About — SAIA

Since 2012, the University of Washington has partnered with national health systems to implement SAIA along the patient care cascade.

The SAIA strategy uses an iterative, five-step process applied at the facility level to give clinic staff and managers a system-wide view of their performance.

Step 1: Understand targeted cascade performance, and identify priority areas for improvement. The cascade analysis tool (CAT) uses routine data to provide a rapid, systems-level view of drop-offs along the care cascade, with an optimization function that allows the user to rapidly assess how many additional people will be served if only one step is fully optimized while other stay the same. As an analytic tool, CAT helps frontline staff and facility managers to prioritize where to intervene by providing a view of the greatest potential for flow improvements across the entire cascade.

Step 2: Process mapping to identify facility-level modifiable bottlenecks. Enabling facility-level staff to identify and gain consensus on bottlenecks to address in their health system is essential to defining innovations to implement. SAIA applies sequential process flow mapping procedures, coupled with workflow observation, to identify bottlenecks and guide discussion on opportunities for workflow modifications.

Step 3: Define and implement facility-specific workflow adaptations to address modifiable bottlenecks. After identifying modifiable barriers within cascade steps, facility staff identify a simple, specific change to improve performance within the targeted step. Selected workflow adaptations should be feasible to implement, be within the scope of influence of facility management and frontline staff, and be expected to lead to rapid, substantial improvements in the targeted cascade step. Ideas for adaptations come from brainstorming solutions with facility staff, complemented by best practices from the literature and high performing services in-country. An implementation plan for the innovation is described in writing by facility and study personnel to ensure consensus among facility staff, and clarify operational design and roles. Steps 3 and 4 are analogous to continuous quality improvement.

Step 4: Monitor changes in routine performance. Facility staff monitor change in routinely reported data from the cascade step selected for improvement. Measuring the absolute change in the proportion of patients progressing through targeted steps captures large, rapid improvements accompanying modifications.

Step 5: Repeat cycle. Systems engineering improvement processes are by definition iterative, with ongoing testing of innovations responsive to evolving, contextually specific barriers. Facility staff repeat steps 1–5 at the end of each cycle to identify new approaches to modify previously identified barriers, or if the first cycle was successful, focusing on improving priority bottlenecks identified in a repeated systems analysis.