The Essentials of Quality Improvement in Radiology

The MFI is framed as three questions: 1) What are we trying to accomplish? (ie, SMART aim statement), 2) How will we know a change is an improvement? (ie, battery of metrics), 3) What changes can we make that will result in improvement? (ie, change concepts to be tested with PDSA cycles).1 In this model, proposed process changes are iteratively tested and results analyzed, similar to scientific hypothesis testing. Mura, waste related to the presence of unevenness in workload; eg, only scheduling MRI scans during daytime/midweek); Muri, waste resulting from overstressed staff, equipment, or processes; eg, overbooking outpatient CT scans; and Muda, waste resulting from non-value-added processes; eg, requiring patients to register multiple times during a mammogram visit. The key drivers are identified during brainstorming sessions by the QI team members most familiar with the work, drawing from their clinical experience or other aspects of the workflow. Because they help achieve the aim, these drivers are commonly referred to as the "leading indicators," while the outcomes are referred to as "lagging indicators." Design changes to the system are identified as change interventions,11 These changes are deliberately intended to improve performance of the key drivers, not the outcome, Importantly, no changes can directly improve the outcome without improving the key processes, Without knowing how the key drivers are performing; ie, without measurement), it is impossible to know why the outcome is improving or getting worse, PICK Chart The PICK (Possible, Implement, Challenge, Kill) chart (Figure 5) is used to help determine which changes should be prioritized, This tool incorporates two dimensions: the degree of impact, and the difficulty of implementation (Figure 5).12 The team can review the suggested change interventions together and use sticky notes or a smartboard to place the proposed changes into the quadrants of the chart, High-impact, low-effort changes should definitely be implemented ("Implement"), whereas low-impact, high-effort changes should be avoided ("Kill"), Those that are easy to implement but have low impact may be considered based on time and resources ("Possible"), Those of high impact but high difficulty to enact ("Challenge"), such as creating a new program, may be considered, but they require significant investment in resources to achieve a long-term return aligned with an organization's overall strategy, Fishbone Diagram The Fishbone dia