December 2020 PSQI Hot Topic

Prioritization Methods: Which QI Project Solution Ideas Should We Tackle First?

Lauren Atkinson, MPH, CST

Improvement Specialist Supervisor

Maine Medical Partners


Learning Objectives:

  1. Describe when to use a project prioritization tool.
  2. Understand how to set up and facilitate use of an impact/effort matrix with a group.
  3. Differentiate which project ideas to prioritize first using an impact/effort matrix.

Healthcare teams often have many great ideas about how to make their processes better. So how do you decide which idea to tackle as a first step? If your team has already engaged in a root cause analysis which yielded several solution ideas, a priority matrix can help make that decision objective and thorough. An impact effort matrix is a prioritization tool that should be used to think about which solution ideas to begin working on first, depending on resources (time and cost) and the potential impact the change will have. It leverages stakeholder consensus to find the most efficient path to achieve meaningful goals for patients and staff.

The impact/effort matrix is a tool that is very easy to use. The level of impact an idea would have is shown on the y axis, and the level of effort the change would require is shown on the x axis, as seen in the example below. The matrix is broken down into four quadrants. Quick wins, which have a high impact, and require minimal effort to complete, should be started first. If a team is working together for the first time, quick wins can be very important to keep team members engaged in the improvement process, and to build excitement around what they can accomplish as a team. The ideas that fall into the ‘major projects’ quadrant should be considered when there are enough resources and leadership buy-in to achieve success. Fill-ins should be completed as time allows, and thankless tasks should be re-evaluated or discarded.

This matrix should be used as a consensus-building tool to help drive decision-making. When facilitating the use of this tool, it’s important to have as many project stakeholders present as possible to be able to make the most informed decisions about where ideas fall on the impact/effort matrix. To begin, draw the matrix out on a large flip chart, white board or electronic board. Then, write all of the solution ideas on sticky notes.  Prior to assessing the impact of a potential idea, the group should revisit the goal statements and consider the patient, care team, financial, and safety outcomes that idea will produce. When considering the effort the idea will require to implement, the team should consider the time needs, number of staff, cost, and educational gaps that need to be closed. Next, based on the consensus of the group, the team should place the sticky notes on the grid in their respective quadrants as described above. Once complete, the finalized matrix should guide the action planning as the team moves into the next phase of idea implementation.


Bens, I. Facilitating With Ease. Wiley, 2018.

Impact Effort Matrix. American Society for Quality.  Accessed November 2, 2020.

Impact Effort Matrix.  MaineHealth Performance Improvement. Accessed November 13, 2020.



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