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Selecting Health Care Improvement Projects: A Methodology Integrating Cause-and-Effect Diagram and Analytical Hierarchy Process

Testik, Özlem Müge PhD; Shaygan, Amir BS; Dasdemir, Erdi MS; Soydan, Guray MD, PhD

doi: 10.1097/QMH.0000000000000119
Setting Priorities for Quality Management

Objectives: It is often vital to identify, prioritize, and select quality improvement projects in a hospital. Yet, a methodology, which utilizes experts' opinions with different points of view, is needed for better decision making.

Methods: The proposed methodology utilizes the cause-and-effect diagram to identify improvement projects and construct a project hierarchy for a problem. The right improvement projects are then prioritized and selected using a weighting scheme of analytical hierarchy process by aggregating experts' opinions. An approach for collecting data from experts and a graphical display for summarizing the obtained information are also provided.

Results: The methodology is implemented for improving a hospital appointment system. The top-ranked 2 major project categories for improvements were identified to be system- and accessibility-related causes (45%) and capacity-related causes (28%), respectively. For each of the major project category, subprojects were then ranked for selecting the improvement needs.

Conclusion: The methodology is useful in cases where an aggregate decision based on experts' opinions is expected. Some suggestions for practical implementations are provided.

Department of Industrial Engineering, Hacettepe University, Ankara, Turkey (Dr Testik and Messrs Shaygan and Dasdemir); and Department of Medical Pharmacology, Hacettepe University, Ankara, Turkey (Dr Soydan).

Correspondence: Özlem Müge Testik, PhD, Associate Professor, Department of Industrial Engineering, Faculty of Engineering, Hacettepe University, 06800, Ankara, Turkey (

The authors would like to thank the experts and the hospital staff for their help and suggestions during the implementation of this study. The authors would like to also thank the editor and the 2 anonymous referees for their valuable comments, which greatly improved the article.

The authors declare no conflicts of interest.

© 2017Wolters Kluwer Health | Lippincott Williams & Wilkins