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Module 4 - Problem Identification, Prioritization and Aim Statement - Nov 2025

The document outlines the process of problem identification, prioritization, and aim setting in quality improvement (QI). It emphasizes the importance of using various tools and data to identify and prioritize problems, as well as formulating clear problem and aim statements. Key components include understanding the dimensions of quality, employing prioritization tools like Pareto charts, and ensuring aim statements are SMART (Specific, Measurable, Ambitious, Realistic, Time-bound).

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Berhanu Yelea
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19 views33 pages

Module 4 - Problem Identification, Prioritization and Aim Statement - Nov 2025

The document outlines the process of problem identification, prioritization, and aim setting in quality improvement (QI). It emphasizes the importance of using various tools and data to identify and prioritize problems, as well as formulating clear problem and aim statements. Key components include understanding the dimensions of quality, employing prioritization tools like Pareto charts, and ensuring aim statements are SMART (Specific, Measurable, Ambitious, Realistic, Time-bound).

Uploaded by

Berhanu Yelea
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Problem Identification,

Prioritization and Aim Setting


Module Objectives

 Use appropriate problem identification and


prioritization tools for aim setting
 Identify problems using the dimensions of
quality
 Utilize different types of data to identify
problems
 Apply tools to prioritize problems
 Formulate problem statement
 Formulate aim statement for identified
problems
Introduction

A problem is

“ the difference between things as perceived


and things as desired”
Gause and Weinberg (1989)

“ the gap between the existing state and the


desired state of a process”
Health Quality Ontario
Problem Identification
Problem Identification in QI

 What to improve?
 Need to identify the opportunity for
improvement

 Effectiveness issues: system does not


deliver according to performance
expectations
 Efficiency issues: system uses too many
resources to deliver its performance
 Responsiveness issues: system does
not address
Federal Democratic the Ministry
Republic of Ethiopia, needs of its
of Health (2017), HSTQ, clients
QI-TC Participants workbook
Identify Problems in Quality of
Care
Person
Centere Safe
d

Six
Timely healthcare Effective

quality
dimensions
Institute of Medicine, 2001
Equitable Efficient

Adapted from Institute of Medicine (2001) Six Healthcare Quality Dimensions


What Tool to Use?

Common tools for problem identification and


prioritization:
 Data for various sources
 Observation/ Walk through
 Pareto Chart
 Prioritization matrix
 Process map
 Root cause analysis – fishbone, 5 WHYs
Compare Performance with Target
(II)
PENTA 3 Coverage in Kebele X
60

50

40
Number

30

20

10

0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
PENTA 3 Target group
Observation
Data Quality
Improvement Clinical skills
Observation - Walk-through

