The CQI Method Toolkit
1 · Charter (Model for Improvement)
Answer the three questions before you cycle. A vague aim produces a vague project.
2 · PDSA cycles
Small, fast, low-risk tests. Add a row per cycle; each should build on the last.
| # | Date | Plan | Do | Study | Act |
|---|
1 · Event
2 · Timeline
Reconstruct what happened, when, in order — before memories fade.
| Time | What happened |
|---|
3 · 5 Whys
Ask "why" past the first answer, to a system-level cause. Stop when the next "why" would just re-state the same fact.
4 · Fishbone (Ishikawa)
Sort candidate causes into the classic dialysis categories.
People
Process
Equipment / Technology
Environment
Materials / Supplies
Management / Policy
5 · Root cause(s) & corrective actions
Rank each action's strength. Forcing functions/design are strongest; education/reminders are weakest and most over-used — don't let the list end there.
| Corrective action | Strength | Owner | Due date |
|---|
Process under review
Failure modes
List each process step's possible failure mode. Score 1 (rare/mild/obvious) – 10 (frequent/catastrophic/undetectable). RPN = Severity × Occurrence × Detectability — attack the highest first.
| Process step | Failure mode | Effect | Sev (1–10) | Occ (1–10) | Det (1–10) | RPN |
|---|
Where These Methods Come From
PDSA (Plan–Do–Study–Act) is the Model for Improvement's test cycle, formalised by Langley, Moen, Nolan, and colleagues and adopted as the Institute for Healthcare Improvement's default improvement engine; systematic review shows most healthcare PDSA applications under-document the sequence of iterative small-scale cycles this tool is built to enforce. Root Cause Analysis is the standard retrospective, blame-free, systems-focused method for sentinel events, using the 5-Whys and fishbone/Ishikawa categories (People, Process, Equipment, Environment, Materials, Management) common in patient-safety practice; corrective actions are strongest as forcing functions/design changes and weakest as education/reminders — the hierarchy this worksheet is built to surface. Failure Mode and Effects Analysis is the standard prospective risk tool, scoring Severity × Occurrence × Detectability into a Risk Priority Number to prioritise design changes before harm occurs. All three methods are explained with a worked dialysis example in the QAPI vs. CQI field manual, Sections 5 and 7.
