title: How to Diagnose Solutions to a Quality of Care Problem.
abstract: To change a particular quality of care outcome within a system, quality improvement initiatives must first understand the causes contributing to the outcome. After the causes of a particular outcome are known, changes can be made to address these causes and change the outcome. Using the example of home dialysis (home hemodialysis and peritoneal dialysis), this article within this Moving Points feature on quality improvement will provide health care professionals with the tools necessary to analyze the steps contributing to certain outcomes in health care quality and develop ideas that will ultimately lead to their resolution. The tools used to identify the main contributors to a quality of care outcome will be described, including cause and effect diagrams, Pareto analysis, and process mapping. We will also review common change concepts and brainstorming activities to identify effective change ideas. These methods will be applied to our home dialysis quality improvement project, providing a practical example that other kidney health care professionals can replicate at their local centers.
authors.affiliation: Division of Nephrology, St. Michael's Hospital.|Keenan Research Center, Li Ka Shing Knowledge Institute of St. Michael's Hospital.
authors.forename: Ziv
authors.initials: Z
authors.lastname: Harel
authors.affiliation: Division of Nephrology, St. Michael's Hospital.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Silver
authors.affiliation: Division of Nephrology, University Health Network, Toronto General Hospital.
authors.forename: Rory F
authors.initials: RF
authors.lastname: McQuillan
authors.affiliation: Division of Gastroenterology and.
authors.forename: Adam V
authors.initials: AV
authors.lastname: Weizman
authors.affiliation: Division of Nephrology, St. Michael's Hospital.
authors.forename: Alison
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.affiliation: Keenan Research Center, Li Ka Shing Knowledge Institute of St. Michael's Hospital.|Department of Nephrology, Humber River Regional Hospital, Toronto, Ontario, Canada.
authors.forename: Gihad
authors.initials: G
authors.lastname: Nesrallah
authors.affiliation: Division of Nephrology, University Health Network, Toronto General Hospital.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chan
authors.affiliation: Department of Medicine, Mount Sinai Hospital, and.|Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
mesh_terms: D006437:Hemodialysis, Home / Q000592:standards*; D006801:Humans; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D058996:Quality Improvement; D060891:Root Cause Analysis / Q000379:methods*
keywords: Change ideas; Health Personnel; Home dialysis; Humans; Quality improvement; Quality of Health Care; Root cause analysis; kidney; peritoneal dialysis; renal dialysis