However, they are unsure how to identify the main causes for their low use of home dialysis and how to use the results of such an analysis to promote change within their dialysis unit. The team is aware that the most effective changes target the primary or root causes of the quality of care problem. The team is now tasked with identifying opportunities for improvement and testing their effects on the system of care for home dialysis. In the previous article in this Moving Points feature ( 1), an interdisciplinary team consisting of ( 1) a lead nurse or physician from the home dialysis unit ( 2) technical experts from the predialysis clinic and in–center dialysis program (nursing staff, physician, social worker, etc.) ( 3) a clinical leader ( i.e., manager) from the dialysis program ( 4) an improvement advisor and ( 5) an executive sponsor was formed with the aim of promoting home dialysis (home hemodialysis and peritoneal dialysis) uptake from its current level of 15% to a target of 30%. These methods will be applied to our home dialysis quality improvement project, providing a practical example that other kidney health care professionals can replicate at their local centers. We will also review common change concepts and brainstorming activities to identify effective change ideas. The tools used to identify the main contributors to a quality of care outcome will be described, including cause and effect diagrams, Pareto analysis, and process mapping. Using the example of home dialysis (home hemodialysis and peritoneal dialysis), this article within this Moving Points feature on quality improvement will provide health care professionals with the tools necessary to analyze the steps contributing to certain outcomes in health care quality and develop ideas that will ultimately lead to their resolution. After the causes of a particular outcome are known, changes can be made to address these causes and change the outcome. To change a particular quality of care outcome within a system, quality improvement initiatives must first understand the causes contributing to the outcome.

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