Quality Improvement Tools in Health & Social Care

Service quality is as essential as availability in health and social care. Care professionals have to continuously look out for gaps in quality and act to address those gaps. Quality improvement tools are instruments used in assessing quality gaps as well as in addressing the shortfalls.

In this article, we look at various care quality improvement (QI) tools and how we can use them to improve the quality of healthcare practices and care homes.

Quality improvement tools

The QI tools covered in this article include:

1. Voice of the customer (VOC)
2. Suppliers, Inputs, Process, Outputs, and Customers (SIPOC)
3. Affinity diagrams
4. Kano Model
5. Fishbone diagrams
6. Cause-and-effect matrix
7. Control charts
8. Run charts
9. Root cause analysis
10. Failure mode and effect analysis (FMEA)
11. The Pareto principle
12. The 5-why analysis

We will continue to update this article with more QI tools as we write about them.

More articles about QI tools:

• 5-S principles, processes and tools for quality improvement
• FMEA in six sigma
• Lean tools and examples
• Kanban board

Now, let’s dive in and have a comprehensive look at the different quality improvement tools.

1. Voice of the customer (VOC)

What is VOC?

Voice of the customer is the process of collecting relevant views of your “customer” on your product or service to inform critical business decisions. In health and social care, a “customer” is typically a patient, a resident or their relatives. Thus, VOC is very relevant when assessing the quality of care and an essential part of quality improvement tools.

In its simplest sense, the voice of the customer is about listening to your customers. Whether through focus groups, ethnographic research, or surveys, this process connects you with your customers to obtain feedback that converts into valuable data. It’s a key way to understand how expectations of a product or service stack up against the results.

Health and social care, as with any other industry, is governed by some basic business principles. However, for many, it is considered to fall slightly outside the realms of a ‘traditional’ business model.

This is perhaps, in part, due to its status as an essential product that we accept gratefully, and the VOC process has been widely overlooked. Feedback from patient groups has mostly been used to manage the risk of negative exposure rather than to improve future services.

By failing to recognise patients as customers and not managing their expectations and results of their experience, we create a one-size-fits-all’ service. We are blinkered to the most obvious areas for improvement.

How to apply the voice of the customer to improve the quality of care

Voice of the customer is an effective method of gathering insight into a patient’s needs, both expected and unexpected, combining them with any original assumptions, and compiling the data into an evidence-led argument that has the power to be very convincing when presented to clinicians.

Quality improvement processes will allow both health and social care patients the opportunity to take an active role in improving the care they, and others, receive. As well as recognising the voiced opinions of a service user, the idea of care managers going for a Gemba walk, spending time in the workplace and interacting with them, has started to be explored in recent years.

Seeing both the problems and successes of currently implemented procedures, those who generally work in more isolated management roles can get a better understanding of what works well and be made aware of previously unthought-of challenges. Again, this data is at the very heart of creating new procedures and services, and improving established ones.

While assessing the voice of the customer, it’s not only the patients or users of a service who should be considered. Health and social care professionals working alongside their patients are also an integral part of the success or failure that a service will enjoy or endure.

Those members of staff can not only offer valuable opinions from the point of view as someone who has to manage the various steps of a process, but they are also the ones closest to the patients. Their experience can offer up clear insights into how a particular system is functioning, and what to do to improve it.

Using the voice of the customer allows a health and social care system to adapt and evolve according to real data. This will give rise to vastly improved services and quality of care. It also provides the opportunity to recognise failings and how they compare to original expectations. In turn, this will translate into clear financial benefits as a service is fine turned and adapted into a more streamlined version of its original self – the version that the “customer” wants.

Thus, if you really want to transform your health or social care services, it is important to master the art of using VOC. It is one of the more important quality improvement tools available. Not many tools can do what it does.

2. Suppliers, Inputs, Process, Outputs, and Customers (SIPOC)

What is SIPOC?

SIPOC is an acronym which stands for suppliers, inputs, process, outputs, and customers. Together, these form the entries in SIPOC table (see SIPOC diagram in this article. Feel free to use it as your SIPOC template). Thus, it is one of the most useful quality improvement tools.

