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Problem solving

Sometimes, it is not enough to just cope with the problems – they need to be solved.

Most people engage in problem solving every day. It occurs automatically for many of the small decisions that need to be made on a daily basis.

For example, when making a decision about whether to get up now or sleep in for an extra 10 minutes, the possible choices and the relative risks and benefits of obeying the alarm clock or sleeping later come automatically to mind.

Larger problems are addressed in a similar way. For example: “I have tasks that need to be done by the end of the week. How am I going to get them all done on time?”

After considering the possible strategies, 1 is chosen and implemented. If it proves to be ineffective, a different strategy is tried.

People who can define problems, consider options, make choices, and implement a plan have all the basic skills required for effective problem solving.

Sometimes following a step-by-step procedure for defining problems, generating solutions, and implementing solutions can make the process of problem solving seem less overwhelming.

Six step guide to help you solve problems

Step 1: identify and define the problem.

Step 2: Generate possible solutions

Step 3: Evaluate alternatives      

Step 4: Decide on a solution      

Step 5: Implement the solution

Step 6: Evaluate the outcome

Problem solving is something we do every day.

Some problems are small or easily solved - others are more complicated and can seem overwhelming.

One way of tackling problems is to use a specific and systematic problem solving procedure. If you’ve tried to solve certain problems without much success, try these steps out and see if they help.

Learning to solve problems effectively will help you to minimise the level of stress in your life and improve your overall sense of well-being.

Try it out and see.

Where to get help

Centre for Clinical Interventions (CCI)

See your doctor

Visit healthdirect (external site) or call 1800 022 222, mental health emergency response line (mherl).

This information provided by

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This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.

Related sites

Link to HealthyWA Facebook page

Department of Health


Eight-Step Problem Solving Process for Medical Practices

Whether you are hoping to solve a problem at your practice or simply trying to improve a process, the easy-to-follow OODA Loop method can help.

Practice managers know that there are four key objectives at the core of process improvement:

• To remove waste and inefficiencies • To increase productivity and asset availability • To improve response time and agility • To sustain safe and reliable operations

The question is, how do we do all this? I would suggest a proven technique known as the OODA Loop.

problem solving methods in health care

The OODA Loop consists of four overlapping and interacting processes. Managers must: O bserve the current situation and form theories, O rient the picture by setting improvement targets and determining root causes, D ecide by developing solutions, and A ct by means of implementing and evaluating. The OODA Loop can be subdivided further into an eight-step problem solving process.

Observe Step 1: Clarify the Problem This is a critical step. You need to recognize the correct problem and be sure it is completely understood by all. It helps to state the problem by developing a “problem statement” in terms of what, where, when, and the significance. You also need to “lay eyes” on the situation, ensuring you have first-hand observation. This will then help in drafting a flowchart that diagrams the steps of the process. Lastly, you need to conduct surveys and interviews, talking with the “customer” or end user who determines the value of the process under review. Step 2: Break Down the Problem and Identify Performance Gaps It is tempting to jump to action but you must refrain from doing so just yet. Gather and review the key data. Understand what data is necessary and what role it plays in problem solving. Are there gaps in your analysis? Are there bottlenecks in the process you are reviewing? Under this step, you must also look at waste in your practice as it relates to the problem. There are generally eight types of waste: defects, over production, waiting, over processing, transportation, intellect, motion, and excess inventory. You should always look for waste in your processes.

Orient Step 3: Set Improvement Targets Where do you want to be? Determine your desired outcome for the practice. Be sure to look at both strategic and tactical targets. Strategic targets are visions of what your practice strives to become. Tactical targets define the performance level necessary to make your strategic vision a reality. Remember to keep your tactical targets challenging but achievable. Step 4: Determine Root Causes This is the most vital step in the problem solving process. All too often practice managers find themselves addressing problems that have been “solved” many times before. This is usually due to directing problem solving efforts at the symptoms of a problem rather than at the root cause of the problem. It often helps to do much brainstorming and when you think you understand the cause of the problem, ask what caused the problem (continue to ask “why?”).

