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Framework for Improvement

A framework for problem solving

Children’s Mercy uses a standard approach for continuous improvement that is referred to as the Framework for Problem Solving. Many of us were socialized to think of problems as originating with people. Over the years we’ve learned that it is most often our systems that fail us, not an individual. Yet, we still frequently leap to the “who” when a problem arises. The Framework for Problem Solving enlists a new way of thinking, to pause and consider the complexity of the problem and the factors that contributed to the problem, so that the problem is fully understood before identifying solutions. Learning and guiding colleagues in this way of thinking can feel foreign if we are accustomed to making quick analyses and problem solving decisions. However, using a rigorous, experimentation-inspired problem solving approach rooted in the principles of quality and safety science is a valuable practice that prepares us to develop and design countermeasures that are effective and sustainable.

Improvement tools

Improvement tools are used to assist with understanding the problem fully, designing and testing countermeasures, and then ensuring sustainability. Examples include fault tree, process map, a complete set of measures, fishbone diagram, PDSA cycle, run and control charts, standard work, and visibility board. However, it is not as much about using tools as it is about asking appropriate questions that allow a deep understanding of the gap and the possibilities of how to bridge it.


Direction for continuous improvement education is provided by the Improvement Academy Steering committee, which includes representatives from Quality, Safety, Education, Graduate Medical Education, Pediatrics, and Nursing. The Improvement Academy Steering Committee reports to the organization’s Education Steering Committee.