In simple terms, SIPOC is an instrument for improving processes. It allows you to list all of the suppliers, inputs, process, outputs, and customers for a process. By so doing, you can develop a comprehensive, yet simple overview of any process. All the relevant elements are identified to help define a large or complex operation/project that is not well scoped or systematised.

SIPOC is useful at the Measure stage of the Six Sigma DMAIC process, which is an acronym for Define, Measure, Analyse, Improve, Control Method. However, it is also useful as a separate tool as well. It is similar to Process Mapping but more comprehensive.

Example of how to apply SIPOC in health and social care

SIPOC is critically important in health and social care because it minimises defects from common mistakes. Health and social care professionals, managers and administrators can reduce critical errors and procedural deviations by deploying SIPOC at various levels of their organisation.

SIPOC could cut short waiting times in hospitals and clinics. It could minimise the risk of falls and injuries in hospitals, care homes, or private dwellings. It can also help to prevent medication errors, as well as increase the level of turnaround time for laboratory results. Moreover, it allows organisations to save on unnecessary expenses.

Thus, SIPOC is a vital tool to add to your arsenal of quality improvement tools.

Towards the end of the SIPOC, you can append a note regarding the additional needs and requirements of the patients which can’t be provided by the existing processes.

As a SIPOC example, let us use a hospital scenario to detail out the aspects of a diagram of SIPOC.

Suppliers

The key suppliers could be any of the following. For example:

• Trauma bay
• ED
• Outside Hospital (OSH)
• EMS
• Floor
• Clinic
• OR
• The brace company

Inputs

For inputs, list down all the products and services delivered by suppliers. For example:

• Patients

Processes

For process, list high-level process steps. For example:

• Nursing Assessment (Intake with risk assessment)
• Documentation in EPIC/ Incident
• Treatment protocol selection
• Treatment protocol execution
• Notification and physician documentation
• Disposition with no new pressure sores and all pre existing sores identified

Outputs

For outputs, list the product or services delivered to the customer. For example:

• Patient is transported to post SICU with appropriate documentation, no new sores, and all pre-existing sores identified and treated. A “Packaged Patient”.

Customers

For customers, list down the key internal or external customers. For example:

• Floor
• LTAC
• Nursing home
• Morgue
• Rehab/ SNF
• Family
• Home
• ER
• Radiology

The SIPOC example above assumes so many things. However, it is a useful way of showing this QI tool can be used in practice.

More on SIPOC

As you can see, SIPOC is very useful as an essential quality improvement tool.

It is essential to know who supplies for the inputs. From what source the packaged patient came from. What is the source of the back brace? The suppliers may be company selling the brace, the consultant who says that the brace is needed, and the emergency department or even the floor nurse who delivers the patient. Also, for trauma scenario SIPOC diagrams, EMS is an important supplier.

In healthcare projects, we described the input being the “packaged patient”. He is the patient who has completed many essential steps and is being prepped for the next level – the procedure which is being worked out for improvement. Packaged means he has a history with physical exams, has had a cervical spine collar put on, has had imaging studies, etc.

The output is usually the packaged patient already with an additional feature or value-added. This might be the brace as the added feature. Knowing who your customers are is a challenging process.

He may be another payer sponsor (for the patient), the patient, other doctors, or EMS. Or the customer could also be the service in trauma depending on the circumstance the patient is in. Or it may be the social worker who receives the braced patient and is ready to render services so that the patient will heal in his care. Physical and occupational therapists could also be customers.

SIPOC will benefit your organisation in the long run. Improvement reaped from it allows your services and products to better match your patients or clients’ needs, and at the same time, makes your facility even more profitable, sustainable and efficient.

3. Affinity Diagrams as Quality Improvement Tools

What is an affinity diagram?

An affinity diagram is a method for organising a collection of data points or ideas based on their conceptual relationships (see affinity diagram example below). Using this technique, seemingly disparate issues or possibilities can be grouped into more comprehensive and manageable concepts and solutions.

Affinity diagrams are excellent quality improvement tools and are useful in solving many patient- or client-related problems.  

How to use affinity diagrams to improve the quality of health and social care

Within the healthcare industry, quality of care is a complicated metric to define. This is because there is no single point of data that determines the quality of care provided.

