Continual Improvement with No Budget
A hospital IT department runs a continual improvement register with 47 open items. Last year only 6 were completed. The register is a spreadsheet owned by one service-improvement manager; items have no owners, no target dates, and no link to incidents or problems. The CIO is sceptical because 'improvement' has become synonymous with unfunded wish lists. Staff say improvements never get prioritised against operational firefighting, which consumes roughly 80% of capacity. One high-value item - reducing repeat imaging-system logins that cause clinician delays - has been open for 14 months. The board wants evidence that improvement effort returns value before approving any budget.
1. Diagnose why the improvement programme is failing and what is missing from a recognised improvement model.
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Diagnosis: the register is a backlog of intentions, not a managed improvement pipeline.
Missing elements against a structured improvement approach:
- Ownership: no named owners or accountability.
- Prioritisation: no value/effort ranking, so items compete with firefighting and lose.
- Linkage: no connection to incidents/problems, so effort is not grounded in real pain (the imaging login issue is a classic recurring-incident cause left unaddressed).
- Baseline and measures: no 'before' data, so value cannot be shown.
- Capacity: 80% firefighting leaves no protected time, guaranteeing stagnation.
- Governance: no review cadence or decision rights to start/stop items.
So 6 of 47 is expected, not surprising. The fix is structural, not motivational.
2. Propose a prioritisation and governance approach that could win board support.
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Make improvement a small, evidence-led portfolio:
- Triage the 47 items: close duplicates, park low-value ones, and shortlist a handful with clear value.
- Score each on value (clinician time saved, incident reduction, risk) versus effort, and assign a named owner and target date.
- Protect a fixed slice of capacity (e.g. 10-15%) for improvement so it is not always beaten by firefighting.
- Review monthly at a small board with decision rights to approve, fund, or kill items.
- Tie items to incident/problem data so they address measured pain.
This converts a wish list into a governed pipeline the board can judge, and it makes the 80% firefighting figure itself a target for reduction.
3. The imaging-login item has been open 14 months. How would you build the business case and measure its return?
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Business case:
- Quantify the pain: number of repeat logins per clinician per shift, minutes lost, and clinician hours per week across the imaging department. Convert to a cost or capacity figure.
- State the intervention and cost (likely a small configuration/SSO fix).
- Show the payback against the measured time recovered.
Measures:
- Repeat-login count per clinician per shift (baseline vs after).
- Clinician minutes saved per week and derived hours.
- Related incident volume and clinician satisfaction in imaging.
- Time-to-complete for the improvement itself, to prove the new process works.
Sequence: fix the measure first, then implement, then report the delta. A 14-month delay plus a quantified saving is exactly the evidence the board asked for, and it demonstrates that governed improvement returns value.