#MEQAPI – Tweetchat Dec-6 2018 8:00ET 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. The co-host will explain how they see their issue in terms of the fishbone root cause dimensions, and other participants will assist by asking clarifying questions, offering insights, or describing their past experiences related to the issue.

To identify their selected issue, the co-host will have kept a diary of everything in the work or care environment that

  • Was Surprising
  • Was Frustrating
  • Was Confusing

During the chat the co-host will address their issue to each of the fishbone arms, and Tweet two things. What they think is a cause, and what they think might be a fix. Usually we would do these apart, but it’s an hour, its Twitter, so we are doing them together.



  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

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s