1. “Add Scientific thinking to sixth sense …. ………………… the commonsense”
Problem Solving Dr Kithsiri Edirisinghe MBBS, MSc , MD ( Medical Administration )
“Add Scientific thinking to sixth sense ….
………………… the commonsense”

2. Session outcomes
Complete knowledge in “Defining and Identifying problems “
Development of the skill in “Analyzing problems “
Insight to “ finding Solutions to a problem”

3. Session 01
“Defining and Identifying problems “
What is problem ?

4. What is a problem ? “An observed gap between what is expected and
what actually exits”

5. The definition A perceived gap between:
the existing state and a desired state
, or a deviation from a norm, standard, or status quo.
Many problems turn out to have several solutions 
(the means to close the gap or correct the deviation), 
difficulties arise where such means are either not obvious or are not immediately available.

6. The Equation P = ( E – A ) C P – problem
E- expected level A- actual Level
C = Concern level
Influenced by many factors
Political
Social
Professional
Organizational
Individual

7. Problem and solution Problem need to be solved Objective completely
partially
Objective
is the quantified level improvement expected of the problem situation

8. Problem Solving process : the steps
Identify the problem
Analyze the problem
Set objectives
Identify the solutions
Select the options
Implement the solution

9. Problem solving Techniques
Go to this link and study all the PS techniques

10. Problem solving Techniques
Pareto analysis
Cause and effect analysis
Histogram's
Scatter diagrams
Floor charts
Control charts check sheet
Cost benefit analysis

11. 1. Identifying the Problem
Situational analysis
Formal recognition
Definition
Watch V 01 for use of PDS document

12. a. Situational analysis
“ Snap shot “ of the problem - Situational Analysis
Noticing something is not right
Information flow from the others
Observation
Information
Complains
Conflicts

13. a. Situational analysis
Identify
Stake holders
Scope of work
Expectation – out come
Examine the current state
Constrains
Time available to solve the problem

14. Hospital clinic
Let s identify issues !

15. b. Formal Recognition Convinced that there is a problem
Use experience personnel to prioritize problem
Use Pareto analysis for a complicated issue
80 to 20 rule
V 02 & V 03

16. c. Definition of the Problem
Clearly indicate the extent of the problem.
Qualify and quantify

17. 2. Problem Analysis Cause and effect diagram Place objectives
Study and analyze the problem

18. Analysis...... Identify a “core” or central problem
Methods and Tools
Identify a “core” or central problem
List all the problems related to or stemming from the core problem
Determine which related problems are causes and which are effects of the core problem
Arrange the problems in a cause-effect heirarchy around the core problem

19. Study the problem
Identify key stakeholders and ensure the ‘right’ people participate
Collect relevant background information
Ensure lessons learned from previous similar issues are considered
Prepare a problem tree / fish bone which provides a simplified but robust version of reality

20. Analysis .....
Methods and Tools
Purpose: to identify major problems and their main causal relationships.
Output: a graphical arrangement of problems differentiated according to ‘causes’ and ‘effects

21. Analysis List causes List effects Main causes – categories Sub causes
Sub effects

22. Methods and Tools
Problem Tree Example

23. Fish bone Diagram

24. Fish Bone diagram Poor Quality in Private hospitals
Doctor centered culture
Unknown patient choice behaviour
High Patient Expectations
Poor regulation
Poor Quality in Private hospitals
Untrained staff
Lower Perception of the Administrator
Widening demand gap
Resource constrains

25. Expected problem improvement
3. Set objectives
Expected problem improvement
SMART
Specific
M – measurable
A- achievable
R- reliable /realistic
T – time bound

26. Problem Tree

27. 4. Identify the solutions
Select the options

28. Determine options Solutions Convert Be Creative The cause a solution
Effect to a good result
Be Creative

29. Solution and objective tree
Solutions
Good results

30. 5. Evaluate & Select options
Debate ,study, agree
ECT matrix-
Effect,
Time
Cost

31. ECT Matrix Solution Effect Best effect Cost Minimum cost Time
Shortest time
Total Points
Rank a 2 5 3 10 b 4 8 c 1 9 d 6 15

32. 5. Implementation Implement Monitor Control Feed back
implementation plan
Inauguration
Monitor
Monitoring systems
Control
Mechanisms
Feed back
Regular and adaptations

33. Activity
You are requested by the DG of health services to solve the issue given below
Dengue epidemic
RTA – Road traffic accident
HAI – Hospital Acquired Infections
Rising cost of health care
Shortage of nurses

34. Thank You !