MODULE 0 - INTRODUCTION
Module 1: Personality Preferences and Performance in Teams
Module 2: Fundamentals of Quality Improvement
Module 3: Presentation of Self - Presence and Impact
Module 4: Using your authority and Influencing change
Module 5: Co-consulting

IN2.3 – What is the problem we are trying to solve?

Sarah spots a problem

[Audio – Sarah part 2 with image – patient looking poorly, Sarah looking at drug chart]]

Stop before you start

Once you have identified a problem, it can be tempting to leap into action. But in quality improvement, we need to stop before we start and make sure we have really understood the problem we want to tackle…

[Video – original stop before you start]

Using Observation

You will see how Sarah used this approach as she started her own quality improvement on the ward where she works. But first of all, watch the film below to see how observant you are…

If we are focusing on a task, we may miss what else is going on around us. This is why it is important to deliberately stop before you start, observe and notice before leaping to action.

Learning from observation

Sarah took some time to notice what happens on the ward that might be contributing to drug errors. Click on the images to see what sort of things she realises may be part of the problem.

[Flip cards – See doc and images – Catherine sent through drug images]

Improvement tool: Fresh eyes

You can enhance your observation work by using an approach called Fresh Eyes. This simply means adopting the point of view of a different character as you observe what happens around you. When we adopt a different perspective, it can significantly change the things we notice and what we understand about the situation. Perhaps suggest to a number of colleagues that each person adopts a different point of view for one shift, and capture their observations at the end. Or you could ask relatives or visitors, or colleagues from other departments, for their observations: what do they notice? You may be surprised at the new insights this gives you.

Some suggested perspectives you could try are:

  • 5 year old child
  • Supermarket manager
  • Architect
  • Chef
  • Event organiser
  • Transport manager
  • Person with hearing impairment
  • Wheelchair user

Improvement Tool: Fishbone Diagram

A Fishbone or Ishikawa diagram is an improvement tool that can help us identify the causes of the problem we are experiencing. It helps us explore all the real reasons that may be underlying the problem, and work out where might be a good place to start.

Sarah notes some of the challenges she has observed that may be contributing to medication errors on the ward. She captures them on a Fishbone diagram to help her see where she might want to start.
Drag and drop the sticky notes to the correct heading to see what themes emerged for Sarah.

[PADLET – What other factors could contribute to errors?]

[IMAGE – Redraw Sarah’s fishbone diagram Perhaps as a drag and drop]

Improvement Tool: 5 Whys

As an alternative to a Fishbone, you might want to try out 5 Whys. This is a technique originally developed at the Toyota Motor company to help teams get to the root cause of problems and prevent them recurring, rather than just tackling the symptoms. It is simple to use and helps uncover things we might otherwise miss. You could use it very quickly with a team at a handover session, for example.

[VIDEO – 5 Whys from HCSW course]

Additional Resources

Constructing a fishbone: https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2011/06/How-to-construct-a-fishbone-diagram.pdf

Point of care https://www.pointofcarefoundation.org.uk/resource/patient-family-centred-care-toolkit/tools/process-mapping/

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