1.2 IDENTIFY THE PROBLEM

Why?

Identifying a very clearly defined and specific problem is the first critical step to successfully implementing the problem-solving process. The strategy of improving the quality of services involves solving problems in order of priority. Why is it important to prioritize problems?

Resources and time are limited. You can't solve all the problems at the same time, so your efforts should initially focus on the most important problem.

To gain experience and acquire expertise with the problem-solving process, the first problem you work on should be one that is easily studied and resolved. Choose a problem with plenty of data easily available.

If the resolution of the first problem is successful, that solution can be reproduced easily at the local or national level, and even more so if it corresponds to the priority policies of the institution.

What?

A problem occurs when there is a difference between what "should be" and what "is"; between the ideal and the actual situation. A problem:

expresses the difference between the hoped for and the actual situation; is directly or indirectly related to the health of the population;

is expressed in terms of processes, effects, impacts, and satisfaction.

How?

You can select a problem by using one of the following techniques: a direct observation technique, such as a user survey a consensus technique like a prioritization matrix , which uses brainstorming as a first step

a data analysis technique, such as using a control chart

a) USER SURVEY

What is it?

A User Survey is a technique for collecting information that uses a questionnaire (a list of questions) to measure the magnitude of a problem (How big is the problem?).

Who uses it?

The team and the manager, with participation from all staff.

Why use it?

It is an easy, direct observation technique that allows measurement of users' perceptions and attitudes.

When to use it?

When you want direct information about a topic rapidly, and when you want to evaluate the users' needs.

How to use it:

1. Define the problem to be investigated. 2. Create the questionnaire:

o The questions should have a logical sequence.

o Frame questions without using technical terms.

o Avoid hypothetical questions--instead, focus on the present.

o Have each question require only one answer to avoid confusion.

o Avoid words with double meanings and words that are emotionally charged.

o Give options that are exclusive, and try to include all of the possible responses when asking closed questions.

o Use open-ended or controversial questions at the end.

3. Review the questionnaire with all staff for feedback and to gain commitment to use the results. Note: In some circumstances, using a statistically defensible sample size and method together with having the survey questionnaire reviewed by a statistician can make the results more persuasive to Ministry officials and other decision makers.

4. Test the questionnaire (for format, sequence, and comprehension) with a small group of users (a focus group).

5. Do a statistical analysis with the preliminary results of the test.

6. Define a sample of users to whom the survey will be applied.

Some tips:

The questions planned for the questionnaire can be open- or closed-ended in format:

Open questions allow the people surveyed to respond in their own words and develop their answers. The benefit of open questions is that you receive more detailed information, but the survey takes more time.

When asked closed questions, the people surveyed have to choose between various options. The benefits of closed questions are that you can collect more information in less time than you can with the open format and you can get more precise answers. However, you lose the depth of information you receive with open questions.

b) BRAINSTORMING

What is it?

Brainstorming is a lively technique that helps a group generate as many ideas as possible in a short time period.

Who uses it?

The team members, the management, or the users can all participate in brainstorming. If you invite people with different perspectives to brainstorm, you are more likely to see innovative ideas generated by the group.

Why use it?

To identify problems, analyze causes, select alternative solutions, do strategic planning, generate ideas for marketing change, and handle many other situations.

When to use it?

In the facility, with community or user groups, in meetings.

How to use it:

1. Explain the objective of the session: for example, to select problems, analyze causes, or generate ideas. 2. Explain the technique to the group. Tell them that you are looking for a lot of ideas, and that you want

their thoughts and ideas to flow freely. There is no right or wrong answer. The idea of brainstorming is to produce as many innovative ideas as possible.

In countries where participation in meetings is structured, brainstorming takes practice. (If you set up a brainstorming session in which many participants have no real experience in expressing their opinions and many levels of staff are present, it can produce a deafening silence.)

3. Silent reflection: Ask the participants to think about the proposed objective or topic for a few minutes. Time: approximately 5 minutes.

4. Brainstorm: The participants call out their ideas and add those that come to mind during the discussion. Annotate them on a flip chart in the order they are mentioned. Write down the ideas using the words of the speaker. Ask for clarification only if the meaning is not clear. Time: approximately 20 minutes. (For groups with little or no experience in brainstorming, it is often useful to have them practice in small subgroups before convening before the entire group.)

