#MEQAPI – Tweetchat Nov-29 2018 8:00 PM ET 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 will be participating in a twitter-based Rapid Improvement Event (RIE)

A companion blog at Physicians Weekly provides additional detail of the RIE approach using the daily diary method to identify opportunities.

Participants 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 were 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 captured 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 ranked items in descending order of the rating

During the chat (Nov 1st) we will conduct QI cafe’

The chat will have six topics, following the Lean Six Sigma DMAIC process.

  • Define: Identify and refine the problem, the stakeholders, the critical to quality elements, the voice of the customer
    • Supplier
    • Inputs
    • Process
    • Outputs
    • Customers
  • Measure: How will success be measured, how will the current as-is state be measured, how will we measure the to-be results of any solution
    • Output metrics – what will measure the outcomes we want
    • Process metrics – what do we need to measure while things are being done and which will predict success of the outcomes metrics
    • Balancing metrics – how will be check that we aren’t making anything else worse. What do we need to measure to ensure that no untoward side effects are being caused
  • Analyze: Root cause analysis and analysis of alternatives
    • Policies & Procedures
    • Equipment & Technology
    • Measurement
    • Environment
    • People
    • Materials
  • Improve: Implement solutions
    • Plan
    • Do
    • Study
    • Act
  • Control: ongoing monitoring and evaluation to make the solutions stick and to ensure that the desired outcomes are realized.
    • M&E
    • Organizational Change Management (OCM)
    • Induction and Training
    • Ongoing process improvement



  1. Define: What is the problem you want to solve, the stakeholders, the critical to quality elements, the voice of the customer, what is the future state?
  2. Measure: How will success be measured, how will the current as-is state be measured, how will we measure the to-be results?
  3. Analyze: What are the root causes and what alternatives do you have for Policies, Equipment, Measurement, Environment, People, Materials?
  4. Improve: What do you need to plan for, what will you do, how will you see what happened, what will you do to adopt?
  5. Control: How will you make it stick – what will you do iro M&E, OCM, Training, Ongoing process improvement?
  6. Next Steps:  What do you need to do next to get clear on what has to happen, get agreement, get started?


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.