Problem Statements Matter Farrokh Alemi, Ph.D. In this section we discuss process improvement. These slides were organized by Dr. Alemi.

Important & Central Problem Statement Focus on problems that are central to the organization and not convenient for the team to solve. Our survey of 92 quality improvement efforts has shown that many improvement efforts succeed in solving the problem they were tasked to but these problems do not improve survival of organization, its market share, or its finances. It is important to select problem that are central to the organization’s future.

Words Matter 6. Problem Statement QI units gather data, benchmark against peer organizations and assign teams to the identified problem. The evidence they provide regarding extent of the problem is a key measure when it comes to finding if the team has solved the problem.

1. No Solutions Problem Statement In defining the focus of process improvement, the quality improvement unit should follow 4 principles. First is that the problem statement should not contain any solutions. Including a solution undercuts the point of bringing a team together to solve the problem The statement should not blame any group employees. Doing so will make various people act defensively to avoid blame. The statement should describe the customer's experience, in the customer’s voice, so that various inter-disciplinary team member can have a shared understanding. The problem should be stated both as a gap and as an opportunity so that different types of ideas are triggered among the team members.

2. No Blame Problem Statement The second principle is that the problem statement should not blame any group employees. Doing so will make various people act defensively to avoid blame.

Problem Statement 3. Patient’s Experience The problem statement should describe the customer's experience, in the customer’s voice, so that various inter-disciplinary team member can have a shared understanding.

Problem Statement 4. Gap & Opportunity The last principle is that the problem should be stated both as a gap and as an opportunity so that different types of ideas are triggered among the team members.

What Is Wrong? The therapists arrived too late and we were not able to serve the food on time. Let us look at some examples? What is wrong with the statement of the following problem: The therapists arrived too late and we were not able to serve the food on time.

What Is Wrong? Blames the therapists, focusses on providers instead of patient experiences, doesn’t describe the opportunity. The therapists arrived too late and we were not able to serve the food on time. Blames the therapists, doesn't describe patient experience but the provider’s behavior, doesn’t describe the opportunity.

Better Statement Most patients complain that their food arrives too late and cold. Some find it arrives just in time. Here is a better statement. It describes both a gap and an opportunity. It does not assume that it is the fault of the therapists. It describes the patient experience.

The computers keep breaking down during admission process. What Is Wrong? The computers keep breaking down during admission process. Let us look at another problem statement. What is wrong with a problem defined to be “Computers keep breaking down during the admission process.” Which one of the 4 principles we discuss in these slides are followed in this problem definition.

The computers keep breaking down during admission process. What Is Wrong? Blames the IT department, no patient experience described, no description of the opportunity. The computers keep breaking down during admission process. . Blames the IT department and doesn't describe the patient experience

Better Statement Most patients have to wait long time for admission. Some are admitted without wait. Here is a better description of the same problem. This description focuses on patient experience and does not blame it on IT, it does not presuppose the solution will be improvement in computers.

Problem Definition Matters The take home lesson is that words used for problem definition matters.