Decide Step 5: Select Solutions When selecting solutions, consider both quality and practicality. Be sure to also gain acceptance (or “buy in”) from those that must implement the solutions. Some key factors to consider when analyzing solutions include effectiveness, feasibility, and impact. When developing your action plan, be sure that you have created a clear and detailed plan that everyone can understand.  Most importantly, build consensus with others by involving all of your team appropriately to cultivate a sense of ownership in the solution and in its success. Effective communications can be a deciding element as to whether the plan succeeds.

Act Step 6: See the Plan Through Collect data according to the action plan. Remember the old adage, “You can’t manage what you can’t measure.” You may need to implement a contingency plan as conditions change and you need to keep the project on focus. Continue to provide required training during this step as well. Step 7: Confirm Results and Process Ensure the plan is producing the intended results. Monitor the project for performance relative to: a) the baseline developed in steps 1 and 2; b) the improvement targets established in step 3; c) where you thought you would be at this stage; and d) meeting targets by the established deadline. You should return to any step as necessary. Step 8: Standardize Successful Processes This is the most commonly skipped and under completed step of the entire problem solving process. You can define this step by asking a series of questions : What is needed to standardize the improvements? Is the appropriate documentation in place? Were other opportunities or problems identified by the problem solving process?

If the answer to this last question is yes, begin the process over ... that is why it is referred to as the OODA Loop.

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Practice Administration Stability and Key Determinants of Success

Sachin Gupta, CEO of IKS Health, discusses how independent practices can remain administratively stable during the pandemic and after, as well as provides the key determinants of success for new and growing practices.

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Are your physicians and staff members juggling too many responsibilities? Your practice administrator may be able to help.

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By building external and group self-awareness, a physician leader can better adapt to the quickly changing healthcare landscape

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A poor capacity management system can lead to unrealized revenue, loss of patients, and increased physician burnout.

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problem solving methods in health care

LSU Health New Orleans

Strategies for Problem Solving

Nursing students will be expected to have or develop strong problem-solving skills. Problem solving is centered on your ability to identify critical issues and create or identify solutions. Well-developed problem solving skills is a characteristic of a successful student. Remember, problems are a part of everyday life and your ability to resolve problems will have a positive influence on your future.

6 Steps of Problem Solving

Step 1: Identify and Define the Problem

It is not difficult to overlook the true problem in a situation and focus your attention on issues that are not relevant. This is why it is important that you look at the problem from different perspectives. This provides a broad view of the situation that allows you to weed out factors that are not important and identify the root cause of the problem.

Step 2: Analyze the Problem

Break down the problem to get an understanding of the problem. Determine how the problem developed. Determine the impact of the problem.

Step 3: Develop Solutions

Brainstorm and list all possible solutions that focus on resolving the identified problem. Do not eliminate any possible solutions at this stage.

Step 4: Analyze and Select the Best Solution

List the advantages and disadvantages of each solution before deciding on a course of action. Review the advantages and disadvantages of each possible solution. Determine how the solution will resolve the problem. What are the short-term and long-term disadvantages of each solution? What are the possible short-term and long-term benefits of each solution? Which solution will help you meet your goals?

Step 5: Implement the Solution

Create a plan of action. Decide how you will move forward with your decision by determining the steps you must take to ensure that you move forward with your solution. Now, execute your plan of action.

Step 6: Evaluate the Solution

Monitor your decision. Assess the results of your solution. Are you satisfied with the results? Did your solution resolve the problem? Did it produce a new problem? Do you have to modify your solution to achieve better results? Are you closer to achieving your goal? What have you learned?

