The PICK Model
Once you have identified possible solutions, you face a prioritisation problem: which ones are worth pursuing, and in what order? The PICK model is a simple 2x2 matrix that sorts ideas by two dimensions — impact and effort — so you spend your energy on the changes most likely to move the needle.
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What the PICK model is
The PICK model was developed by Lockheed Martin as part of their Lean Six Sigma programme and has been widely adopted in healthcare improvement, particularly through the NHS Institute for Innovation and Improvement. It provides a structured way to sort a list of potential solutions or improvement ideas into four categories based on two axes: impact (how much difference will this make to the outcome?) and effort (how much time, resource, and difficulty is required?).
The model is deliberately simple. Its value is not analytical precision — it is structured conversation. A team that argues about which quadrant each idea belongs in is doing exactly what the model intends: making their assumptions about impact and effort explicit, so that prioritisation is based on shared understanding rather than the loudest voice in the room.
The four quadrants
High impact, low effort. Do these first. These are your quick wins — significant improvement for relatively little cost or disruption. Don’t over-analyse. Just do them.
High impact, high effort. Worth doing — but plan carefully. These need a business case, a PDSA cycle, and Bootstrap CUSUM to verify they worked. Don’t let effort become an excuse to avoid them.
Low impact, low effort. Do if time allows, after I and C quadrant actions are complete. These are nice-to-haves — they improve things marginally but won’t move the outcome measure.
Low impact, high effort. Stop. Do not pursue these. The effort required is not justified by the outcome. This is the hardest quadrant to enforce — but the most important discipline.
High impact + low effort = Implement immediately. High impact + high effort = Challenge yourself to find a way. Low impact + low effort = Possible if you have spare capacity. Low impact + high effort = Kill it — no matter how attached people are to the idea.
How to run a PICK session
The PICK model is most effective as a team exercise, typically after a root cause analysis or 5 Whys session has produced a list of potential solutions. A well-run PICK session takes 30–60 minutes and produces a clear action priority list that the team owns collectively.
- Generate the list first — without evaluation. Write every potential solution on a separate card or sticky note. No filtering, no judgment at this stage. Include even the ideas that seem impractical. Evaluation comes next.
- Define impact and effort for your context. Impact means: how much will this move the outcome measure we are trying to improve? Effort means: how much time, cost, and disruption is required to implement this fully? Agree these definitions before placing anything on the matrix.
- Place each idea on the matrix as a team. One idea at a time. If people disagree, that disagreement is valuable — it means assumptions about impact or effort differ. Surface those assumptions and resolve them.
- Prioritise the Implement quadrant first. These are your immediate actions. Assign owners and deadlines before leaving the room.
- Plan the Challenge quadrant carefully. Each high-effort idea needs a PDSA cycle with a pre-specified Bootstrap CUSUM test. What outcome measure will confirm it worked, and by when?
- Be ruthless about Kill. Kill means stop — including stopping things already in progress that belong here. Sunk cost is not a reason to continue a low-impact, high-effort activity.
Common pitfalls
Everything ends up in Implement. This happens when impact is assessed optimistically and effort is assessed optimistically. Apply the sufficiency test to each idea: will this alone produce the result, or is it just one of several necessary conditions? If it is one of several, the impact of this idea alone is lower than it appears.
The Kill quadrant stays empty. Teams resist killing ideas because someone in the room proposed them. The facilitator’s job is to enforce the logic: if impact is genuinely low and effort is genuinely high, it goes in Kill regardless of who suggested it. If the idea has a champion who believes impact is higher than the team rated it, they should make that case explicitly — not just resist the Kill label.
PICK is done once and never revisited. As the Implement quadrant ideas are completed and the outcome measure shifts, the remaining ideas should be re-evaluated. An idea that was in Challenge when resources were constrained may move to Implement once capacity is freed. Bootstrap CUSUM on the outcome measure tells you when enough has changed to warrant a fresh PICK session.
Before committing to the Implement quadrant, apply one additional test from Goldratt and Dettmer: are these ideas together sufficient to produce the result, or are they each necessary conditions that only work in combination? If the answer is “each one helps but none alone is sufficient,” you need to implement all of them — not cherry-pick the easiest. The PICK model tells you the order and the priority. The necessary/sufficient test tells you whether the set is complete.
PICK and Bootstrap CUSUM
The PICK model produces a prioritised action list. Bootstrap CUSUM answers the question the PICK model cannot: did the actions that were implemented actually work?
📊 How PICK and Bootstrap CUSUM work together
Before PICK: Run Bootstrap CUSUM on your key outcome measures to quantify the problem. A flat line with no change point tells you the system is stable at a level you do not want. An upward change point tells you something made things worse at a specific point. Either way, the data defines the problem you are solving before you generate solutions.
After PICK — Implement quadrant: Set a Bootstrap CUSUM prediction before you start. We expect an upward change point in measure Y within Z periods. This pre-commitment is what makes the evaluation honest. Without it, any result can be declared success.
After PICK — Challenge quadrant: These are higher-stakes, longer-lag interventions. The Bootstrap CUSUM prediction is even more important here — because the lag is longer, the temptation to abandon the intervention before it has had time to work is greater. Pre-specify the change point before you start. Then wait for the data.
The combination is the complete improvement cycle: RCA finds the cause → PICK prioritises the solutions → PDSA structures the test → Bootstrap CUSUM delivers the verdict.
Where PICK sits in the improvement method
PICK is Step 6 of the seven-step improvement method. It sits between generating possible solutions (Step 5) and making a plan to implement them (Step 7). Its role is simple: ensure that effort goes to the actions most likely to move the outcome, not the actions that are most familiar, most comfortable, or most championed by the most senior person in the room.
This concept sits within a broader framework for making improvements that stick. See the complete 7-step improvement method for how PICK fits into the full cycle, or go to Why Nothing Changes for the diagnostic framework that precedes it.