“Add Scientific thinking to sixth sense …. ………………… the commonsense” Problem Solving Dr Kithsiri Edirisinghe MBBS, MSc , MD ( Medical Administration ) “Add Scientific thinking to sixth sense …. ………………… the commonsense”

Session outcomes Complete knowledge in “Defining and Identifying problems “ Development of the skill in “Analyzing problems “ Insight to “ finding Solutions to a problem”

Session 01 “Defining and Identifying problems “ What is problem ?

What is a problem ? “An observed gap between what is expected and what actually exits”

The definition A perceived gap between: the existing state and a desired state , or a deviation from a norm, standard, or status quo. Many problems turn out to have several solutions  (the means to close the gap or correct the deviation),  difficulties arise where such means are either not obvious or are not immediately available.

The Equation P = ( E – A ) C P – problem E- expected level A- actual Level C = Concern level Influenced by many factors Political Social Professional Organizational Individual

Problem and solution Problem need to be solved Objective completely partially Objective is the quantified level improvement expected of the problem situation

Problem Solving process : the steps Identify the problem Analyze the problem Set objectives Identify the solutions Select the options Implement the solution

Problem solving Techniques Go to this link and study all the PS techniques http://www.youtube.com/watch?v=dENYL2mk4OE&list=PL5E8E6546FDB5B1D2 http://www.mindtools.com/pages/article/SubscriptionProcessedProblem.htm

Problem solving Techniques Pareto analysis Cause and effect analysis Histogram's Scatter diagrams Floor charts Control charts check sheet Cost benefit analysis

1. Identifying the Problem Situational analysis Formal recognition Definition Watch V 01 for use of PDS document

a. Situational analysis “ Snap shot “ of the problem - Situational Analysis Noticing something is not right Information flow from the others Observation Information Complains Conflicts

a. Situational analysis Identify Stake holders Scope of work Expectation – out come Examine the current state Constrains Time available to solve the problem

Hospital clinic Let s identify issues !

b. Formal Recognition Convinced that there is a problem Use experience personnel to prioritize problem Use Pareto analysis for a complicated issue 80 to 20 rule V 02 & V 03

c. Definition of the Problem Clearly indicate the extent of the problem. Qualify and quantify

2. Problem Analysis Cause and effect diagram Place objectives Study and analyze the problem

Analysis...... Identify a “core” or central problem Methods and Tools Identify a “core” or central problem List all the problems related to or stemming from the core problem Determine which related problems are causes and which are effects of the core problem Arrange the problems in a cause-effect heirarchy around the core problem

Study the problem Identify key stakeholders and ensure the ‘right’ people participate Collect relevant background information Ensure lessons learned from previous similar issues are considered Prepare a problem tree / fish bone which provides a simplified but robust version of reality

Analysis ..... Methods and Tools Purpose: to identify major problems and their main causal relationships. Output: a graphical arrangement of problems differentiated according to ‘causes’ and ‘effects

Analysis List causes List effects Main causes – categories Sub causes Sub effects

Methods and Tools Problem Tree Example

Fish bone Diagram

Fish Bone diagram Poor Quality in Private hospitals Doctor centered culture Unknown patient choice behaviour High Patient Expectations Poor regulation Poor Quality in Private hospitals Untrained staff Lower Perception of the Administrator Widening demand gap Resource constrains

Expected problem improvement 3. Set objectives Expected problem improvement SMART Specific M – measurable A- achievable R- reliable /realistic T – time bound

Problem Tree

4. Identify the solutions Select the options

Determine options Solutions Convert Be Creative The cause a solution Effect to a good result Be Creative

Solution and objective tree Solutions Good results

5. Evaluate & Select options Debate ,study, agree ECT matrix- Effect, Time Cost

ECT Matrix Solution Effect Best effect Cost Minimum cost Time Shortest time Total Points Rank a 2 5 3 10 b 4 8 c 1 9 d 6 15

5. Implementation Implement Monitor Control Feed back implementation plan Inauguration Monitor Monitoring systems Control Mechanisms Feed back Regular and adaptations

Activity You are requested by the DG of health services to solve the issue given below Dengue epidemic RTA – Road traffic accident HAI – Hospital Acquired Infections Rising cost of health care Shortage of nurses

Thank You !