Find Out What’s Going On

When you’ve decided what to work on and have put together a team, your attention will turn toward digging in and finding out more about what’s really going on. In addition to reviewing relevant data you already collect, there are several methods you can use to collect, display, and analyze additional data. We’ll look at a few.

a. Observation Using a Tally Sheet

Observing a process can be surprisingly helpful in revealing what’s impeding a particular procedure, process, or system. Just having one or two people observe an activity, such as an EKG, ,a few times and taking notes can uncover a good deal about what’s happening, particularly where there is unexpected and possibly unproductive variation (where people are doing things in significantly different ways).

b. Other Ways to Collect, Analyze and Display Data

A Run Chart: This is where the data points (points where measurements are taken) are connected with lines. Frequency at each data point may reflect absolute numbers or averages. You might want to track “no-show” percentages for new appointments over a period when three different interventions were introduced to figure out what made a difference, what didn’t, and what you might want to try next. [Click here for instructions for creating a run chart.]

No-Shows for New Patient Appointments

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A Pareto Chart: To find out what is most important in a situation, such as with types of patient complaints during a specified period, a Pareto Chart can be useful. In a Pareto Chart, bars represent the frequency of each factor (here type of complaint) over a specified period of time. Vertical bars are arrayed in descending order of frequency. The vital few categories of complaint become immediately apparent (usually the first two or three bars in a group). [Source: the Institute for Healthcare Improvement:www.ihi.org Click here for instructions for a Pareto Chart

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A Process Map / Flow Chart: A process map or flow chart offers a great way for a group of providers to work together to identify the discrete steps in a process about which they are concerned. Disagreements about the precise nature of these steps can often be illuminating. A process map can also help a group identify roadblocks in the process that should be addressed. A sample flowchart is provided below. For instructions on how to map a process, click here.

Process Map / Flow Chart for the Clinical Visit

c. What Can You Learn From Your Baseline Data?

When you start an improvement project, everyone has ideas about what the problem is. The data are a chance to go beyond everyone’s theory to find evidence about what’s actually happening.

For example, in one practice, everyone thought they knew the reason for long patient wait times. The front office knew it was the medical assistants’ inefficiency. The medical assistants knew it was certain doctors trying to do everything for every patient at every visit. The doctors knew it was the inefficient front office and medical assistants. A flow chart and log of time patients spent at each step of their visit showed that things ran pretty smoothly except for certain patients (in retrospect, everyone knew who they were) with whom the doctors always ended up spending a lot more time. The data helped everyone stop finger-pointing and develop a way to schedule these patients for longer appointments (ideally at the end of the day), to have the medical assistants help the patient identify the one thing they most wanted to accomplish that day, and for the doctor to focus the patient on that most important thing from the patient’s point of view.

As you talk about the data, pay attention to the points in the discussion where team members disagree about the meaning of information you have been collecting. This often provides clues to differences in approach and/or understanding. Instead of trying to determine “who’s right,” try to assume everyone is speaking a piece of the truth. Encourage everyone to hold their own particular hunches “lightly.” And then do your best to help team members surface their assumptions. You will usually discover team members are operating under very different assumptions concerning what is expected, desirable, allowable, and/or feasible. Don’t try to “paper over” these differences in the service of group harmony. Mine them for all they are worth.

Note: Working with other practices is another good way to begin to see things differently and get new ideas.