Instead, there are numerous outcome measures gathered across the course of each patient’s interaction with the healthcare system. Examples include mortality rates, re-admissions, treatment effectiveness and timeliness.

Determining these measures requires all aspects of each patient’s interaction with the healthcare system to be evaluated as either positive or negative. Affinity diagrams are useful in accomplishing this task.

Processing data

Healthcare workers report their actions, and the outcomes thereof, throughout the process of treating a patient. Likewise, patients provide feedback, via answers to questions, surveys, or reports of good or bad conduct. When reviewing this collected data, representatives of all parties can together determine which pieces of data are related — such as a nurse reporting a supply shortage and a patient reporting an extended delay in treatment — and group them accordingly.

Once this process is completed, a relative quality level can be determined, using the same affinity diagram to visualise the problems and relate them to solutions posed by stakeholders. Use of the diagram process throughout quality assessment and improvement means that all parties will be familiar with all relevant experiences and outcomes. This means that proposed solutions will be more informed and comprehensive, increasing the likelihood of their swift implementation.

Applying affinity diagrams in social care

Social care quality can be measured in ways similar to that of healthcare quality, though it can be more difficult to determine objectively. This is because the relationship between caregivers and clients is largely determined by personal characteristics, such as personality and compatibility. Still, the outcome measures overlap, particularly when comparing long-term care. Things like continuity of care workers and staff attitudes impact quality in both industries.

An affinity diagram is a useful tool for determining which components of care quality are subjective. Caregivers can provide detailed breakdowns of the services they perform for clients and the methods that they use. Clients, in turn, can detail their likes and dislikes, as well as what is objectively effective.

Separating this information into groups based on relationships will visually illustrate where the bulk of the problems lie. Objective problems can then be addressed with changes to rules and practices, while subjective problems can be solved by switching carers, for example.

Some peculiarities with using affinity diagrams as QI tools

Because those in care can suffer from impairments that influence their ability to accurately evaluate or report their circumstances, the presence of trusted parties who can interpret or add context is crucial. Poor quality care may go unnoticed if the persons effected are unable to report it, or if their report is misunderstood.

Affinity diagrams address this issue by their nature, involving all relevant stakeholders collectively. This means that parents, guardians, interpreters, or other key parties will be active participants in the creation of the diagram, helping to articulate client concerns. Thus, if there are deficits in care quality, they can be communicated and addressed. This makes affinity diagrams very flexible quality improvement tools.

4. Kano Model as a Tool for Quality Improvement

What is the Kano Model?

The Kano Model is one of the most important quality improvement tools available.

When we refer to the Kano model, we are talking about the theory of a product as oriented to the client’s satisfaction. Every business, no matter in which field it is active, should be customer-oriented and should focus all its strategy to fulfil the client’s needs and wants.

How to apply the Kano model to improve the quality of healthcare and social care

Now that we know the short definition of this theory, it is crucial to make sure we apply it in the right way and for that Kano simplified the process by creating few categories of the client’s wishes. We’ll discuss to explore what clients are looking for and what should a business do to direct the client to a “delight” dimension, as Kano calls it.

Must-be Quality

The first category, called “Must-be Quality” talks about the basic needs of every client. For example, when it comes to couple therapy, both will want to fix their marriage problems at the end of the sessions.

One-dimensional Quality

Next one, “One-dimensional Quality”, explains that specific decision of the company that will bring a satisfied or an unsatisfied client. For example, deciding to implement the idea of letting all the older and pregnant people before the other ones at the store, will bring you an excellent social promotion and you will gain the respect of your clients.

Attractive Quality

“Attractive Quality” brings an unexpected improvement of a product, that will get a super impressed client on your side, but not a disappointed one if the product does not have this specific quality. For example, offering discounts for persons with disabilities will show that your business is taking care of the vulnerable groups of people.

Indifferent Quality

“Indifferent Quality” should not bring any impact on the client’s satisfaction. The client might not even notice this quality of the product or service, but the company decides to do it anyway. Taking the example of the couple therapy, maybe the psychologist will try to use an informal language to feel closer to the clients. They might appreciate that, but in case they do not, it will not make any difference because this is not a “must-have”.