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Creative Problem Solving in Healthcare

problem solving methods in health care


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There are 5 primary strategies to use when looking for creative ways to solve problems in healthcare:

We all have to deal with problems, not only at work, but also in our personal lives. Planning a wedding or a party, finding child care, paying bills, trying to arrange transportation for family members to get where they need to go…all of these are frequent problems that we have to deal with.

As a healthcare worker, your workplace is always changing. It is full of challenges and new clients. You must monitor your client’s condition and perform prescribed treatments. You must know when to inform health professionals about your client’s condition. You must help your clients to make decisions.

Problems can quickly arise and you will have to solve these problems. You need to know what to do and when to do it. Some of these problems will require creative solutions. Being able to creatively problem-solve is an important skill for today’s healthcare workers. Knowing the types of problems that can arise and planning for them in case they do happen will help you to deal with problems effectively.


Problem-solving requires critical thinking skills and creativity. What is a problem? What does creativity mean? What is critical thinking?

A problem is a gap or difference in what the situation now is and what you would like it to be.

Creativity is basically the production of order out of chaos. Creativity is developing new, flexible, open-minded approaches or solutions to a problem.

Critical thinking is examining and reflecting on ideas and thinking. Then judgments are made and a course of action decided upon. By combining critical thinking and problem solving, the problem is identified, information is gathered, beliefs and ideas are challenged, and different options are examined creatively. Asking questions is the way to build critical thinking into problem solving.


Several strategies that you can use to solve problems creatively are brainstorming, thinking hats, problem reversal, S.W.O.T., and role playing.

Brainstorming Brainstorming is often used by groups, but can also be used by you alone. It is used to create as many possible solutions to a problem as possible. To be effective, the ideas must not be judged or evaluated in any way as they are being developed, no matter how bizarre they seem. Wild ideas are welcomed. Ideas can build on other ideas. New ideas can be created by changing ideas already mentioned.

The more solutions that can be created, the more likely you are to find an effective one. Also, the more variety there is in the solutions, the more likely you are to find an effective one. Once all possible ideas have been created, they are considered for possible consequences. A solution is then selected.

Consider for a moment Divide a square into 4 equal parts. How many possible ways can you think of to divide a square into 4 equal parts?

Below are 4 of the possible answers to this exercise. There are actually many different ways to divide a square into 4 equal parts. This exercise helps to develop your creative thinking skills. It also shows that there is often more than one right answer to a problem.

problem solving methods in health care

Thinking hats Thinking hats can also be used in groups, or by you alone. It was originally designed by Edward de Bono. It uses six colored (imaginary) hats. Each hat stands for a different way of thinking about a problem or issue. Using all of the hats will help you to consider the problem more creatively. You will be able to think about the problem from a different viewpoint than you usually take. If it is being used with a group, all members have on the same colored hat at the same time.

1. The white hat is neutral. Facts, figures, and information are examined. It helps to decide if more information is needed.

2. The red hat is for feelings, hunches, and intuition. There is no need to explain your feelings.

3. The yellow hat is for optimism and a logical, positive view of things. It looks at the benefits. It also helps during the evaluation of ideas.

4. The black hat is the logical negative. It uses caution and judgement. It does not encourage creativity. It helps during the evaluation of ideas. It is usually better to use the yellow hat before the black one, to look at the benefits first.

5. The green hat is for creative thinking and new ideas.

6. The blue hat is used to think about the problem-solving process. It ensures the process is being followed. It helps to decide what should be done next.

problem solving methods in health care

Problem reversal Sometimes, you will get a different view of a problem if you look at it from the opposite direction. State the problem in reverse. Change a positive statement into a negative one. For example, if there is a problem with a co-worker and you want to improve the situation, consider what would make the situation worse.

