On Quality Improvement Action Planning: How it Works

The goal of Quality Improvement Action Planning® is to produce lasting results—to get the leader and/or team where they want to be because they are achieving the results they choose. Of course, no process is a panacea, and QIAP does involve an investment of time and effort on the part of the leader and/or team. Those who have made this investment, however, are reaping great rewards. The following chart summarizes QIAP's key parts:

Here’s how QIAP works…
When a problem is identified, either through your quality improvement processes or by an outside agency, the first consideration is Plan A. This is a set of steps the facility will take immediately to reduce and minimize harm to residents. We might call these steps “quick fixes” or “band aids”—they are taken quickly and are not intended to be the final solution. This, however, is the number one error leaders and teams make in problem solving—they stop with Plan A. The results are often not satisfying because as soon as the problem seems to get better, it crops back up with different names and faces. Then more band aids are applied while the underlying causes fester. This is exactly what keeps leaders in the weeds—rushing from problem to problem in the best of worlds or crisis to crisis in the worst.

As Plan A is being carried out, the leader or team turns their attention to Step 1—What is the problem? This step requires an analysis of the situation and the creation of a well-defined problem statement. Often, the problem that is first identified gets revised as data is collected in Step 2.

Step 2—What is causing the problem? This is more than just a quick brainstorm by team members or leaders. Too often, I see people sitting around a table in thirty minutes and “deciding” what the causes are. This is something like a detective never going to the scene of the crime and sitting at his or her desk writing down how the crime happened and who did it. This method leaves out so much evidence that any decisions and actions that arise from it will inevitably be inadequate to the task. Hence, it is absolutely predictable that any complex problem approached in this way will occur again—because it has yet been really solved.

What is needed is an in-depth analysis of possible root causes. The interdisciplinary team may brainstorm possible root causes in order to decide what data it will need to move to Step 3—What is the goal? After brainstorming an exhaustive list of possible root causes, the leader or team can categorize the list. Generally I have found that teams end up with two or three main categories.

The possible root cause categories drive the design of Plan 2—Plan to get data. All actions to be carried out as part of Plan 2 must be assigned to a particular individual (not the team) and have a due date by which the step will be completed. Based on the possible root causes, a plan is developed for gathering information from residents, families, vendors, staff, medical records, physicians, and anyone else who might have knowledge to share or who will be impacted by the solutions that might be implemented.

This is where the process of organizational change begins—when people are invited into the problem in constructive ways, they often begin to change their behavior to be more in line with the goals, even before the goals are clear.

I advocate staff interviews, even of staff not often included in such analyses such as housekeepers, laundry staff, and dietary staff. For example, a team studying improving activities in their facility included housekeeping staff in interviews. They brought a whole different perspective about why residents weren’t attending—they noted that when they ask residents why they aren’t going to activities, residents reported that they were in pain or depressed. This led the interdisciplinary team into a whole new set of questions about effective assessment of depression and pain as they relate to participation in activities. This came from the housekeeping staff, not nursing.

I will take on more of the process in my next post…