Have you ever kicked the can with your quality improvement project?
by Tamala S. Bradham, Ph.D., DHA, CPHQ, CPPS, CCC-A
Ok, I’m guilty! There have been times that a project that I have been involved with has been indefinitely delayed. One quality improvement project where the can was kicked a few times was to develop a patient information sign. Our team knew the “Aim”, “Drivers,” and “Measures”. Sounds simple, right? More than a year later, we still have not completed this project. The real question, then, is why?
Why do we kick the can?
A) The can was kicked so we could reach it better to pick it up.
B) The can was kicked to move it out of our way because something else got our attention.
C) The can was kicked to buy us more time.
D) Someone asked us to kick the can.
Answer A) Sometimes we kick the can because we learned from a previous PDSA (plan-do-study-act) that we needed to go in a different direction. Sometimes, the change we thought would occur from the project did not occur so we have to take a step back and re-evaluate. We need a new way to get to the can so we can reach our aim.
Answer B) There are other times that we have great intentions and ideas on a quality improvement project but it never gets completed. Sometimes this occurs because the “Aim”, “Drivers”, and/or “Measures” were not fully developed or understood by the team. Maybe the project required different team members. There are times that other more pressing items come up that must be addressed and the project goes to the inevitable “parking lot”. Things happen and the can was moved, unfortunately, to the recycling bin.
Answer C) We all need more time (or a clone of us). We need to try a new PDSA or need more data to determine if the quality project should continue and/or move to “spread”. (Spread is the process of taking a successful implementation process from a pilot unit or pilot population and replicating that change or package of changes in other parts of the organization or other organizations, [IHI, 2014]). The project will be completed, but we just need more time so we push the can out a little farther.
Answer D) When we are working on a project, we may become so attached to it and not necessarily see that it is not aligning with the set Aim (and/or mission of the organization). The path the can is on is not the road on which we are to travel. So, someone asks us to take a different direction and leave this can behind. This can be hard to hear, especially if you have invested time and resources into a project.
There is no correct answer. These are just a few of my experiences. There have been times that I just needed the can to move a little so we could reach our aim or just needed more time. And, there have been times that the project was scrapped by the team and/or leadership as we needed to move in a different direction. I do firmly believe that there are no “bad” projects. We learn from them all. It is exciting to see positive things occur from a quality improvement project. It is also equally rewarding to learn from a quality project that, at this point in time, did not turn out the way we thought it would. Having the opportunity to learn is a gift.
What are some reasons you have kicked the can on your quality improvement project?
Institute for Healthcare Improvement. (2014). How to improve, Science of Improvement: Spreading Change. Retrieved from
I may not always get it right (ask my kids) but that is the beauty of quality improvement! We take small steps and learn what worked and what didn't and try again.
Failure is an option but giving up is not! After all, things would be very boring if we were all perfect!
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