There is a thin line between bringing something useful to your clients or make them feel offended by having an overwhelming attitude regarding some categories.

For example, if you decide to create discounts for people with disabilities, it is a little step between making them have by showing that you care about their social status. You want to help them have a better life and to reach the “Delight” dimension, or they can feel offended by treating them differently, and they might feel not good enough to procure their goods in the same way as the others.

More on the Kano Model

The Kano model uses these types of qualities to make a difference in business behaviour and to encourage it to pay more attention to the attitude regarding its clients.

The way the customers feel treated brings a significant impact regarding their further decisions. Even though every client is different and the same approach might not have the same results for all of the clients, the company needs to analyse these types of qualities and choose the best way to bring the client’s satisfaction.

Thus, the Kano Model is an indispensable quality improvement tool.

5. Fishbone Diagrams

Fishbone diagrams are uniques quality improvement tools that you must have in your arsenal.

What is a Fishbone Diagram?

A fishbone diagram, or cause-and-effect diagram, is a brainstorming tool used to determine the root causes of an issue. The name is based on the diagram’s structure. The issue being investigated forms the “head,” with underlying categories branching from a line behind, similar to the way fish bones are arranged.

Benefits of Using Fishbone Diagrams

This type of diagram excels at getting to the bottom of an issue. As the problems are broken down further, the branches form a hierarchy that visually separates symptoms from causes. The categorical structure also makes it easy to determine at a glance where the majority of the problems lie, encouraging targeted solutions.

Using Fishbone Diagrams as Tools for Quality Improvement

Like most quality improvement tools, the use of fishbone diagrams originated from the wider business application.

Issues in health and social care are often incredibly complex. Both industries rely on myriad interrelated disciplines working together seamlessly to provide the best care and services. Consequently, when there is an issue, it can be challenging to pinpoint the primary cause or causes. A fishbone diagram is well suited to making sense of these sorts of problems.

The backbone

The first branching categories, forming the “backbone” of the fish, break problems down according to the main contributing areas of responsibility. For instance, a standard list might include personnel, equipment or supplies, environment, procedures, and policy. But the diagrams are versatile, and the categories can be tailored for maximum relevance to health and social care.

Fishbone in health and social care

In the case of health and social care, problems are measured in terms of impact on patient or resident disposition. The entire system of operations is built around providing a positive care experience and effective treatment for patient illnesses. However, patients have a role to play in this process as well. Their willingness to follow the instruction of doctors and nurses can determine the quality and effectiveness of their own care.

A fishbone diagram can incorporate this reality by including “patients” among the main category breakdown. The same applies to those being cared for in social care settings. For instance, an elderly person in an assisted living environment may not be receiving the attention that they require from the staff. However, the policy may dictate a specific schedule of interaction with residents, excepting urgent requirements or specific requests.

In practice

As the participating parties add possible causes and symptoms of the problem to their corresponding branches of the diagram, the role of policy in the problem would be revealed in its place and the patient’s role. In this case, not making use of the option to request additional attention — would show up in the patient category. This would allow all stakeholders to see how they are contributing to the issue and what agency they may have in resolving it.

Using that same example, suppose the system is not working for the patient because of a health-related issue. Fishbone diagrams are constructed such that with each new entry, you pose the question: “Why?” This means that, where other problem-solving methods might mistake the patient’s failure to use the request system as the cause of the problem, a fishbone diagram would push further to the real underlying issue. To ensure this, a category of “health” or “condition” should also be a fixture when applying this method to health and social care concerns.

As discussed so far, fishbone diagrams are very useful quality improvement tools that you and your team should learn and use when exploring problems in care.

6. Cause-and-Effect Matrix

What is a Cause-and-Effect Matrix?

A cause-and-effect matrix is known as a CE matrix in short, which is another great quality improvement tool. The matrix explores how input factors affect the output of a project. It is a reliable way of identifying the relationship that exists between multiple input factors and the outputs. You can pinpoint the exact factors that cause a particular result.

Benefits of Using the Cause-and-Effect Matrix

• It can help you identify the root cause of negative results that are happening in your healthcare facility.
• It is a cost-effective way to determine the essential and non-essential inputs in your system.
• It is a reliable matrix that can prioritise inputs or causes for the optimum results or outputs.

