#MEQAPI – Tweetchat Oct-18 2018 3:00ET QI Workshop

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.

This chat is a working session for a small-scale DIY Lean Six Sigma targeting process. A number of people in healthcare – patient’s, caregivers, nurses, physicians, etc are going to try their own QI discovery using the following steps. This chat will be to mull through questions and issues in getting started.

Before the chat, participants will have carried out the following steps

  • For three days, kept a diary of everything in the work or care environment that
    1. Were Surprising
    2. Were Frustrating
    3. Were Confusing
  • To maximize recall, participants are encouraged to make the diary note as soon as possible after it happened. Experience has shown, they tend to evaporate from memory pretty fast, so the idea is to grab them while they are hot. Immediately is good, end of day is ok, more than that is going to be less than half as effective
  • Participants will capture what the issue was, what effect it had on what they were trying to do, and on a scale of 1-5, rate each. 1=Min 5=Max what impact (or potential impact) it had
  • At the end of the three days, participants will rank items in descending order of the rating

During the chat (Oct 18th) we will conduct a speed-dating form of QI cafe’

For each of the main bones of the fishbone, get ready to attack your issue and Tweet two things. What do you think is a cause, and what do you think might be a fix. Usually we would do these apart, but it’s an hour, its Twitter, so we are doing them together. PLUS, you are going to comment or question what the other players in the game put out as their causes and solutions.

It’s going to be hectic.

You will do this with your primary issue, but maybe as time goes on and the chat is coming near, you think the secondary or tertiary issue are actually better, you can switch.



  1. Policy: What laws, policies, rules, regulations, etc. cause your issue, what are potential solutions to your issue?
  2. Equipment: What equipment and device factors cause your issue, what are potential solutions to your issue?
  3. Measurement: What quality, safety, and performance metrics cause your issue, what are potential solutions to your issue?
  4. Environment: What environmental factors cause your issue, what are potential solutions to your issue?
  5. People: How do the people in healthcare – the staff, cleaners, technicians, clinicians, researchers, public, media, friends, family, etc cause your issue, what are potential solutions to your issue?
  6. Materials: What “medical stuff” that patients need cause your issue, what are potential solutions to your issue?


MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered. We expand this to include Accessibility, STEEEPA.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.


The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser and board member at the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and blogs regularly for Physician’s Weekly.



Published by

Matthew Loxton

Healthcare Analyst using Lean Six Sigma, Knowledge Management, & Organizational Learning to improve healthcare http://linkedin.com/in/mloxton

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