Choosing a problem or process to work on can be intuitively obvious–staff and patient/families can easily point to broken processes. Other considerations are whether the process is clinically important and whether it can be fixed at all. And is there “clinical enthusiasm” for the effort?

The more checks (yes) you can make from the list below, the more urgent it is to address that process:

• Does the process contain suspected waste and inefficiencies?
• Is the process regarded as complex, broken, difficult to navigate, or encumbered?
• Does it affect other key processes?
• Does it employ significant clinical and/or financial resources?
• Does the process generate low customer satisfaction?
• Is the process “value added” to the customer or is it conducted purely for business value?
• Does it primarily involve checking or rechecking work?
• Is the process valued as an end unto itself? (sacred cows)
• Does the process have unanswerable performance questions?
• Is it extensive, fragmented, or redundant?
• Are there regular exceptions to the process?
• Are there known reasons to “destroy” the current process, e.g., other examples that work better by an order of magnitude?
• Are there known technological advances to explore?
• Is the process performing poorly, compared to a national database?
• “Low-hanging fruit” is a term used for easy fixes. To simply standardize the process and agree on one way to do it is an improvement. Therefore, the most helpful next step would be to Flowchart the process and make simple improvements to define the best current process.