S.W.O.T. Analyzing the strengths, weaknesses, opportunities, and threats (S.W.O.T.) is another way of evaluating a problem. It can also be used when evaluating the solutions. What are the possible benefits? What strengths are present? What are the weaknesses? What new opportunities or situations can be created? How can we take advantage of these opportunities? What is the possible harm in the problem? What is the possible harm in the solution?

problem solving methods in health care


1. Think before acting. Use a problem-solving process.

2. Think clearly – stay open-minded. Recognize the effects your emotions can have on your thinking. Separate facts from opinions. Look for errors in reasoning. Consider the evidence (information) – do not jump to conclusions. Don’t try to make the facts fit the solution you want to use.

3. Ask as many questions as you can. Make sure you are asking the right questions to find out what the problem really is. Find out all you can about the problem.

4. Get good ideas from everyone and from everywhere. Edward Land was taking photographs of his family on vacation. His daughter asked him, “Why do we have to wait to see the pictures?” Land thought about this and came up with the idea of instant photography and the Polaroid Camera.

5. Be selective. You cannot solve every problem. Make sure the problem is yours to solve.

6. If a problem seems to be overwhelming, break it into parts.

7. Make the best use of what you have. People often waste a lot of time and energy on “if only.” When you are solving problems, focus on what you have available and what you can change or fix. Spending time on “if only” will just waste time. Spending time and energy saying, “It wouldn’t be a problem if only we had twice as much money for equipment” does not solve the problem – especially if you know you are not going to get twice as much money. Gather the facts as they exist and develop realistic solutions.

8. Look for the opportunity in the problem. Developing creative solutions takes advantage of the opportunity in the problem. For example, a long-term institution for the elderly is looking at the possibility of having to lay-off employees. At the same time, there is a community need for daycare services for the elderly. Perhaps a creative solution would be to develop a daycare program for the elderly instead of laying the employees off.

9. Don’t wait for a problem to occur. If you can take action before a situation turns into a problem, do so.

10. Plan for problems before they occur.

11. Negotiate. Negotiation means that those involved have some of their needs met. This is usually a good strategy in problem-solving. Everybody gets something.

12. Ensure the solution fits the problem. Once the solution has been put into action, it is important to evaluate the plan to ensure the problem has actually been solved and not just hidden for a while.

13. Expect success. Believe in your ability. Work towards realistic goals rather than trying to save the world. Use your skills, time, and energy wisely.

14. Look forward, not backward. Don’t always count on strategies that worked in the past. Be curious. Have the self-confidence to try new things.

15. Although we would like to have all of our problems solved quickly, don’t expect to be able to solve every problem, especially with the first strategy used.

16. Keep your sense of humor.

17. Avoid judging during the gathering of information and development of ideas. The most important question in the creative process is “How might we…?” “We can’t because …” is a barrier to creative problem solving.

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I look upon the “Herb Interaction” book as a “quickie” for my pharmacy team, no need to get bogged down on the computer.
The book on “foot ulcers” spoke to me, I now understand the importance of foot care.
We forget sometimes the power of the patient for healing through compliance and self care habits. We should provide understandable information.
The Dr’ Guide books were a great door opener and relationship builder with the allergy medical team. Our reps loved them.
We had the highest BRC (business Reply Card) return rate of all time – it built up great customer goodwill and easier repeat calls.
The distribution of the Dr. Guide books was the most cost effective, most quickly integrated and best ROI program I have had in years – no committee development meetings, no sky high “creative” costs and so appropriate for our product / treatment messages.

Fresh Perspectives

Fresh Perspectives: New Docs in Practice | AAFP News Blog

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Want to Solve Problems in Public Health? Here's How

I have many loves in family medicine. I love delivering a newborn directly into a mother's arms. I love excisional biopsies of funny looking moles. I love giving someone hope after a chronic disease diagnosis.  

41910292 - ethnicity design team brainstorming discussion teamwork concept

What I love most, however, is community-based preventive medicine. As such, I wrangled a contract directly out of residency that is 20 percent population medicine. (Lesson No. 1: Ask for what you want. You might actually get it).

