Step 1: Identify Opportunities

“The secret of change is to focus all of your energy not into fighting the old but on building the new.”
– Socrates

The first step of our quality improvement journey begins when someone recognizes that an opportunity for improvement exists.   This can be an outcome or process that is causing concern or identifying the potential for a proactive positive change.  However, with competing priorities and limited resources, college health professionals need to prioritize where and how to allocate resources to obtain maximum benefit.

Step 1 will guide you through identifying, prioritizing, and ultimately selecting a specific opportunity to focus on. By the end of Step 1, you should be able to answer the following questions:

  1. What is the problem or opportunity for improvement?
  2. How do you know that it is a problem?  What data/analysis supports this?
  3. Why is this issue important?

There are several frameworks and tools to help us assess and prioritize opportunities for improvement.

Idenfiying Current Gaps or Opportunities for Improvement

The Institute of Medicine and the HHS Public Health Quality Forum have defined quality aims in the delivery of patient care and increasing positive population health outcomes, respectively.   These aims are helpful for prioritizing and focusing our improvement efforts.

  • Population-centered: Protecting and promoting healthy conditions and the health for the entire student population
  • Patient-centered: Providing care and services that are respectful of and responsive to individual student preferences, needs, and values and ensuring that patient values guide all clinical decisions.
  • Equitable: Providing care and services that do not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.  Working to achieve health equity.
  • Proactive: Formulating policies and sustainable practices in a timely manner, while mobilizing rapidly to address new and emerging threats and vulnerabilities
  • Health promoting:  Ensuring policies and strategies that advance safe practices by providers and the population and increase the probability of positive health behaviors and outcomes
  • Risk-reducing: Diminishing adverse environmental and social events by implementing policies and strategies to reduce the probability of preventable injuries and illness or other negative outcomes
  • Vigilant: Intensifying practices and enacting policies to support enhancements to surveillance activities (e.g., technology, standardization, systems thinking/modeling)
  • Transparent: Ensuring openness in the delivery of services and practices with particular emphasis on valid, reliable, accessible, timely, and meaningful data that is readily available to stakeholders, including the public
  • Effective: Justifying investments by utilizing evidence, science, and best practices to achieve optimal results in areas of greatest need.  Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively).
  • Efficient:  Avoiding waste, including waste of equipment, supplies, ideas, and energy.  Understanding costs and benefits of interventions and to facilitate the optimal utilization of resources to achieve desired outcomes
  • Safe: Avoiding harm to students from the care and services that are intended to help them.
  • Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care or services.

  • Population-level surveys such as National College Health Assessment, CORE Alcohol and Other Drug Survey, and/or Healthy Minds Survey
  • EHR reporting, chart review, and/or peer review activities
  • Insurance and billing claims
  • Student experience and satisfaction via surveys, comment boxes or feedback stations, focus groups, key informant interviews, and/or other feedback mechanisms
  • Incident reporting
  • Feedback or ideas from staff
  • Feedback or ideas from campus partners such as faculty, student affairs, administration, and families
  • Benchmarking activities:  trending your data over time to assess trends (internal benchmarking) and/or comparing your data to other like organizations (external benchmarking)


Many departments struggle to balance a growing list of new and pending improvement opportunities while the need for core services continues, often without additional resources. Deciding how to prioritize and separate the high priority improvement opportunities from lower priority improvement opportunities can be daunting.

tipWhen you are first learning quality improvement,
select just one priority as you learn the methodology.


The following criteria can be helpful in prioritizing problems and projects:

  • Be important and relate to national guidelines or priorities. Examples include: Healthy Campus 2020 priority areas; AAAHC, The Joint Commission, or International Association of Counseling Services (IACS) accreditation standards; professional society/body guidelines
  • Select projects that are aligned with the mission, strategic goals, and objectives of your institution, division, and department.
  • Represent key community and staff concerns;
  • Address issues or processes that are: high risk, problem prone, and/or high volume;
    Be measurable;
  • Include areas that the team will realistically be able to improve. For example, you can determine that equipment is broken, but you cannot use improvement projects to fix it. However, if patients are not receiving necessary screenings, you can improve the process by redesigning systems such as clinic flow patterns, and then test these changes to see if they work.

Some organizations choose to formally assess key criteria using a structured tool such as a priority determination worksheet or priority setting matrix, which may be reviewed by the organization’s executive team, management team, or quality improvement council. Other, less formal strategies usually rely on the skill and experience of managers.


Improvement Journey Exercise #1

  1. What is the problem or opportunity for improvement?
  2. How do you know that it is a problem?  What data/analysis supports this?
  3. Why is this issue important?


Once you have prioritized a problem or opportunity for improvement and completed Exercise #1, you can continue on to Step 2: Establish a Team.