a brief explanation of the reasons why we should address the problem now. The burning platform establishes what makes this project a priority now, versus, let’s say, something else. The burning platform or business case should answer the following questions:
Why are we addressing the problem now?
What benefits can we expect for our patients, staff, physicians, and healthcare organization?
How does this project support /relate to the overall strategic goals of your department?
How is it aligned with the strategies of the hospital?
The burning platform may also include a statement about the consequences of not addressing the issues now, and a statement that establishes a clear link between the project and the strategic