This document provides guidance on how to choose and implement a quality improvement project. It explains that you should organize a team, identify improvement topics using available data or staff input, prioritize topics using a decision matrix, develop a problem statement, set an aim, conduct a root cause analysis, develop an action plan, implement and test the plan, and evaluate results over time. As an example, it describes how one agency improved their syphilis testing rate among HIV patients from 46% to 78% by identifying a lack of tracking as the root cause and implementing a simple solution of testing all patients at their first visit each year.

1. How to choose a quality
improvement project 101
Judi Grimes
Metropolitan Nashville Health Department

2. Goals
1. Explain the need to prioritize
projects
2. Be able to use a decision matrix
and flow chart
3. Convert case studies into models
for practice change

3. READY

4. Organize a team to begin the
process
● Identify leader/facilitator
● Identify staff
● Set a meeting time
● And.....................

5. Ask yourself, “Self, am I
ready to take action?”
Is there management support?
Are the right people at the table?
Do I have the time to invest in making changes at
this point in time?

6. Identify and prioritize 3 topics for
improvement
FIRST: List any data findings that
have been collected from a work plan
or other activities.
This could be a survey, monitoring results, audit
findings, or whatever.

7. What if data is not available?
● Ask your staff some questions:
● Is there anything we could stand to do faster?
● Does staff have to do anything that creates
roadblocks to service?
● Can we change something to better serve the
needs of our clients?

8. SECOND: Use a decision
matrix to prioritize
Don't know how? Check out
http://asq.org/learn-about-quality/decision-makin

9. THIRD: Develop a
problem statement for
the selected topic

10. A good problem should:
● State the effect of the problem
● State the gap
● Be specific and use facts
● Be measurable
● State the problem but not the solution
●
● Example: Clinic X in neighborhood Y has identified 56
cases of tuberculosis from a population of 10,000
people as evidenced by electronic chart review

11. AIM

12. Identify the desired goal/result for your agency

13. Define where you want to be
● Targets should be challenging but not the complete
goal
● If a process, complete a flow chart
● Do a root cause analysis to identify possible
factors influencing the #1 topic
● Talk about the chosen topic for improvement and
brainstorm about influencing factors (Fishbone
analysis)
● Select the factor the group thinks has the most
significant impact and is possible to achieve

14. FIRE

15. Develop a QI Action Plan for the
selected factors and implement
● A detailed outline of how to correct the root
cause of the problem and specify the exact
action to be taken
● Ask: What, by whom, by when?
● Consider testing the plan and revising if needed

16. Evaluate
● Look at the results over time and standardize
improvements
● See if the proposed action yields the expected
improvement
● Allow time for change to occur
● The results determine the next steps...
● Keep your successes moving forward!!!

17. Case Study

18. Improving syphilis testing
● Background: Agencies that receive Ryan White
HIV funding grants are required to provide and
track primary care services to individuals with
HIV. One reported measure is the rate of
syphilis testing
● Prior to this project, syphilis testing rate among
HIV positive individuals in metro Nashville was
46% – way below the national average

19. Improving syphilis testing
● In preparation for the annual QI plan, syphilis
testing was identified as something to improve
● After using a decision matrix, it was decided
that this should be of primary importance
because of the abysmally low testing rate
● A fishbone diagram was used to identify root
causes...

20. Improving syphilis testing
● The problem turned out to be simple – there
was no good tracking system for determining
when to do the annual syphilis test
● A decision was made to just do it on each
patient's first visit of the calendar year
● Management buy-in occurred easily because
there was no cost involved
● Annual syphilis testing rate improved to 78% by
the end of the year

21. Thank you!
Please direct questions to:
Judi.grimes@nashville.gov