As part of this endeavor, I am pursuing a master's degree in public health. I hope to use this training to make connections in the world of public health policy; to learn how to create, implement, message and evaluate programming; and perhaps to eventually break into creation of, or participation in, policy. I will have some required coursework in, for example, biostatistics and epidemiology, but I will also have myriad electives on topics like environmental public health and behavioral economics.

Throughout the course of my program, I hope to distill the most useful-to-the-family-medicine-doc public health pearls from my classes and pass them along. This post is the first in this series. Thus far, I have taken courses on problem-solving in public health and intro to persuasive communication.

The course on problem-solving in public health taught me two things: a remarkably egalitarian way to run a meeting and a systematic approach to solving problems.

The Nominal Group Technique (NGT)

In this setup for running a meeting, start by imagining a group of eight people. During each session, one of them is the moderator, one a notetaker and one a timekeeper. The moderator's job is to decide how long each part of the session ought to take, and the timekeeper's job is to cut people off once time is reached. The notetaker … takes notes.

Each meeting uses the following series of steps, and as participants get used to the process, they get faster and more efficient.

The NGT is delightfully efficient and focused. Moreover, it imposes a thoughtful, respectful and inclusive methodology to traditionally explosive or at least controversial topics. By using this technique, you can assure all members of the group that each of their voices will be heard with equal weight, as will also be the case in the problem-solving process below.

The Problem-solving Process

Usually applied to public health problems, this series of steps offers a framework through which one can approach just about any problem that involves groups of people. Whether your problem is developing a group visit program or decreasing smoking in pregnant women, you can approach the problem with success in this way. Notably, this process works well in combination with the NGT.

I already have used each of these techniques to great effect. By addressing problems in this step-by-step fashion, I find myself suddenly more organized, and you know what that means: more time for more projects!

Just kidding. I get to read books for fun these days and go on long runs. It is amazing.

Stewart Decker, M.D., is a family physician practicing in southern Oregon. He focuses on the intersection of public health and primary care. You can follow him on Twitter at @drstewartdecker.

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News & Research

Health care problem solving, healthtech fellowship ids problems, develops innovative solutions.

Photo of open heart surgery.

Sim Kahlon is an experienced health care innovator with a computer engineering degree and an MBA in finance . When he became one of the first participants in Harvard’s new HealthTech Fellowship program  last fall, however, he soon realized he was embarking on an educational experience unlike anything he’d previously encountered. 

That realization hit home when he observed a heart transplant surgery firsthand, as a member of a four-person team of interdisciplinary fellows enrolled in an intensive, two-month immersion in the Division of Cardiac Surgery at Massachusetts General Hospital.

“They would be waiting for the donor heart to arrive so they could quickly pick up the heart and put it in the body,” Kahlon said.

Get more HMS news her e

Kahlon was amazed to see a patient’s body with an empty chest—no heart inside. The surgeons’ ability to physiologically support the patient as they waited for a new heart to arrive, he felt, was a testament to modern medicine.

To minimize the potential for delays upon receiving a donor heart, the surgical protocol is to support a patient on an artificial heart-lung bypass machine until the donor heart becomes available.

Although the surgery is highly coordinated, Kahlon said time seemed to crawl while the patient remained completely reliant on the artificial support systems, all the while under constant surveillance. The experience was an epiphany of sorts for Kahlon.

“Just to ponder the miracles of science, and how critical the need is for innovation ...   to keep pursuing, to keep pushing to develop, to make sure there are inventions happening all the time. Because without a heart bypass machine, this would not have been possible,” he said.  

Observing the surgery provoked other questions for Kahlon, who wondered where the donor heart was coming from and what would happen if it was delayed.

“All these questions are going through my mind,” he said. “And I’m thinking, ‘What happens if the donor heart that’s on the way meets with an accident ... and this person is lying on the table without a heart?”

For Kahlon and his colleagues in the program—Bahar Rahsepar, Harvey Chin, and Manny Fanarjian— the program's clinical immersion experiences, such as this one, were designed to prompt just that kind of thinking.

