Clarifying the Issue

Your purpose in clarifying the issue is to identify and gain a clear understanding of in which component of the focus area is the problem (or strength), and which aspect of the component is the area of concern. In the data analysis step, you collected and examined data to identify health priorities or focus areas in your community. In this step, you will examine why the data looks like it does. You will explore factors that contribute to assets and risk related to the specific so you can identify appropriate strategies that address the real problem.

This is a critical step in helping ensure that interventions and resources address the health issue identified. A typical solution to addressing a health problem is to try anything and everything we can think of to reduce or eliminate the problem. This is often an exhausting, unfocused and unproductive strategy.

1. Collect additional data on indicator based on priority questions

   Understanding the relationship between a health indicator, existing resources, and influencing factors is a prerequisite to clarifying the problem. To accurately identify the problem, teams may need to collect additional data about the resources, and status of influencing factors and the knowledge, skills and attitudes of major stakeholders who will be assisting in implementing interventions. There are at least four processes, ARMM, that need to be in place to influence any health indicator outcome, and should serve as a basis for clarifying the problem. These key processes include:
   1. Knowing the specific Audience affected by this issue >
      • Who is the primary audience?
      • What is the criteria used for defining the audience?
      • Are there pockets among the audience who need a different approach than the rest?
   2. Assessing the Resources in place that address the issue. >
      • Who are the major stakeholders who work with this audience?
      • What interventions are in place to address the issues?
      • What resources are in place for ensuring accessibility and availability of resources to all members in the audience?
   3. Understanding Measures or Indicators that are being assessed. >
      • Do stakeholders know the goals, expectations, and indicators they are working to affect?
      • Can they describe what success looks like?
   4. Monitoring Progress towards goals and objectives >
      • Monitoring/measuring progress and outcomes
      • Is progress being monitored?
      • How do they use the data?
      • How do they share results?

2. Hypothesize causes and contributing factors for why your data looks like it does

   Once you have collected this information about the health focus area,you are ready to complete the problem clarification process. The fishbone exercise is a simple way clarifying the issue at hand, or can also serve as a problem solving tool. Sometimes, it is called a cause and effect session, but fishbone visually describes the diagram used.

3. Collect evidence to prove or disprove selected hypotheses

   When you have identified possible contributing factors, you will need to collect additional data to validate your hypothesis. This stage may involve getting additional data. It is important to collect input from major stakeholders during this process. One way of being certain that you have identified the problem correctly is to pose a series of questions that challenge you to identify the specific area of concern.
   • What components should be expanded?
   • What components should be reduced?
   • What components should be eliminated?
   • What components should be created?
   • What components should be replaced?

4. Collect input from major stakeholders in relation to your hypotheses

   It is important to have peer review your exploration of root causes and contributing factors as it could offer critical perspectives. Identify group(s) of stakeholders who did not participate in your team, but share your goals and purpose. Check out the Peer Review Tool to facilate a discussion on testing hypotheses.

5. Identify a small number of high-impact causes to address in the plan

   Only after you complete the problem clarification process are you ready to identify strategies to address the problem described in the next section.

-Adapted from Maryland School Improvement Project