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Understanding your problem


Magnifying glass representing SoPK. View text description

The notion of quality improvement is not new, in fact it’s be around in other industries for a long time (more information about the history of quality improvement can be found by clicking the Interesting Resources button of the QI home page).

The principles of quality improvement have been applied to healthcare and you may hear terms like ‘systems thinking’ or ‘System of Profound Knowledge (SoPK)’. These come from the work of Dr. W. Edwards Deming, who developed an effective theory of management, SoPK looks like this:

By looking at your problem through each of the four lenses you have a better understanding of important aspects that effect what you are trying to improve, which should inform the changes you make.

Videos about SoPK

Applying SoPK

This tool has been adapted by Oxford Health NHS Foundation Trust from Deming’s work and can be used as prompt when applying SoPK to your problem in practice:

System understanding

  • How well do we know the entire system (e.g., patient pathway)?
  • What is the flow of work? (map processes or observe work flow)
  • Do patient needs drive response from the system?
  • What do patients & families say?
  • What gets in the way of doing work well?
  • Is the system reactive or designed with a clear purpose?
  • How safe is the system? Are there any “holes” in the system

Theory of knowledge

  • Is there a culture of continuous learning?
  • What patient / professional / managerial knowledge is influencing this situation?
  • What useful evidence can we use?
  • Grow leaders who understand and teach QI.
  • Embrace scientific thinking (structured, systematic, measured)
  • What are you basing your ideas in:
  • Human factors science?
  • Reliability science?
  • Quality Improvement methodologies
  • No specific approach?

Understanding variation

  • Can any of the tasks be standardised? Where does standardisation not apply?
  • Can you show how good the patient / staff experience can be?
  • Can you show how bad the patient / staff experience can be?
  • How much does work vary (within shift, day, night,weekend)?
  • What actions are taken to minimise variation?
  • Do you batch people to cope with demand rather than fixing problems?
  • Do you try to even out workflow (e.g., planning rotas, planning a team’s annual leave)?
  • Do you aim for highest possible standards?

Psychology & behaviour (human factors)

  • Do staff feel they are free to raise ideas, make changes? Are they supported?
  • Does the team know exactly what is needed?
  • Do people know how the system works and their part in it?
  • Are people working to just get rid of the baton?
  • Is there respect for those who do the work?
  • Is the decision making inclusive?
  • Are you developing people and teams?
  • Are you driving out fear?
  • Are you leading with humility?