1.2 Selecting a QI Project in PMHCA Programs

What Problem Are You Trying to Solve?

Ask these questions when selecting a project:

  1. Is this a recurring issue? One-time events may not warrant a QI project. Look for patterns that repeat across patients, shifts, or time periods.
  2. Does it impact patient care, safety, or family experience? The most compelling QI projects address outcomes that matter to patients and families, not just operational efficiency.
  3. Is it feasible to address with your current team and resources? Consider your staffing, data access, leadership support, and competing priorities. A project that is too ambitious for your current capacity will stall.
  4. Does it align with program’s goals and hospital’s strategic priorities? Alignment with organizational goals increases the likelihood of support, resources, and sustainability.
  5. Can you measure it? If you can’t define what success looks like in measurable terms, the project will be difficult to track and difficult to celebrate.
  6. Will the team rally around it? Choose a project that addresses a frustration or aspiration your team already feels.


⚠️ Keep in Mind

These questions serve as a guide, but some factors may take precedence. For instance, if your hospital is accountable for a quality metric (like ED boarding times or patient experience scores), you may need to prioritize it, despite the challenges. Similarly, if a recent sentinel event reveals a safety issue, urgency may outweigh feasibility. QI provides a structured way to make progress, even on difficult matters.

A prioritization matrix is a practical tool for comparing candidate projects across multiple criteria. It helps teams move from subjective debate to structured decision-making.

How to Build a Prioritization Matrix

  1. List 3–5 candidate projects your team is considering.
  2. Score each project on a 1–5 scale across three dimensions:
    1. Impact: How much will this improve patient care?
    2. Feasibility: Can we realistically do this with current resources?
    3. Alignment: Does this connect to organizational goals and metrics?
  3. Total the scores for each project. The highest-scoring project is your recommended starting point.
  4. Discuss as a team: Does the top-scoring project feel right?
    1. Use the matrix as a guide, not a rigid formula.
    2. Team judgment and context matter.


Example Resource: Prioritization Matrix Template



⭐ Real-Life Tip

Use a team poll or a prioritization matrix to weigh options and select a problem worth solving now. Involve frontline staff in the scoring, as their perspective on feasibility is often more accurate than leadership’s. A sample Prioritization Matrix template will be provided as a companion resource to these modules.

Audience-Specific Examples

Project Selection

Audience Scenario / Application Key Takeaway

Emergency Physician

The ED sees high volumes of pediatric behavioral health visits on weekends, but psychiatric consults are only reliably available on weekdays. Weekend patients wait 2–3x longer for evaluation. This recurring issue impacts care and safety, and is potentially feasible to address with a telehealth pilot that extends consult availability to weekends. The project scores high on impact, moderate on feasibility, and high on alignment with the hospital’s patient experience goals.

Meets multiple selection criteria. High impact, clear measurement (weekend wait times), and a testable intervention (telehealth). Prioritized for QI.

EMS Team / EMS Medical Director

EMS crews lack a standardized protocol for determining the appropriate transport destination for youth in mental health crisis.A recurring gap has significant safety implications; the feasibility is moderate. Developing a protocol requires involvement from the medical director, coordination with dispatch, and agreements on destinations — the stakes for patient safety are high.

Safety urgency may outweigh feasibility challenges. This is a high-priority QI target where even incremental progress (e.g., a pilot protocol in one zone) is meaningful.

PECC

Suicide risk screening is inconsistent across triage nurses. It is a hospital metric and aligns with Joint Commission National Patient Safety Goals — even though changing nurse workflow feels complex. The PECC’s prioritization matrix shows this project scoring highest on alignment and impact, even though feasibility is rated moderate due to workflow complexity.

Metric accountability and patient safety may outweigh feasibility concerns. Starting with a focused PDSA (e.g., two nurses, one shift) makes it manageable.

School Clinician

Post-referral follow-up is lost — only 27% of referred students connect to community behavioral health. Feasible to address with a shared tracking form and a designated follow-up contact. Aligns with the school’s student wellness goals and the district’s mental health initiative.

Good candidate for a first small-scale PDSA. High impact on student outcomes, high feasibility, and strong alignment.

Primary Care Team

A primary care practice finds that 60% of families referred for behavioral health services never attend a first appointment. Chart review shows no consistent process for following up after a referral is made — there is no designated staff member responsible for contact, no tracking log, and no warm introduction to the receiving provider. The team recognizes this is a system gap, not family disengagement, and prioritizes it as a QI project. Feasibility is rated high: a simple referral tracking form and a warm handoff conversation require no new resources.

High impact, high feasibility, and strong alignment with practice quality goals. A strong candidate for an early PDSA cycle.

Behavioral Health Staff

Behavioral health clinicians report spending significant time re-gathering information that was already collected during triage and the ED evaluation. This duplication adds 20–30 minutes per consult and delays disposition. A QI project to standardize the handoff documentation between ED and behavioral health could reduce redundancy and improve time-to-disposition.

Frontline frustration is a powerful project selection signal. When staff can articulate the problem and its impact, engagement in the QI process is naturally high.

Hospital Leadership / CMO

ED boarding time for pediatric mental health is a Board-level metric. The hospital is at risk for regulatory citation and the metric appears in the annual quality report to the community. Even if operationally complex (involving ED, psychiatry, social work, inpatient, and bed management), it warrants prioritization because organizational accountability demands it.

Organizational accountability drives priority. Leadership’s role is to ensure resources, remove barriers, and create the conditions for the QI team to succeed.

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