Identifying a need

The 10-month fellowship program, a collaborative effort between Harvard Medical School, the Harvard John A. Paulson School of Engineering and Applied Science s, and Harvard Business School , embeds participants at Harvard-affiliated hospitals with the goal of having the fellows identify and characterize unmet health care needs through direct observation.

Screening those needs based on factors including clinical impact and potential market, the fellows then brainstorm and iterate novel solutions. The aim is to develop the skills to lead health care innovation, transform challenges into viable business opportunities and, ultimately, improve health care for all.

“We hope to spur innovation with our clinical partners as well as within our clinical partners,” said Paola Abello , director of innovation at the HMS Center for Primary Care who oversees the program.

The fellows began their work by conducting in-person observations for eight weeks. From that effort, they identified more than 370 health care problems for about 20 disease states, Abello said. They then narrowed their list down to the five they were most interested in pursuing.

“The point is to understand what the real need is, right? Because you could have a really fabulous solution, but if you’re not addressing the right problem, it’s not going to take you very far,” said Abello.

Photo of the four fellows: Kahlon, Chin, Rahsepar and Fanarjian

Although the HealthTech Fellowship program falls within the HMS Therapeutics Initiative, right now its focus is on improving health care delivery rather than drug discovery, specifically focusing on potential improvements in digital health and medical technology. The program utilizes the biodesign innovation framework to identify problems that need solutions, landing on a project they believe could address a real need.   

“They are working on congestive heart failure, and how patients can more efficiently monitor their medications and fluid levels from home,” Abello said. “The inability of patients with congestive heart failure to monitor these things is a huge reason why many end up back in the hospital.”

“We’ve talked to probably over 50 experts to date. And everybody’s agreed that this is a problem that needs to be solved,” said Chin, one of the four fellows.

A physician with a master’s degree in biomedical informatics, Chin has started two health tech companies that employ artificial intelligence to solve problems

“I think as a physician, you always feel like things can be better,” he said. “When you are in med school, you learn a lot of medical knowledge. You memorize, ... you learn about the cutting-edge scientific results, but there’s a missing piece between new innovation and actually making an impact on the patient side.”

Significant research funding can go into developing solutions for problems that ultimately are not adopted by the health care system or physicians, Chin said. The solution is not something people really want or need

“My main motivation is learning about how to think about the business side of medicine more structurally,” he said.

A better way

Fellowship participant Manny Fanarjian is a physician and a biomedical engineer who did his residency in internal medicine.

“I can’t tell you the number of times you run into a hurdle or an inefficiency or a gap in the way that care is delivered,” he said. “And you just think to yourself, ‘There’s got to be a better way to do this.’”

The fellowship provided Fanarjian with focused time to think about those kinds of health care problems and an opportunity to try to solve at least one of them.

For example, Fanarjian said, silos in health care systems create difficulties when a patient gets an MRI at a hospital in one health care system and then gets transferred to another hospital in a different system. Providers might not have access to the previous imaging, or they find that lab results and information get shared in an inefficient way—or not at all. Often, the imaging scan just gets repeated in the new hospital, he said.  

“And that comes in at a cost to the system and a nuisance to the patients, and potentially, you know, more radiation exposure, depending on what kind of scan it is,” he said, adding that “the entire [health care] system is not built in a patient-centric way.”

“Patients who have multiple chronic comorbidities, they literally plan their lives around their medical care. And it doesn't serve them that well,” Fanarjian said.

Fanarjian said there are tools that allow blood pressure monitoring from a patient’s home, and even dialysis can be done from home now. But more work needs to go into finding and scaling additional solutions. The fellowship provided him with further expertise.

“There’s a lot of skills that I learned that I just didn't have before, around patent writing and some product design, stakeholder interviews and market research, and pitching to investors. These are all things that are really important in developing new technologies that I just didn’t have access to before,” he said.