Thus, CE matrix is one of the most useful quality improvement tools available.

How to Use Cause-and-Effect Matrix to Improve Quality of Health and Social Care

The process of applying the cause-and-effect matrix to improve the health and social care system has several steps. The vital part of the process is to ensure that you have a team leader who understands the health and social care system’s challenges well. The team leader should know every department in the system and how it operates. So, how can you use the cause-and-effect matrix to improve health and social care?

Step 1: Assemble a Team

The first step is o assemble a diverse team that is knowledgeable about their departments. The diversity of your team will ensure that you generate multiple ideas about the causes of a particular effect. The problem with a team with the same skill sets is that they won’t know the causes of their fields’ effects. The team leaders should be someone with vast experience in the health and social care industry.

Step 2: Brainstorming

The team needs to brainstorm ideas on why there are adverse effects on the health and social care system. The process works in reverse because you first identify the effects and then work backwards to identify the causes. Once the team identifies possible root-causes to an effect, you can work on narrowing down the list to a few causes. The disadvantage is that you may identify multiple causes that are remotely related to your effects.

Step 3: Process Map

A process map makes it possible for the team to understand how each effect occurs from the start to the finish point. The process is tedious but essential if you will identify the changes that will improve your services. It also helps the team to know how each new input can improve or worsen a particular effect. You can plan objectively on the best point to inject new inputs to improve the health and social care processes.

Step 4: Evaluating the Effects

You must evaluate the effects of the input changes in the processes to ensure positive results. For example, you need to evaluate whether online prescriptions eliminate inconsistencies in prescriptions that arose from handwritten prescriptions. Evaluating whether an input solves a negative output ensures that you stay on the right track.

Some of the health and social care issues that have adverse effects include lack of patient follow-ups, poor inventory management, double prescriptions, and other essential services. You may have to evaluate every service individually to identify the benefits of any changes. Overall, the cause-and-effect matrix will help you solve the challenges you face by replacing the inputs that produce adverse effects.

7. Control Charts

What is a control chart?

It is a graph that is used to analyse changes in a process over a period of time. The chart has three lines: the central line to represent average, the upper and lower line to represent the upper control limit, and the lower control limit respectively. Data is plotted in line order.

It is a great quality improvement tool.

Benefits of using control charts?

Control charts act as a guide, on when to take corrective action and when not to take corrective action. These charts demonstrate when things are going within normal variations, as well as when the process is out of the set control metrics.

How to use control charts to improve the quality of health and social care

Generally, a control chart has a central, upper, and lower line. These lines are determined by collecting data over a given time. You can conclude if the result is consistent or unpredictable by comparing data with these lines. We are going to focus on how using a run chart can improve the quality of Health and Social Care in a community. The basic procedure in preparing a control chart involves the following steps below.

Choosing the appropriate period for collecting and plotting data

The collection of the data requires a separate worksheet. Data should be collected in subgroups. They do not need to follow each other in chronological order. Missing data can be represented using asterisks. The subgroups can vary in size. The data required includes the number of people attending the health and social service. We will then plot the number of people on the y-axis and time on the x-axis.

Analysing the control chart

The control limit can be calculated by estimating the standard deviation, �, of the sample data. The result is then multiplied by three. Whatever you get is added and subtracted to the average to get the Upper and lower limit respectively. There are four possible outcomes during analysis.

An ideal state shows that health and social care delivery is in statistical control, and the community’s needs are being met.

The threshold state shows that health and social care delivery is in statistical control. However, the needs of the community are not being met.

The brink of chaos state shows that the health and social care delivery is in statistical control, but also is not producing defects.

The state of chaos shows that health and social care delivery is in statistical control. However, the needs of the community are not being met.

Writing a report

You can use the data collected to determine many things but primarily to determine whether the variation is stable or unpredictable. Control charts can, therefore, help the health system to visualise the existing service delivery variations. The Control Charts can help the health care system understand and remove the causes of a particular variation when necessary. They are an improvement strategy. They can thus confirm if a change is an improvement or a detriment. Furthermore, they can also identify potential changes that could lead to improvements in the health and social care provided to a community.