5. Once the list is finished, discuss it with the group to:

o Clarify the meaning of some ideas

o Combine similar ideas that are worded in different ways

o Eliminate those ideas which are not related to the objective of the session

6. Do all this by group consensus. Time: 5-15 minutes. At the end of this stage, you will have reduced the list of ideas to those that represent most of the major ideas of the group.

c) CONTROL CHART

What is it?

A Control Chart is a tool you can use to monitor a process. It graphically depicts the average value and the upper and lower control limits (the highest and lowest values) of a process.

Who uses it?

The management, the team.

Why use it?

All processes have some form of variation. A Control Chart helps you distinguish between normal and unusual variation in a process. If you want to reduce the amount of variation in a process, you need to compare the results of the process with a standard.

Variation can exist for two reasons:

1. Common causes are flaws inherent in the design of the process.2. Special causes are variations from standards caused by employees or by unusual circumstances or events.

Most variations in processes are caused by flaws in the system or the process, not by the employees. Once you realize this, you can stop blaming the employees and start changing the systems and processes that cause the employees to make mistakes. (It is important to remember, however, that some variations are not "mistakes" introduced by employees, but, rather, they are innovations. Some variations are deliberately introduced to processes by employees specifically because these variations are found to be more practical.)

When to use it?

First, you need to define the standards of how things should be. Then, you need to monitor (collect data) about processes in your organization. Then, you create a control graph using the monitoring data.

How to use it:

1. Select the process to be charted and decide on the type of control chart to use. o Use a Percent Nonconforming Chart (more information available from Health Tactics  P Chart ) if

you have data measured using two outcomes (for example, the billing can be correct or incorrect).

o Use an Average and Range Control Chart (more information available from Health Tactics  X-R Chart) if you have data measured using a continuous scale (for example, waiting time in the health center).

2. Determine your sampling method and plan:

o Choose the sample size (how many samples will you obtain?).

o Choose the frequency of sampling, depending on the process to be evaluated (months, days, years?).

o Make sure you get samples at random (don't always get data from the same person, on the same day of the week, etc.).

3. Start data collection:

o Gather the sampled data.

o Record data on the appropriate control graph.

4. Calculate the appropriate statistics (the control limits) depending on the type of graph.

5. Observation:The control graph is divided into zones:

______________________________ Upper Control Limit (UCL)

______________________________ Standard (average)

______________________________ Lower Control Limit (LCL)

6. Interpret the graph: o If the data fluctuates within the limits, it is the result of common causes within the process (flaws

inherent in the process) and can only be affected if the system is improved or changed.

o If the data falls outside of the limits, it is the result of special causes (in human service organizations, special causes can include bad instruction, lack of training, ineffective processes, or inadequate support systems).

o These special causes must be eliminated before the control chart can be used as a monitoring tool. In a health setting, for example, staff may need better instruction or training, or processes may need to be improved, before the process is "under control." Once the process is "under control," samples can be taken at regular intervals to assure that the process does not fundamentally change.

o A process is said to be "out of control" if one or more points falls outside the control limits.

1.3 DESCRIBE THE PROBLEM

Why?

Before attempting to resolve a problem, you need to describe it in detail. You do this so you can understand how the problem affects the process being examined, such as delivery of a health service to the users.

What?

To help you describe the problem, you may want to answer certain questions about the problem, such as:How frequently does the problem occur?

When does it generally occur (for example, at a particular time of the year, on a set week, on a specific day)? Is the problem related to time?

Where does it generally occur (for example, is it limited to a particular area, or is it everywhere)? What relation does the problem have to location?

Who is most affected (for example, individuals or families, people of different gender, race, age, or socioeconomic status)?

How?

To describe a problem, follow these steps: 1. Use a flowchart to identify the flow of events in the process you are examining, such as the steps the users

take to use the health service. 2. Decide on the indicator you will use to describe the problem. An indicator can be an amount, or the steps in

a process. For example, if the indicator is "waiting time," you need to divide the number of patients who had a long waiting time by the number of all patients receiving care that day. That percentage is the indicator. You can use an indicator matrix to help you construct indicators.

3. Collect the data for describing the situation. This data can be collected from existing sources (such as Health Information Systems) or by direct observation. In the latter case, some of the techniques used for collecting data could be an exit interview, a supervision guide, or a tally sheet.

4. Describe the indicators graphically using tools such as:

o A table , which enables you to present the data you have collected.

o Graphs, which are very useful tools for presenting data, since they allow you to better visualize relationships, trends, or behaviors. You can use a

bar graph

line graph

pie chart

histogram

a) FLOWCHART

What is it?

