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Is It Time to PICK at Your Problems?

The Business of Medicine

Prioritizing practice management issues with the PICK chart

In this edition of the Business of Medicine video series, Healthcare Process Improvement Leader Amy Lueb describes how to create a PICK chart to organize and prioritize a list of issues or tasks.

Stayed tuned for the MedAmorphosis MedAcademy

Our upcoming online courses provide easy-to-implement tools and guides for strengthening practice business performance.


Have you ever felt overwhelmed by lists of issues you have to fix? Do you feel like everything has to be done at once? Have you found yourself asking, “Where do I even start?”

The first step to managing an overwhelming list is find a way to organize and prioritize.Think about it this way: If you are unable to truly focus on a task or issue, how do you expect to implement a successful solution?

In this short tutorial we will give you a tool to help you find a starting point and reach a solution. This tool is called a PICK chart, which stands for Possible, Implement, Challenge & Kibosh. We will get to the meanings of those terms in a moment; first let’s discuss setting up this tool.

Setting up the PICK chart

The PICK chart is a grid you create to systematically prioritize each problem based on frequency of occurrence and how that single problem affects workflow.

The X, or horizontal, axis represents the problem’s frequency, from rarely to often. Of course, you and your team have to determine what “often” means – is it hourly, daily, weekly, monthly or even annually?

The Y, or vertical, axis represents the problem’s impact on workflow, from low to high. Again, it’s up to you to define those terms, but a high impact usually indicates an issue can break or shutdown a specific process or workflow.

In order to complete a PICK chart, you first have to list all issues and assign each a number. Then have a team discussion about each problem’s frequency and level of impact. Once the group has reached consensus, place the issue’s number on the chart, using the X axis and Y axis as guides. If you’re facing many issues, you may want to limit discussion around placement on the chart. For example, you might halt discussion after one to two minutes then let majority rule.

Once you’ve charted all issues, draw a line from the middle of the horizontal axis and one from the middle of the vertical axis. This yields four quadrants: P, I, C and K, or Possible, Implement, Challenge and Kibosh.

Defining the quadrants of the PICK chart

The Possible category occupies the upper-left quadrant. These indicate rare problems with a medium to high impact on workflow; so it is “possible” the team will work on these issues.

The Implement category occupies the upper-right quadrant. These issues happen often and have a medium to high impact on workflow. Typically, a management team starts with and “implements” solutions for problems in this category.

Challenge issues fall into the lower-right corner. These happen often but don’t affect work flow as much as other issues. They may be a “challenge” to address, due to the frequency.

Finally, Kibosh problems lie in the lower-left quadrant. They rarely happen and have a minimum effect on workflow, so you can “kibosh” for now, leaving time to focus on more pressing matters.

Prioritizing issues from the PICK chart

Knowing to start with problems of high frequency and high impact on workflow, address the Implement quadrant first. Focusing on solutions to these issues will yield the greatest return.

Next, it is up to the team to decide whether to tackle the Possible or the Challenge quadrant secondly. Remember, you don’t ignore issues falling into the Kibosh zone; rather, you don’t prioritize them above other issues.

Keep in mind that some people may downplay some issues because they feel they may get into trouble if they speak out. Others may push a personal agenda due to dealing with a particular issue longer than others; or they may feel their department performs better than another.

In the role as facilitator, it’s important to combat potential pitfalls by taking the time to collect data and by encouraging open and honest communication. At times people’s perspectives are skewed by personal experiences, so definitive observations or numbers can really help clarify a problem’s importance.

The PICK chart is a key tool that can make even a laundry list of tasks more approachable.

In lessons two and three of our MedAmorphosis MedAcademy we show how to expand on this tool to fully develop a project, as well as to prioritize and implement solutions around issues.

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