Photo of the HealthTech fellows inside MGH

Another benefit to the program was working closely with the three other fellows who all have a diverse range of experiences in health care, medicine, and science. His colleague, fellow Bahar Rahsepar, for example, has a PhD in biomedical engineering.

Rahsepar’s work has involved neural engineering—how memories might be modulated in relation to stress disorders. Primarily focused on basic science research, she was interested in learning more about translation, that is, how to take her discoveries from bench to bedside.  

“Different strategies that could be employed in translating basic science research into actual impactful results for patients. That's the broad category of what I’m interested in,” she said.

For the fellows group, she said, one of the key questions was ‘What is the impact for patients?’

‘It’s like, if you solve this, would there be time saved? Would quality of life be improved for patients? All of those questions come into consideration,” Rahsepar said.

The coronavirus pandemic, she added, also played a role in the group’s ultimate decision to concentrate on improvements to congestive heart failure care. As the pandemic led to a wider use of telemedicine, the possibilities surrounding home monitoring and care became more apparent.

Abello said this first fellows pilot group has already sparked industry interest, especially among investors in the venture capital community, she said.

“If they’re able to launch and develop a product for congestive heart failure patients, that’s a huge community of patients that will be served,” she said.

In fact, Abello said, it was an entrepreneur who provided the initial funding to support the fellowship program which, at this point, is completely supported by philanthropy.

“[Investors] see this as an opportunity to cultivate a pipeline of really strong talent that will stay in Boston,” she said. “But in order to grow this program, we need to continue getting support to be able to educate these future entrepreneurs and innovators.”

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Business Management Articles / Quality Management


by Rene T. Domingo

Hospitals and other health care providers deal with a host of problems besides treatment of sick patients. This includes service delivery problems, management and people problems, logistics, maintenance and resource allocation problems. Unfortunately, very few tools are used by management and the medical staff in addressing these problems. Problems often recur or remain unsolved because of reliance on personal styles, subjective approaches, and purely qualitative approaches. Most of the methods and tools used by manufacturing and service industries to solve quality problems can be applied in problem solving in health care. These simple tools have proven effective in dramatically reducing if not eliminating defects, failures, wastes, and customer complaints in these businesses. Hospitals that have launched a Total Quality Management (TQM) program to improve their services use these tools on a regular basis.

These tools and methods, most of which are quantitative in nature, can help health care institutions achieve the following goals:

{ establish facts and objectivity through "management by fact"

{ clearly define, identify, and document a problem

{ clearly define, identify, and document an opportunity

{ facilitate problem analysis and problem solving by individuals or groups

{ enhance and simplify management reporting

{ facilitate communication, dissemination, and transfer of knowledge or technology by providing a common language for analysis and presentation

{ make meetings more organized, productive, and focused

{ help in developing countermeasures and preventive measures

{ measure the effectiveness of the solution to the problem and the amount of improvement

{ help in the formulation of standards and procedures

{ sustain the organization's TQM and continuous improvement programs

Among the simple yet effective tools that all health care personnel from management to employees can adapt and employ are: tables, tally sheets, flowcharts, bar chart, pareto diagram, fishbone diagram. There are other more sophisticated statistical tools like multivariate analysis that can be used to analyze for more complex problems. However, these may require computer assistance and extensive training in statistics.

The tools can be applied in almost any medical and non-medical operation and processes in the hospital or health care institution like: nursing services, medical services, radiology, laboratories, pharmacy, admissions, medical records, accounting, dietary, housekeeping and maintenance. Among the problems that the quality tools can address are: long queuing time or waiting time for the patient, slow response time to calls, errors in medication and records, cold meals, slow turnover of rooms and slow shift-turnover of nursing staff.

{ Tables and tally sheets

Well prepared tables contain critical and often numerical data that are clearly and effectively presented to highlight problems and opportunities. Tables can also show which problems should be given priority. A small clinic uses a table to highlight and compare the costs of rework of its major service providers. The table shows that the administrative staff is the most wasteful and costly for not doing their jobs right the first time. Training or retraining them may be one way to improve their performance.