A Flowchart is a tool that graphically represents the steps of a process or the steps that users have to take to use the service (user Flowchart).

Who uses it?

The team, the manager.

Why use it?

The Flowchart helps you analyze the number of steps and the time required for each step, to detect bottlenecks, unnecessary steps, repetitions, and other obstacles.

When to use it?

When you want to describe activities, identify problems, identify the causes of problems, detect "bottlenecks," and define indicators. <>

How to use it:

< TD process. the in step previous to you returning line a has symbol decision symbol, END it connecting with Along line. by connected are symbols The of end represents circle and

Different symbols are used in a Flowchart to indicate the different types of actions in the process:

a circle for the beginning or end of the process

a rectangle for a step in the process (activities)

a diamond for the decision points

process, point diamond rectangle A beginning>

How to create a Flowchart:

1. Observe for a few repetitions the process you will be charting. Write down all the steps taken and decisions made in the process.

2. Mark the path of the Flowchart from the beginning to the end by connecting all the rectangles (activities)and diamonds (decision points).

3. Return to the beginning of the path and repeat Step 2 for any paths that branch off from the main path (at the decision points).

4. Record the last step at the bottom of the page, draw a circle around it, and connect the primary path and any branching paths to the last step.

5. Review for accuracy.

b)a. BAR GRAPH

What is it?A bar graph is used to graphically present data that you have gathered. The type of data represented in a bar graph is the number of occurrences measured in different categories of data. A bar graph is often used to graphically represent the information you have gathered in a table. For example, in the bar graph below, you can see a comparison of the number of users of different services--outpatient, inpatient, and other--by type of service.

Who uses it?

The team and the managers.

Why use it?

It helps you visualize relationships among different categories of factors affecting services to the users.

When to use it?

It is used when the information corresponds to a nominal scale (a counting of occurrences), and when you want to compare two or more groups (no more than six).

How to use it:

1. Draw vertical and horizontal axes. 2. On the vertical axis, create a scale to measure the frequencies of the variable (for example, number of users

or number of times).

3. On the horizontal axis, note the nominal scale (different qualities of the variable), for example, male/female, inpatient/outpatient, types of contraceptives, etc. It doesn't matter in what sequence the data categories are listed.

4. Draw a rectangle for each quality of the variable. The height represents the frequency with which that characteristic was observed. For example, in the bar graph below there are 30 outpatient users, 40 inpatient users, and 50 other users.

b. Line Graph

What is it?

A line graph is a type of graph that represents data or sets of data that have been collected over a period of time. The data are plotted on a graph corresponding to standard intervals of time, and a line is drawn connecting the data points. If updated regularly, line graphs help managers to follow a trend over a period of time and take actions to manage the trend.

Who uses it?

The team, the manager.

Why use it?

A line graph allows managers or team members to see trends in data (increase, decrease, or no change) over a period of time. This can be useful to help you visualize changes in the process over time or to let you compare the performance before and after the implementation of a solution.

When to use it?

To visualize a process during a specific period of time to help you describe a problem, or when you want to evaluate a solution to a problem.

How to use it:

1. Decide on the period for collecting data (for example, 30 days, 12 months, etc.). 2. Gather the data. To see a trend, it is generally useful to collect 20-25 data points over the time period.

3. Draw the vertical line (Y axis) for representing the data. The scale will depend on the values of the data. (In the example below, the Y axis represents "number of clients seen in the clinic".) Starting at zero in the lower left corner, label the marks on the far left vertical line in increments of 5, 10, 20, or 100.

4. Draw the horizontal line (X axis), where each point represents the time. It can be hours, days, weeks, months, etc. (In the example below, the time frame used is months.)

5. Plot the data you have collected over the period of time studied. Put a dot on the graph to show the value of the data for each time period your graph will cover (on the example below, for each month).

6. Connect all the dots that you have plotted on the graph. It will form a line that shows the trend of the data observed over the period studied. If you want to continue the process of observation, make a new dot on the graph for each sequence of time chosen.

c. Pie Chart

What is it?

A pie chart is a tool that helps you visualize the relative importance of several categories of a variable.

Who uses it?

The team, the manager.

Why use it?

To provide a rapid, graphical overview of data you have collected, such as information about different types of users, types of treatments, types of methods, etc.

When to use it?

When you have collected some data (for example, a counting of events or a distribution of values) and you want to graphically depict the data.

How to use it:

With the help of a table, transform your data into percentages of the total. 1. Select the number of categories for organizing the data.

