Defect Check Sheets

• Creating a measurement plan
• Mini-surveys
• Third next available appointment
• Defect check sheets
• Patient flow sheets
• Sampling plan

This is a simple data collection tool to help your team identify the most important source of a problem with quality.  You can use this in the following circumstances:

• Defect:  there are multiple defects occurring, and you want to see which ones are most common
• Defect cause:  you have a defect, and you want to investigate what are the most common causes of the defect
  

Step-by-step Instructions

1. Before starting, your team should use an Ishikawa diagram or other process to identify the different possible causes of a quality problem.
2. Generate a list of what the team believes are the most common defects, or defect causes.  (List as many as you wish, but a typical list size is 6 to 10.)
3. Create a defect checklist (see example below).  Include an ‘other’ category.  
4. Decide how you are going to collect the data.  You can go forward in time and check each new service provided or patient encounter for potential defects.  Or, you can go back in time and search for these events (e.g. a chart audit).  
5. Pick a time frame for collecting data, ideally long enough to observe at least 50 defects / defect causes.  For go-forward data collection, try to keep this short (e.g. 2-3 weeks).
6. Identify who will be collecting data (e.g. chart reviewer, or service provider).  Have them mark the check sheet each time it occurs in the appropriate category.  Each recorder uses the same check sheet throughout the data collection (i.e. do not fill out a separate sheet for each defect).  Provide specific instructions on the definition of the defects / defect causes.  
7. Option:  you can also use the defect check sheet to measure your overall rate of defects.  Create a tick box at the bottom for each person served or item processed, for whom a defect might occur. 
   

Download this template in Word format.

Advanced Tips:

Q:  Do I really need to use a defect check sheet? 
A:  If there is a strong consensus within your team that quality problems can be isolated to only 2 or 3 areas, then you can consider skipping this step.  However, defect check sheets and the accompanying Pareto chart can be very useful when your QI team can’t agree on what is the biggest problem. 


Q:   What if I have a rare defect and it will take me too long to observe 50 events?
A:  Consider measuring similar ‘near misses’ or defects in a process that could potentially lead to the adverse event occurring.  Either of these is likely occurring more frequently. 


Q:  What if two or more defects or defect causes occur at the same time? 
A:  Use your judgement; you can either put multiple tick marks, one for each defect or defect cause, or ask staff to identify the only the most important defect or defect cause.  (In most instances, however, the former approach is preferred.)


Q:  I have a lot of different categories of defect causes.  How should I collapse them into fewer categories?
A:  Group together categories where the potential ideas to fix the defect or cause are the same.