8. Run Charts

What is a run chart?

A run chart is a line graph that displays data over a given period of time. Events are shown on the horizontal axis and time on the vertical axis. One of the many benefits of a run chart is that it does not require complex calculations. It is an analytic tool used to understand trends over time. It is another useful quality improvement tool.  

Benefits of using run charts

A run chart helps you make projections before you start a project. It can be used to track improvements during a project. It shows how a project is performing while helping you determine the direction to take in a project.

How to use run charts to improve the quality of health and social care

Data can play a huge role in improving service delivery. A run chart uses data that has been collected over a long period of time and represents it for analysis. Afterwards, a report can be drafted—the results aid in project improvement. We are going to focus on how using a run chart can improve Health and Social Care in a community.

Collection of data

The type of data that is relevant in this case can be broken down into two types. The first type is community data. It involves the population that is being targeted to receive the health and social care service.

The second type of data is the facility data. It is the actual number of people who attend health and social service. It can also contain information about the management of the facility. The run charts will have the people attending the health and social service plotted on the y-axis against time on the x-axis. The data recording process needs to be done regularly for accuracy.

Data analysis

The analysis involves the interpretation of the run chart plotted. It is essential to focus on meaningful health and social care trends rather than daily data. That is the whole point of plotting a run chart. A run is a consecutive number of points on the same side of the mean or median.

A shift is happening when nine or more points are above the central line. The most common errors involve assuming there is a shift when a natural variation or not recognising when there is a trend.

Writing a report

Analysis of the run chart helps to determine if the health and social care delivery are stable. A report is written for evaluation. Its main purpose is to communicate the information collected efficiently.

A report can present the information in any of the following states. An ideal state is where health and social care delivery has been stable over time. The process is predictable and meets the need of the community. The Threshold state shows the health and social care delivery is predictable, but the need of the community is not consistently met. A state of chaos shows that health and social care are unpredictable, and the needs of the community are not being met.

9. Root Cause Analysis

What is root cause analysis?

Root cause analysis refers to a tool that health care organisations use to study past events where a patient suffered harm or experienced something undesired. Health care organisations study these events to identify and address exactly what led to harm, which is the root cause.

Benefits of using root cause analysis

Root cause analysis (RCA) is crucially important for patient safety. When health care organisations fully understand what caused such harm, they can create a solution to address the root cause and prevent future harm. So, the patient can remain safe from more harm in the future.

How to use root cause analysis to improve the quality of health and social care

RCA can help in examining how and why a patient experienced a terrible incident such as unexpected death, falls resulting in injury, serious pressure ulcers, and other problems. To use this tool, health care organisations need to know the following:

• They have to know that RCA is used only to determine how to fix a particular problem, not to check symptoms;
• Health care organisations also need to remember that a problem may have more than one root cause;
• When they use RCA, health care organisations should do so in a systematic way;
• Health professionals should keep cost in mind as they think about a solution to the problem;
• They also need to keep in mind that, whatever the fix, it needs to be sustained;
• Even more important is the fact that using root cause analysis to determine a problem not only can cause a change to culture but it can also cause resistance from the people who will have to implement the change;

Steps for root cause analysis

Once they are aware of these facts, health professionals who are interested in using root cause analysis should follow these steps:

• First, define the problem that they are looking to examine;
• Collect any data found during the investigation;
• Prepare questions basing on the problem that they first defined: this will help the health professionals determine the factors that led to the problem;
• Determine which factors contributed to the incident-they don’t have to look at the symptoms;
• Identify actions that can help correct the one problem instead of causing other problems;
• Communicate the reason for the corrective actions to all the health professionals involved;
• Indicate the benefits of the corrective actions to avoid resistance from the other people involved;
• Inform your team about the time needed to implement the solution to the root cause;
• Implement the solution suited to the problem;
• Determine if the solution found during the investigation can also help solve other problems

Since root cause analysis is one of the basic tools used for continual improvement, you’d better use it solely to determine and improve harm that a patient experienced; this should not be used as a symptom checker for it is not one. Here’s how to use this tool: find an issue and its cause and then identify the right solution to it without causing more harm.

10. Failure Mode and Effects Analysis (FMEA)

What is a FMEA?