Categories (a) (c) (d)  Number of

eventsFraction of total categories (a ÷ b) = c

Percentagesd = (c X 100)

Data 1 24 0.333 33%Data 2 28 0.388 39%Data 3 12 0.166 17%Data 4 8 0 .111 11%Total (b) 72   100%

2. In column (a), fill in the number of events or data for each category. Place the sum total in the last cell (b).

3. In column (c), compute the fraction of the total that each category represents by dividing (a) by (b). The results in (c) will always be decimals.

4. Multiply each number in column (c) by 100 to obtain a percentage and round to the nearest whole percent. Enter the percentages in column (d).

5. Check your calculations by totaling the percentages listed in column (d). The sum of percentages should equal 100.

6. Draw the pie chart:

o Draw a circle.

o Represent the values of the different categories on the circle in percentages. If you are not using a computer to create the pie chart, draw guides to help you (divide the circle into four or eight equal parts).

o Title your graph and indicate in the legend the period of time of the survey, as well as the location.

         

d. Histogram

What is it?

A histogram is a diagram that graphically depicts the variability in a process or procedure within your agency. When you want to see how a procedure is working in your organization, you can gather data about that procedure (such as the amount of time the procedure takes) and create a histogram. The histogram allows you to see the variation in the amount of time it takes to do that process.

Who uses it?

The team members, the managers.

Why use it?

Discovering and displaying this variation will greatly increase the team's knowledge about a process.

When to use it?

When you want to see the pattern of variation of a particular process, such as when you are describing a problem, or during data collection and analysis.

How to use it:

The steps to create a histogram include:1. Gather the data about the variable you are interested in. 2. Look at the data and determine the categories or intervals you will use to organize the data. For example, if

you are measuring the number of weeks it takes to receive an order of contraceptives, "number of weeks of waiting time" is the data category.

3. Construct a frequency table for your data. The frequency corresponds to the number of times each value is observed. Using the example of waiting time to receive an order of contraceptives, the frequency table might look like this:

Number of weeks of waiting time

Frequency

1 week I2 weeks I3 weeks IIII4 weeks IIIII5 weeks III6 weeks I

4. To draw the histogram, first draw horizontal and vertical axes. The horizontal axis (X) has the data categories (such as time, or a measurement, like weight). The vertical axis (Y) represents the frequency of the observations (the number of observations for each category).

5. For each category of data, draw a rectangle (without space between the rectangles). The width of the rectangle represents the interval between two groups, and the height represents the observed frequency.

c) A Table

What is it?

A table is a compact and easy-to-understand method of graphically organizing data.

Who uses it?

The team members, the managers.

Why use it?

If you have a lot of data to present, organizing it in a table makes it easier for the viewer to understand.

When to use it?

When you need to present data in a simplified, organized way, such as for a presentation or a report.

How to use it:

1. Count up your data, and then summarize the data according to the categories or variables you are interested in. For example, the number of users treated in a health center can be categorized by age, gender, type of contraceptive used, type of illness, etc. In the example below, the categories we are interested in are gender and status (inpatient/outpatient).

2. Create a table with columns and rows. Sum up the categories. Totals will be at the margins (edges) of the table.

3. Each column and row has a label.

4. All the totals in the margins (edges) of the table should add up to the total in the lower right box of the table.

Example: Number of patients seen at Town Hospital on January 24, broken out by gender and inpatient/outpatient status.

Inpatient Outpatient TotalMale 10 50 60Female 25 75 100Total 35 125 160

d) Indicator Matrix

What is it?

An Indicator Matrix is a chart that will guide you as you construct indicators.

Who uses it?

The team, the manager.

Why use it?

To help you organize the information you are collecting.

When to use it?

When you need to construct indicators as you describe the problem.

How to use it:

Create a chart (see example below).

What to Measure?

Description of Indicator

Formula Source of Numerator

Source of Denomin-ator

Quality Standard

           

1. Write the questions that you have about the problem in the first column. For example: How many are there? When does it occur? Where does it occur? Who is most affected? How much time does it take?

2. Write the description of the indicator in the second column: for example, proportion of..., time of..., percentage of..., rate of....

3. Write the formula of the indicator (numerator divided by denominator, or number of events) and its expression in the third column.

4. In the fourth and fifth columns, indicate the sources for obtaining the necessary data for the numerator and denominator. The sources may include daily reports, files, surveys, observations, interviews, etc.

