Updated: Jan 22, 2022
(1) Model for Improvement – Institute for Healthcare Improvement
Intent: Introduce a framework or outline that can support analysis and decision-making regarding the development and approval of policies, ordinances, and projects.
Summary of the Process: Identify the problem, develop the decision criteria and ranking, identify facts and assumptions, identify up to three alternatives, identify the pros and cons of each option, rank the options, and select the best course (s) of action. Keep decision-makers updated on the status of the project throughout the process.
Context for “Better” Communities and Government
The preamble to the U. S. Constitution. “We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”
- How do “We the People” define “more perfect” or better?
- What feedback do we need to assess the results?
- What methods do we apply to identify needed changes and priorities?
- What methods do we use to determine when the change results in improvement?
American Society for Quality. An ideal situation represents a standard of perfection—the highest standard of excellence defined by stakeholders, including direct customers, internal customers, suppliers, society, and shareholders. Reducing variation from the ideal results in outcomes where everyone gains (more needs are being met) or at least, is not any worse off in the long term.
Framework or Outline
Name. Identify the Proposed Change (project, policy, process, ordinance, resolution, et al.).
Identify the Purpose (intent) – The Why
- What is the reason for the change, e.g., the “problem”?
- What is the ideal/desired end state?
- How will you know that change will result in improvement? Who will decide and by what method?
- What are the criteria for determining the best solution (s)? Cost, safety, compliance, convenience, etc.?
- Additional criteria that support citizen engagement would be derived from the following categories: Financial, Social, Cultural, Natural, Intellectual, and Political.
- Information: Decision Support Matrix
Document the Problem Statement. A problem statement is a short description of the issues that need to be addressed by a problem-solving team and should be presented to them (or created by them) before they try to resolve a problem.
Other Examples: Have other organizations or counties faced a similar opportunity or problem? Did they successfully address the issue (s)? If so, how?
- Coordinate with Stakeholders. Identify the stakeholders that will be affected by the change. In addition to elected leaders, this can include members of other boards and commissions, private sector groups, citizens, etc.
- Stakeholders include everyone who will be affected by what is done over the near, mid, and long-term, e.g., over the life cycle of the initiative or program. They include:
- Direct – receive the product or service (those affected by the change);
- Internal – Provide the service or product (support implementation of the change); and
- Indirect – Others that support or have an interest in the production and delivery of the service or product.
- Stakeholders include everyone who will be affected by what is done over the near, mid, and long-term, e.g., over the life cycle of the initiative or program. They include:
- Who are the stakeholders that participated in the proposed change? Did they concur with the proposed changes? Is this information documented?
- Reference: See Community Stakeholder Matrix.
Identify References. Includes identification of any statutes, ordinances, et.al., that need to be considered when proposing a new change.
Identify the Facts. A fact is an event, item of information, or state of affairs existing, observed, or known to have happened, and which is confirmed or validated to such an extent that it is considered ‘reality.’
- Truth: The true or actual state of a matter
Collect Data. Data are facts and statistics collected together for reference or analysis.
Operational Definitions. Document the definition for the data to be collected.
- Operational Definition.By What Method? For What Purpose?
“No true value. There is no true value of any characteristic, state, or condition that is defined in terms of measurement or observation. Change of procedure for a measurement (change in operational definition) or observation produces a new number… W. Edwards Deming
“Surveys.” There are generally accepted standards for conducting a survey and using the data to derive conclusions. In 2017, the Brown County Redevelopment Commission (RDC) supported a statistically valid survey that complied with federal standards. The survey identified that 53.1 % of residents fell within the Low to Moderate (LMI) income level. This qualified the county for federal planning grants. Too often, general “surveys” are used to collect information which is then used to support a need for change. This can result in actions that cause more harm than good.
Identify Assumptions (non-facts). An assumption is a thing that is accepted as true or as certain to happen, without proof. Terms associated with an assumption include the following:
- Speculation. Ideas or guesses about something that is not known.
- Conjecture. Inference formed without proof or sufficient evidence.
- Opinion. A view or judgment formed about something, not necessarily based on fact or knowledge.
- Anecdotal. Not necessarily true or reliable; based on personal accounts rather than facts or research.
- Allegation. A statement claimed as fact often without proof.
- Hope. A feeling of expectation and desire for a certain thing to happen
Identify Constraints. A constraint is a limitation or restriction. This would include resources (people and budget) statutes, policies, any enforcement-related issues, etc.
Identify Potential Second-Order Effects – Include as a risk.
- “Every action has a consequence, and each consequence has another consequence. These are called Second-Order Effects. Every change you make to a system will have Second-Order Effects, which may affect the system’s functionality. Be careful when making changes, they may have the opposite effect of what you aimed for.” Josh Kaufman – How to think about second order effects
Identify Risks. A risk is “an uncertain event or condition that, if it occurs, has a positive or negative effect on a project’s objectives.” A probability of occurrence (0-100%) and effect (high, medium, low) can also be associated with a respective risk. A mitigation strategy can also be identified.
Propose Alternative Solutions. Identifying up to three options is helpful. Options can identify the respective scope. The higher the degree of change (scope), the higher the cost and risk of problems. For example, updating an ordinance due to a change in state law would be an incremental change (smaller scope).
- A significant change that includes policies that exceed state standards would require extensive analysis and coordination to justify the change and to ensure that the solution does not create more problems than it solves.
Analyze Alternatives. What are the Pros and Cons of each proposed option? These should be developed with stakeholder groups.
Compare Alternatives. The alternatives can be assigned a weight and compared to the defined criteria included in the purpose statement.
Identify the Recommended Solution (s) and make a Decision.
Develop the Plan of Action and Milestones (POAM) for Implementing the Recommendation. Incorporate the Improvement Cycle for Learning and Development:
- PLAN a change or test aimed at improvement. What are you going to do and why?
- DO. Carry out the change, preferably on a small scale. What is the plan of action and milestones? Who is doing what and when? What will “done” look like?
- STUDY (Check). Examine the results. What was learned? What went wrong? What went right? What were the surprises?
- ACT. Adopt the change, abandon it, or run through the cycle again.
Plan for a Follow-Up Assessment. Review the new change on a periodic basis. What was supposed to happen? What actually happened? What went wrong? What was learned? What additional improvements are needed?