 Enables providers to better understand the


experience of care from the patients’ and
families’ point of view

 It generates data that address the total


experience of the patient including
frustrations, confusion, anxiety

Adapted from Institute for Healthcare Improvement, Walk-through Tool


~~~~~~Vilfredo
Pareto~~~~~~

Prioritization Tools
If you’re Noah, and your
ark is about to sink, look
for the elephants first,
because you can throw Pareto Chart and Prioritization
over a bunch of cats, dogs, Matrix
squirrels, and everything
else that is just a small
animal and your ark will
keep sinking. But if you
can find one elephant to
get overboard, you’re in
much better shape.
What is a Pareto Chart?

A graphical tools, that helps to prioritize efforts to


where it will have most impact.
It is build up of three (3) key components:
1. Bar/Column chart – representing
categories/frequencies displayed in order of size
2. Line graph – representing the cumulative
percentage
3. Two vertical (y-) axis
Pareto Principle

 A small number of effort account for most


of the results.
 80/20 rule
Steps for Constructing a Pareto
Chart
1. List all the possible categories/groups
2. Collect the data – how many of each
3. Arrange the categories/groups from the highest to the
lowest
4. Calculate the total, add up the frequencies
5. Calculate percentage for each category/group
6. Calculate the cumulative percentage
7. Draw the axes – horizontal: categories/groups
vertical left: frequencies/ ‘raw’ data
vertical right: cumulative percentage
8. Plot the data in your graph
9. Label the axes and annotate the graph (specifying the vital
few and useful many)
Pareto Chart on Neonatal deaths

 Use the following data to prepare a Pareto Chart


(30 min.)
Contributing factor
(Causes of Neonatal Cumulative
deaths) Frequency Percentage Percentage
Birth
Prematurity
Asphyxia 45
49 32.2% 32.2%
Neonatal
Birth Asphyxia
Sepsis 31
45 29.6% 61.8%
Pneumonia
Neonatal Sepsis 31
9 20.4% 82.2%
Congenital Abnormalities 11 7.2% 89.4%
Tetanus
Pneumonia 4
9 5.8% 95.2%
Prematurity
Tetanus 49
4 3.0% 98.2%
Malnutrition 1 0.6% 98.8%
Diarrhea 1 0.6% 99.4%
Birth injury 1 0.6% 100%
Total 152 100%
Pareto Chart on Neonatal deaths

 Causes of neonatal deaths in the scenario facility

Cause of Neonatal Deaths in 2016


60 100

50 80
Vital few

Cumulative percentage
40
60
30
Frequencies

40
20 Useful many
10 20

0 0
Prioritization Matrix

 Which identified problem should be


prioritized?

 Common criteria used to prioritize


problems
 Cost and/or gains when resolved
 Availability of solutions
 Availability of resources (staff, time,
equipment, etc.)
 Urgency of solving
 Size of problem
Adapted from National Association of Country & City Health Officials (NACCHO), First Things First
Step-by-Step Instructions

1. Create a matrix
2. List the problems vertically and the
criteria horizontally
3. Add one extra column on the right for
priority score
4. Weight the criteria, according to level of
importance
5. Rate the problems for the criteria
according to predetermined rating scale
6. Calculate priority scores
Adapted from National Association of Country & City Health Officials (NACCHO), First Things First
Example of Prioritization Matrix
Small Group Exercise

 Work in groups of 3-5 participants (per


facility, department, organization) – (20
minutes)
 Brainstorm with your group about
prevailing health problems in your work
place
 List the problems and the criteria you use
to rank them
 Develop the prioritization matrix
 Which health problem are you prioritizing
and why?
Problem Statement
Components of Problem
Statement
A clear and concise statement that describes
the symptoms of a problem. Guided by the
following questions:
1. What is the problem? What is not functioning as
desired? What are the boundaries? (Size)
2. How do we know it is a problem?
3. How long has it be a problem (time)?
4. What are the effects (impact) of this problem?
5. Where does the problem exist?
6. How will we know the problem is resolved?

Federal Democratic Republic of Ethiopia, Ministry of Health (2017), HSTQ, QI-TC Participants workbook
What is does NOT do…

 Does NOT include the causes

 Does NOT include the actions or


corrections required

 Does NOT assign blame

 Does NOT address more than one problem


Guiding Questions Example
A team at a hospital in Gambela noted a shortage in
medication for Acute Respiratory Infections (ARI) for under
five.
 What is the problem?
A shortage of ARI drugs for children under five
 How do you know it is a problem?
Drugs run out by the third week of the month
 How frequently does it occur?
This shortage has occurred every month for the past nine
months
 What are the effects of this problem?
Patients develop complications causing an increase in
referrals to a first-level facility
 How will you know when it is resolved?
The problem will be solved when ARI drugs last until the end
Federal Democratic Republic of Ethiopia, Ministry of Health (2017), HSTQ, QI-TC Participants workbook
of the month
Examples Problem Statement

Problem Statement Strong?


1. There are many errors in our data
2. Over the past 2 years, only 50% of ANC clients
was tested for HIV in hospital X, leading to high
risk deliveries with potential risk for baby and
health workers to be exposed
3. Maternal clients satisfaction is low
4. Since 3 months Hospital Z has had oxygen
stock-out, resulting in a closed theatre and an
increase in referrals, so far 150 clients were
referred
Small Group Exercise

 Work in the same groups as during the


prioritization matrix exercise

 Write down the problem statement for the


health care problem you rated with the
highest priority

 5 minutes
Aim Statement
Purpose of Aim Statement

 1st Principle of Improvement – know why


to improve

 Is an explicit description, with specific


actions or focus

 An internal and external communication


tool for the work to be done
Components of Aim Statement

Specific
Measureable
Ambitious
Realistic
Time bound
Examples of Aim Statements

S M A R T
To increase the percentage of
syphilis tested pregnant mothers
attending ANC from 0% to 80% by
the end of January 2017.
To improve PNC within 48 hours
To increase number of 4th ANC from
50% to 85% at Y.P. Hospital by the
end of June 2017.
To increase skilled delivery from
68% to 85% by the end of May
2017.
To increase the percentage of
inpatient referral feedback given
from 14% to 85% from Nov 23/2016
Small Group Exercise

 Develop a SMART aim statement for your problem


statement.

 Write the aim statement on a sheet of paper, we will need it


in the subsequent sessions.

 Review your aim. Does it include all the components of a


SMART aim statement?

 We will use 10 minutes for this exercise.


Aim Statement

Date: _______________________

I/We, ____________________________ aim to improve/reduce

_________________________________________________

from _______ to _______ by _________________ 2019.


Summary

 Problem identification is the first step in QI


 Prioritization tools can help focus which
problem to start with.
 A good problem statement answers a
series questions including the size, impact,
location and frequency of the problem
 A aim statement should be SMART

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