5. Eventually, the standard for comparison will be put in the sixth column.

1.4 STATE OBJECTIVE AND SCOPE OF PROJECT

1.1.4 IDENTIFY OBJECTIVE

Objectives are concrete statements describing what the project is trying to achieve. The objective should be written at a lower level, so that it can be evaluated at the conclusion of a project to see whether it was achieved or not. Goal statements are designed to be vague. Objectives should not be vague. A well-worded objective will be Specific, Measurable, Attainable/Achievable, Realistic and Time-bound (SMART).

An example of an objective statement might be to "upgrade the helpdesk telephone system by December 31 to achieve average client wait times of no more than two minutes".

Note that the objective is much more concrete and specific than the goal statement. The objective is measurable in terms of the average client wait times the new phone system is trying to

achieve.

We must assume that the objective is achievable and realistic.

The objective is time-bound, and should be completed by December 31.

Objectives should refer to the deliverables of the project. In this case, it refers to the upgrade of the telephone system. If you cannot determine what deliverables are being created to achieve the objective, then the objective may be written at too high a level. On the other hand, if an objective describes the characteristics of the deliverables, they are written at too low a level. If they describe the features and functions, they are requirements, not objectives.

Why Set Objectives?

Clear objectives lead to a higher rate of project success. By taking the time to properly plan your project’s objectives, the tasks leading towards these objectives are easily created. If a sailor knows where the fish are, he can direct his boat to the proper spot. Project planning is no different.

How to Set Good Project Objectives

Because good project plans require good objectives, it is important to understand how to write good objectives. Good objectives are finite in scope and duration. They are measurable. They are realistic. Good objectives are clear and they require actions to complete. Good objectives have every element of being attainable if the project plan is followed. In fact, objectives can make or break a project.

Objectives for projects can be as simple as “develop a new software program to track expenses” or as long reaching as “increase profits 20% in next quarter.” The important thing is that these objectives lead to a project path.

Examples of Bad Objectives

If good objectives follow the acronym SMART (specific, measurable, action-driven, realistic, time-bound) then bad objectives do not follow this example. Below is a list of poorly written objectives:

Increase the number of clients company x serves.

Make customers happy

Create some sort of new product.

Make more money.

Achieve success.

Share knowledge.

Find Funding.

Eliminate quality problems.

1.4.2 DETERMINE SCOPE

In project management, the term scope has two distinct uses: Project Scope and Product Scope.

Project Scope "The work that needs to be accomplished to deliver a product, service, or result with the specified features and functions." [1]

Product Scope "The features and functions that characterize a product, service, or result." [2]

Notice that Project Scope is more work-oriented, (the hows,) while Product Scope is more oriented toward functional requirements. (the whats.)

If requirements are not completely defined and described and if there is no effective change control in a project, scope or requirement creep may ensue.

Scope creep management is important for effective project management. Projects are expected to meet strict deadlines with resource restraints, and an unvetted and unapproved change in the scope can affect the success of the project. Scope creep sometimes causes cost overrun.

Scope creep is a term which refers to the incremental expansion of the scope of a project, which may include and introduce more requirements that may not have been a part of the initial planning of the project, while nevertheless failing to adjust schedule and budget. There are two distinct ways to separate scope creep management. The first is business scope creep, and the second is called features (also technology) scope creep. The type of scope creep management is always dependent upon on the people who create the changes.

Business scope creep management occurs when decisions that are made with reference to a project are designed to solve or meet the requirements and needs of the business. Business scope creep changes may be a result of poor requirements definition early in development, or the failure to include the users of the project until the later stage of the systems development life cycle.

Scope management plan is one of the major Scope communication documents. The Project Scope Management Plan documents how the project scope will be defined, managed, controlled, verified and communicated to the project team and stakeholders/customers. It also includes all work required to complete the project. The documents are used to control what is in and out of the scope of the project by the use of a Change Management system. Items deemed out of scope go directly through the change control process and are not automatically added to the project work items. The Project Scope Management plan is included in as one of the sections in the overall Project Management plan. It can be very detailed and formal or loosely framed and informal depending on the communication needs of the project.

Features (Technology) scope creep occurs when the scope creep is introduced by technologists adding features not originally contemplated. Customer-pleasing scope creep occurs when the desire to please the customer through additional product features adds more work to the current project rather than to a new project proposal. Gold-plating scope creep occurs when technologists augment the original requirements because of a bias toward "technical perfectionism" or because the initial requirements were insufficiently clear or detailed.