Failure Modes and Effects Analysis (FMEA) is a structured approach for assessing processes to detect possible areas of future failure and how it might happen. It also evaluates the related impact of a given failure, to identify possible required changes to prevent the failure.

Benefits of using FMEA

Executing an FMEA leads to several benefits for factory managers which are far more than just solving the initial problem of defective machines. Several of the main benefits are the ability to recognise and access any failures and providing information on its effects. It also provides an approach in identifying any or all defaults of certain machinery. Data obtained in the FMEA process reveals the information needed for early detection of similar problems in the future and the planning to address them.

How to apply FMEA to improve quality of health and social care

In situations where a mistake is made at a health institute, the general plan of action is to begin a rapid investigation, identify the authorities, start corrective measures, possibly conduct a short session to retrain personnel, then get back to work as usual. Depending on the failure, the process may work well. However, when patient safety is in doubt, a more effective approach must be put in place to review the current quality improvement processes.

An FMEA will perform the process of detecting the failure by conducting a rapid investigation, identifying corrective measures, and starting corrective measures to resolve the specific failure. This way, situations that may go wrong or result in a negative situation can be prevented after discovery. There are three categories in the FMEA focus area, including system global system functions, design components and subsystems, process manufacturing and assembly processes, service functions, and software functions. For quality improvement, the following guidelines are put in place.

Conducting the analysis

With close guidance from the quality services department, overseeing the quality improvement process in other areas dealing with direct patient care of the health institute, the FMEA process should be started and worked to completion.

Flow chart development

The phase involves creating a flow chart of the entire health institute workflow, including a full list of each activity in every area of the workflow. The flow chart starts as a simple drawing and evolves into a more detailed model comprised of every step that is involved in each activity in the workflow process.

Failure mode model development

After mapping out the flow chart process workflow, (which is required to discover which workflow areas have the potential for something to go wrong) to identify all potential failure points, a more detailed analysis of all points in the workflow is done and a list of possible points of failure is identified and noted in a Failure Mode Model datasheet. Each failure point is arranged in three separate groups, according to the seriousness of the failure, the chances of failure, and the method used to detect the failure.

Development of an action plan

During this phase, intense process improvement work is implemented. The FMEA focus group ensures that every failure point is adequately addressed. The team then works on prioritising each point of failure based on its risks.

11. The Pareto Principle

What is the Pareto Principle?

In the late 1800s, renowned economist Vilfredo Pareto observed that in Italy, 20% of the population owned 80% of the land. This startling discovery was found to apply in many other scenarios and has since become a widely used principle in various areas of business, healthcare, etc. In general, it states that 20% of efforts contribute to 80% of the outcomes.

Benefits of using the Pareto Principle

The principle has proved to be beneficial in particular areas regardless of the industry it is applied in:

• An Increase in Productivity
• Easiness in Identifying Problems
• Improving Customer Experience and Customer Service
• An Increase in Profits
• Better Work-Life Balance

How to use the Pareto Principle to improve the quality of health and social care

When it comes to improving the quality of health and social care, the principle has not failed and has shown consistent results. There are different areas where the 80/20 rule can be applied to achieve the benefits mentioned above.

There are a few elementary steps involved in the Pareto Analysis that is common for any issue:

1. Identify the problem area and the possible causes.
2. Obtain necessary data and cross-check this data with the identified causes. The designated team must take the right units of measurement when analysing.
3. Plot the causes along the X-axis with the unit of measurement along the Y-axis. It is the most common form of representing the data that will help identify the distribution of the causes.
4. Identify the areas that account for 80% of the outcomes. You should find that only 20% of the factors contribute to this 80%. The Pareto Principle is not a law and hence, can vary to a certain degree depending on the use-case.
5. Once you identify the 20%, work on improving these factors or causes. It would in-effect elevate 80% of the outcomes.

