Methods & Tools
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Quality Assurance Tools and Methods
Quality assurance storytelling is an organized way of documenting the quality improvement process of a team that is working systematically to resolve a specific problem and/or improve a given process. QA "stories" are described in detail as they unfold in QA storybooks and presented publicly through QA storyboards. Initially developed as Quality Improvement Storytelling for industrial programs, the technique has more recently been adapted and applied to quality improvement efforts in the health sector. Initially this was carried out by the Hospital Corporation of America (HCA). It is increasingly used by others in health as an effective way of documenting the activities of QI teams in various of settings.
The QA storybook is a complete and permanent record of the improvement process, usually kept in notebook format. The QA storyboard is a large display area (section of a wall, or a board or poster) that allows a team to display its work publicly in an ongoing, structured, and visually understandable way. It has been described by HCA’s Batalden and Gillem (1989) as the team’s "working minutes."
By systematically documenting the quality improvement progress made by a team, QA storytelling helps to keep everyone focused on the task at hand and allows team members to describe their work to others in a clear and comprehensible way. It is normally begun as soon as a problem has been identified and continues throughout the QI process. When used routinely, QA storytelling can help make QA part of the ongoing life of the organization.
One team member is usually designated as recorder to maintain a complete and detailed record of the team’s activities. The record should include minutes of team meetings as well as such items as lists of persons contacted, presentations made, indicators monitored, sampling designs and analytical methods employed, data collected, etc. From time to time the recorder may use the information in this record to prepare brief summaries of the team’s progress in resolving the problem in question. Items are selected from this record for posting on the QA storyboard.
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The QA storyboard serves as an ongoing visual record of the team’s progress, helping to keep team members focused on the task while sharing their progress with others. Storyboards use simple, clear statements as well as pictures and graphs to describe a problem, summarize the analysis process while it is under way, describe the solution and its implementation, and display the results. Steps in creating and maintaining a QA storyboard follow.
Step 1. Reserve a section of the wall or secure a large board or poster board (measuring at least one and a half meters high by two meters in length) to serve as the QA storyboard.
Step 2. Mark off and label different areas of the storyboard for displaying the team’s progress during each of the quality improvement steps. Include areas for the problem statement, names of team members, the work plan, activities undertaken during problem analysis (e.g., root cause analysis, graphs, etc.) and the results, solution(s) selected, solution implemented, the results, and any other information that seems interesting or relevant.
Step 3. Post a copy of the initial statement of the problem and the names of the team members. A picture of the team may be added.
Step 4. Keep these up-to-date as the problem statement is refined and/or as team membership changes.
Step 5. Post a copy of the team’s work plan and schedule, and modify it as changes are made during the problem-solving process.
Step 6. As work progresses, display the progress made in analyzing the problem. If analytical tools were used (e.g., flowcharts, cause-and-effect diagrams), include these items on the storyboard. It is also useful to include (if they were used) the list of indicators to be monitored, the data collection forms, and graphs displaying the results.
Step 7. Post the findings of the problem analysis and the solution(s) proposed and selected for implementation.
Step 8. Add any other aspects of the process of solution identification and selection (e.g., selection criteria or selection method) to be displayed for ready reference.
Step 9. Maintain an ongoing display of the progress of solution implementation. Show as much (or as little) detail as team members find helpful, either to focus their own work or to communicate their work to others.
Step 10. When the solution has been implemented and evaluated, post the results for all to see.
Caution
The storyboard is a helpful tool to show the progress of a quality improvement team; it will also stimulate other to initiate or participate in Quality Improvement efforts. Be sure to use it.
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