If there’s a system setup to fail, its CQI.

In the context of our recent converstations highlighting how complex health systems are NOT design to expect failure I took a critical look at some of the CQI initatives I have been involved with and realized that more often then not, these projects were often doomed very near to inception,


Often QI is felt to be a quick, logical change to streamline or create greater efficiency or generate better results. They rarely sound difficult on paper. But they are set up to fail. Here a few thoughts going into our project commitments today to keep in mind.


Failure to:

Pick a specific, attainable goal (ie: too broad topic, too grand scale)

–This is where your SMART AIM statement should guide you

Understand the process or environment

–Compete analysis with a proper PROCESS MAP and FISHBONE diagram is necessary no matter how trivial the project

–This will identify for you possible interventions

Identify and manage significant stakeholders

–This is often one of the largest barriers, and you need to keep those with high power and low interest happy

–Often this is achieved through communication like monthly check-in emails

Failure to manage data

–This is time comsuming, and confusing. You want to have a plan before starting because you won’t have time to redo this

Pick meaningful outcome and balancing measures

–Speak with people at your instition and ascertain if any QI projects or topics have been vetted or backed already. These have more engage stakeholder, are often more meaningful and have a greater chance of success.

Failure to sustain intervention

–Once you have identified an intervention that achieves the desired aim via PDSA cycles the change need to be embraced and integrated into the culture / environment. This is most often where projects fail and I feel that sustainability is the largest killer of QI.