Application in health and social care

This methodology can be used in different areas to improve health and social care:

• 20% of the patients contribute towards 80% of the consultations and clinical issues. By focusing on prioritising these patients via a possible priority list, hospitals can prevent a backlog of work.
• 20% of the patients take up 80% of the nurse’s time. By identifying the patients that fall in this 20%, nurses can allocate their work accordingly to prevent wastage of time.
• 20% of the staff contribute to 80% of the staff problems. This alarming statistic is very critical since often, the management tends to overlook that all the nurses and staff do not contribute to the issues in the hospital. By identifying the 20% and giving them proper feedback, hospitals can bring about drastic improvements in service.
• 20% of the equipment within the hospital accounts for 80% of the budget set for equipment. By identifying this 20% and responsibly reducing costs in this area, hospitals can bring down equipment costs significantly.
• 20% of the services cause 80% of the complaints within the health and social care sector. By identifying these services and improving them, hospitals and social care centres will find significant improvements in overall quality.

It is vital to reiterate the fact that Pareto’s 80/20 Rule is not a law. All the points mentioned above need not always be at a strict 80:20 ratio. The key takeaway here is that there is a contrast in the proportion of cause to effect. Understanding the key areas and applying this principle to achieve higher productivity and higher quality at lower costs should be the aim.

12. The 5-why analysis

Often in life, we provide Band-Aid solutions to problems thinking that they are an actual cure for the issues. In a healthcare setting, not understanding the root causes of negative patient experience can lead to continuously poor outcomes. The 5-why analysis approach can help providers prescribe accurate solutions for quantifiable improvement in the quality of health and social care.

What is the 5-why analysis?

To truly understand a problem, ask why not once, not twice but five times. The 5-why analysis is a Root Cause Analysis methodology developed by Taiichi Ohno as part of the ‘Lean’ automobile manufacturing framework at Toyota. Today the 5-why RCA formula finds use in many industries, including the health and social care settings. It helps to achieve comprehensive and accurate solutions for quality care challenges.

Benefits of using the 5-why analysis

Where there is a poor outcome, there is a reason, and then more reasons behind the reason. The 5-why analysis helps to dig in deep to the root cause of an issue so that solutions don’t balm the symptoms but solve the actual problem. The 5-why analysis leads to comprehensive diagnoses and accurate and long-lasting solutions to problems in all areas of life.

How to use the 5-why analysis to improve the quality of health and social care

• Gathering patient experience data
• Understanding the complexity of care problems
• Driving a culture of awareness
• Coordinating and integrating care
• Risk control

Gathering patient experience data

The 5-why analysis leads to a comprehensive gathering of data relating to the quality of patient care. Practices can use the RCA formulae as a framework for collecting and presenting patient satisfaction/ outcome data. The data establishes the causal pathway that led to a wrong diagnosis, wrong medication, or a poor patient outcome.

Understanding the complexity of care problems

Through a 5-why step data collection and analysis process, practices can understand the myriad of root causes of poor inpatient care. An incident of wrong medication can be traced to wrist band identification issues. These can further be linked to printer issues, label jam problems, and poor product design. The analysis can also reveal and associate these problems with inadequate IT staffing, poor workplace culture, or improper patient communication.

Driving a culture of awareness

Poor patient outcomes may be traced to in-adherence to medication. The latter can be traced to fear, worry, and mistrust, linked to poor nurse communication, linked to a higher workload. Starting from a single problem, a nurse can understand the ripple effect of their actions. Management can understand deep system flaws and the things that need to be changed to achieve an excellent quality of care.

Coordinating and integrating care

Every aspect of patient care relies on other aspects working in harmonious sync. Treatment success and patient experience is an integrated whole from the exam room to the sickbay.

The 5-why analysis of quality care issues can help identify and solve problems in care coordination, from patient engagement to physician and nurse workflows and communication breakdown. The analysis can help healthcare professionals to better cooperate in the interest of the patient’s well-being.

Risk control

The end goal of the root cause analysis in health and social care is to improve patient outcomes and enhance the patient experience. A broadly implemented 5-why analysis can help design and implement risk controls that prevent the escalation of a problem and future harm.

The 5-why analysis can be incorporated into a health centre’s quality improvement processes. The revelations in the analysis can help prescribe accurate solutions for poor patient outcomes, from diagnosis to treatment planning and nursing care.

QI tools – Conclusion

This is by no means an exhaustive list of quality improvement tools used in health and social care. However, as mentioned earlier, this is a living article. We will continue to update this article and add more tools to as we write about them.