A Quality Board is a highly effective tool for teams to continuously monitor system performance, particularly throughout the course of quality improvement projects.
Health Quality Ontario
Maps as a sense-making and data analysis tool are a personal joy. Maps are visual; maps show relationships. Maps help you make sense of a really complex dataset. Maps great.
While working on a process to redesign quality boards for a community hospital, I found myself in a situation where a gigamap felt like the right next step. I had a rich set of data from interacting with multiple clinical teams in one project, spread out across multiple miro boards to do some cross-site analysis. This was done in around 4 days of work, divided over a couple of months.
Primary objectives
- Identify systemic patterns and insights with how teams engage in quality improvement, and how “QI information” flows.
- Find the current role of the quality board.
- Present the data in a format that allows others to explore it.
Personal objectives
- Make something visual.
- Enjoy the process of making it.
1. Data Collection
The data used in this gigamap was generated over interactions with 7 units in a community hospital in Canada. Data was collected through a two-stage approach guided by the research question: How can we make quality boards useful?
2. Contextual inquiry
The initial contextual inquiry included structured observations and short interviews. These were done at the same time. Each unit had multiple sessions, to engage staff on different shifts. Structured observations used pre-printed templates following the POEMS framework (People, Objects, Environment, Messages, Services) to ensure standard collection across units.
Interviews were designed to be short and to the point. Focusing on understanding how they view quality, how they feel like their unit approaches it, and what their general experience has been so far with quality boards. I also asked questions to understand how they felt about their job and what made for a good day at work. In one application of the process, a round of follow-up questions were asked to better understand how they are involved in QI. Notes were taken during the interview and transcribed into miro.
3. Generative activities
The initial contextual inquiry included structured observations and short interviews. These were done at the same time. Each unit had multiple sessions, to engage staff on different shifts. Structured observations used pre-printed templates following the POEMS framework (People, Objects, Environment, Messages, Services) to ensure standard collection across units.
Interviews were designed to be short and to the point. Focusing on understanding how they view quality, how they feel like their unit approaches it, and what their general experience has been so far with quality boards. I also asked questions to understand how they felt about their job and what made for a good day at work. In one application of the process, a round of follow-up questions were asked to better understand how they are involved in QI. Notes were taken during the interview and transcribed into miro.
4. Data analysis and visualization
To answer the primary objectives, the 5 visuals were created.
1) A Systemic Lens was used to illustrate the overall strategy, organizational fit, and understanding how the system actors intersect.
2) Looking at the Context that quality boards exist in, shows the range of systemic and individual drivers of behaviour shows more information into the unseen forces that influence quality board use.
3) When functioning properly, a quality board should facilitate Information Flow. It was helpful to characterize that flow in a clinic microsystem. In the case of a quality board it does all the time. In QI, information is used to inform, it is collected as input, and it can include people in an information exchange.
4) The displays and information spaces in the clinical microsystem each have their own affordances, allowing them to facilitate different levels and types of information flow. The framework below was developed to characterize objects in a standard way.
Arranging these displays and spaces across the three stages of information flow proved to be a helpful exercise for finding the fit of the quality boards.
5) While interviewing staff in the one diagnostic imaging clinic, I was able to ask teams to confirm how their team approaches quality improvement, to develop a “change pathway.” The change pathway describes the high-level steps an idea might go through to be put into practice. In that pathway, staff were asked to identify what information displays and channels they preferred to use in that process and what level of information flow should be achieved.
5. Summarizing key points
The initial contextual inquiry included structured observations and short interviews. These were done at the same time. Each unit had multiple sessions, to engage staff on different shifts. Structured observations used pre-printed templates following the POEMS framework (People, Objects, Environment, Messages, Services) to ensure standard collection across units.
Interviews were designed to be short and to the point. Focusing on understanding how they view quality, how they feel like their unit approaches it, and what their general experience has been so far with quality boards. I also asked questions to understand how they felt about their job and what made for a good day at work. In one application of the process, a round of follow-up questions were asked to better understand how they are involved in QI. Notes were taken during the interview and transcribed into miro.
Focus for the next iteration
This gigamap is lacking iteration because I lacked time. This was a task to help me make sense of the data I had, not something requested by stakeholders. I should try to do some of the following:
- Re-frame this analysis under the framework that I developed through my quality board research
- Elaborate on the narratives I developed, to re-present them in a more appealing format.
- Draw observations about the placement of quality boards from observed footpaths and workflows in clinical areas.
- Collect more quantitative data describing the usefulness of the boards.
- Repeat all of these steps with my coworkers and in a real life setting. Miro makes it kind of hard to collaborate and it hides everything behind a browser link. And true to the value of maps, it’s not the output that should be shared with people; it’s the process of mapping.