Tally sheets can be used to measure, quantify, and locate improvements in quality. A hospital made a two-year tally of patient comments on all its services, medical and non-medical, using a rating scale from “VP” (very poor) to “VG” (very good). We may gauge success as the greatest improvement in the "VG" responses. We can recommend improvement for those units that had high "VP" scores, or had high increases in "VP" scores during the last two years. The tally sheet shows the improvement in the number, length, and types of patient calls received by a nurse station of a hospital after implementing a "kaizen" or work simplification project. For instance, between October and December, patient calls pertaining to air-con adjustment were reduced from 20 to 7 or by 65% after the hospital improved the air-con knobs and mounted a patient information campaign on how to adjust and use the air-con thermostat. Tally sheets can thus measure the effectiveness of any improvement program.

{ Flowcharts

Flowcharts can be used to clearly show the flow of people, services, and information in a hospital. A flowchart can show the flow of service in a hospital, starting with admission and ending with satisfied customers or patients. It also lists the types of services each unit must deliver for the hospital to create total customer satisfaction. The flowchart also conveys that message that everybody works towards a common goal. It shows the flow of services from one hospital unit- the department of laboratories - to the rest of the organization and eventually to the patients. The flowchart conveys the principle that any one failure in service to any department or internal customer will result in a dissatisfied external customer or patient.

Flowcharts can show areas of responsibility as well as areas for improvement. A flowchart in a clinic shows that a client registration process takes up 30 minutes. If the 30 minute registration time were to be reduced further, the flowchart can help analyze which step or steps to eliminate, combine, or simplify. A flowchart can show how nurses respond to a patient call. One hospital used flowcharts to indicate the improvement in charge card approval time of a patient of nuclear medicine from 1 hour to 7 minutes.

Flowcharts and any other problem analysis tool may be supplemented or supported by diagrams or pictures to clarify the work process or problem.

{ Bar charts, pareto diagram, fishbone diagram

Bar charts can help identify differences, gaps, priorities, and trends. They provide visual representation of numbers generated by tables and tally sheets. All tables and tallies can be graphed. Use line graphs to highlight trends, and bars charts to highlight differences among several items or factors. Another popular form of bar chart is the pareto diagram in which the items graphed are sorted from highest to lowest resulting in a stair-like shape. The pareto is used to set priorities or indicate which problem or problems to solve first. It enables us to have a systematic way of dealing with problems and prevents us from firefighting. The pareto rule is that 80% of problems are due to only 20% of the causes. The pareto will help us identify those vital few (the 20%) causes so that we can improve quality dramatically and quickly. A hospital made a pareto diagram on the types of patient calls that a nurse station receives. It shows that the most frequent (around 25%) is call for supplies - linen, blanket, tissue paper, etc. By improving housekeeping procedures and making sure supplies are always sufficient, the quality improvement team has almost eliminated this type of call and freed a lot of time for nurses to answer medical calls.

After the pareto has identified the most critical problem to attach, the fishbone or cause and effect diagram may be used to analyze it. The fishbone diagram looks like a fish. The head represents the problem to be eliminated, while the bones represent all its possible causes. The fishbone is a result of a structured brainstorming of all the members of the quality improvement team. It is usually best to have a cross-functional team to be able to identify all possible causes. A quality improvement team of a hospital made a fishbone analysis of delayed patient's discharge of a hospital. After constructing the fishbone, the team how discussed and decided which among the possible causes were the most probable ones, usually one or two items or factors. These causes were then validated, studied, and eliminated.

Problem solving in health care is too important to be left to chance, personal styles, and disorganized approaches. A thorough and organization-wide application of the tools described above will lead to better communication, teamwork, and faster solution of problems of any kind in the hospital, whether administrative or medical.


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