1. Category 1
Category 2
Category 3
Problem
Category 4
Category 5
Category 6

2. Resources Environment Personnel Repeatedly Over Sleeping Culture
Lack of funds for
new clock
No staff to assist
Dark quiet room
No one else awakes
at same time
Wake up time
before sunrise
Wake up call
not available
Repeatedly
Over Sleeping
Home culture values
watching late-night
movie
No fail-safe alarm
No mandated backup plan
Work culture intolerant
of late arrival
Broken alarm clock
No strict bedtime enforced
Culture
Technology
Policies

3. People/patients Environment Personnel/Training High ER
Low health
literacy
Variability in practice
Busy clinic
Low familiarity with guidelines
Difficulty with
trigger avoidance
Limited space to
provide teaching
Med costs
High ER
Utilization Among
Asthmatics
Limited health coaching/
Counseling by MD
or Pharmacist
Refill data difficult
to access
No requirement for
Inhaler teaching
Confusion about referral requirements
No systematic symptom
questionnaires
No e-prompts
Confusion about insurance coverage
Policies/Practices
Technology
Prescribing
Data collected on many or all of these would better inform assessment of priorities.

4. 5 Whys Approach to Specific Elements
Limited health coaching/counseling
Not provided by MD
Not provided by pharmacist
MDs don’t have time
High demand and no space for additional MD/room
MDs have patients waiting to be roomed
Pharmacist not routinely in clinic
No work area available in clinic module
Several MDs need patient rooms
All providers scheduling patients for same afternoon time
Why?