This course provides students with a set of tools and methodologies to plan and initiate a Problem Solving or Quality Improvement project. The first module presents methods for selecting, scoping and structuring a project before it is even initiated. It also introduces the project classifications of implementation and discovery. The second module describes the A3 problem solving methodology and the tool itself. Further in that same module, the student is shown tools to identify problems in flow, defects, and waste and to discover causes, brainstorm, and prioritize interventions. Module 3 shows a methodology within the implementation class. These methods are designed to overcome emotional and organizational barriers to translating evidence-based interventions into practice. The fourth and last module looks at one more way to approach improvement projects in the discovery class. These tools are specifically for new, out-of-the-box design thinking.
Goal Setting
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Do curso por Johns Hopkins University
Planning a Patient Safety or Quality Improvement Project (Patient Safety III)
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Project Selection Strategy and Tools You Can Use
In this module, you will see the process for defining, scoping, selecting and prioritizing improvement initiatives. Further, you will learn necessary team characteristics and organizational support structures.
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Bob Hody
Hello. Let's talk now about goal setting and how
that relates to the selection of the work you're going to be doing.
The first thing I'd like to talk about is the idea of only having one goal.
You only get one to definitively determine
if your QI effort was successful or not in the very end.
Let's think about what would happen if we had multiple goals.
For example, increase the percentage of
discharge by noon and reduce length of stay on a unit.
Might not sound unreasonable,
but let's think about that.
If discharged by noon were improved,
but length of stay increased,
would that work be ultimately termed as successful?
Now one goes up,
one goes down, one's good, one's bad.
We really wouldn't know.
So, we really recommend that you only list one goal one,
singular goal of success.
However, keep in mind that a single goal can yield multiple benefits.
For example, I had mentioned blood wastage a while back.
And the element of blood wastage was that we were issuing many units of blood out.
And unfortunately, when they came back to the blood bank,
some of those units had to be disposed of
because they exceeded time and temperature parameters.
So, we could have very well focused on the element of,
well, the wastage piece as well as the dollar piece.
And one could have gone up and one could have gone down.
But instead what we did is we listed the goal
in terms of the wastage of a human precious resource.
The dollars that we saved were
significant but they were listed as a benefit down the road.
So we focused on the main thing,
the singular goal, and we were successful.
We actually achieved both.
So, writing a goal statement.
The goal should address the problem using action words with an estimated completion date.
That's what we highly recommend.
So, improve the specific metric from whatever it is at baseline or
today to something better by a certain point in time.
Now, a lot of goal statements don't include
that point in time that you hope to achieve this.
This helps your team later on understand what that success will be.
Not just the what,
but the when as well.
So they need to understand what they're on the hook for essentially and
how long they're going to be engaged in this process. You might be wrong.
It might take you a week,
a month, two months after to achieve that goal.
But at least you're trying to hold yourself and
everybody else accountable to a certain time frame.
So, let's go with an example,
project goal: reduce blood wastage from 4% to
2% of total units issued by October 1st and then you can put in the year.
Another one, implement nurse purposeful rounding on the rehab unit,
minimum 80% compliance by February 1st.
So let's think about that goal.
If the goal was simply to implement nurse purposeful rounding on a rehab unit,
how would we measure that goal?
How would we know we achieved it or not?
You know, what if some people are doing it and some aren't?
So, that's why we inserted that 80% compliance,
so something very specific and measurable.
That ties us into the next topic about SMART goals.
Many of you have heard of this before.
It's very, very simple and straightforward.
Specific, is your goals very specific?
Is it singular.?
Is it something that everybody can understand?
Is it measurable?
Can we measure success or progress towards that goal?
It is achievable.
Are we trying to boil the ocean?
Is it scoped appropriately?
And what ties into that is, is it realistic?
If we wanted to say that starting next year,
we're going to eliminate all infections acquired in the hospital,
would that be realistic?
I don't think so. Folks wouldn't even
engage on that one because they knew it was impossible.
And last but not least, is it timely?
Is it something we can do in a realistic period of time?
Another way of looking at this is looking at the current state and
understanding what the gap is between
the current state and what is the best possible outcome.
So, using the example I just used about hospital acquired infections,
the best theoretical number we could achieve
next year wouldn't be the goose egg, it would be zero.
But how realistic is that? Not very.
So, in the absence of having data really articulate what we think the goal is,
a rule of thumb is to essentially close that gap by half.
So perhaps, we'll decrease infections or current rate by 50%.
And then when we collect data we might realize that that either
is or isn't achievable and we can then modify that goal.
The goal, like the problem statement,
like the key metric,
will most likely morph and change over time.
As we know more, we'll make it more solid.
Let's talk about that type of evolution.
So initially we don't know what we don't know.
Maybe the problem is we know our patients,
patient population, the folks we treat,
our cholesterol levels are too high.
And our metric, okay,
and that's also known as Project Y,
is the patient's, percentage of patients with high cholesterol.
And then the goal would be to reduce the number of patients with high cholesterol.
So again, at the beginning it's rather vague and we don't know.
We will then start to obtain some data and
learn more about that and add more and make that goal more specific.
So, the problem statement might now read
specifics in terms of cholesterol levels exceeding
200 and what percentage of our patients are at increased risk of heart attack and stroke.
So, how are we going to measure? What's our key metric?
Well, how are we measuring total cholesterol?
MGE over DL.
And then what would our goal be?
Reducing patients exceeding 200 milligrams per DL from 75% to 50% by June 9th.
So again, it's okay to start out a little wide if you don't know what you don't know.
But then as you get more data,
morph that goal over time and make it more SMART.
Goal do's and don'ts.
We recommend you have others weigh in.
All the stakeholders should say,
"Do you feel that that goal is realistic?"
That 50% that I talked about earlier,
that's a rule of thumb but it's usually pretty good.
Pretty good. Because it tends to be a stretch goal but it's typically achievable.
Make it a SMART goal.
Do that litmus test.
Go through each element: S, M, A, R,
T and evaluate what your goal statement is.
And make sure it fits that criteria.
Include a metric of success and estimated time of completion.
So, we have to be able to measure it and know what success looks like,
and again, when do we think we'll be done?
And also leave in that category the element of we'll have to measure it for a while,
a period of time,
before we can declare victory.
Address the specific problem.
One of the biggest failure modes we see with goals and for
that matter problem statements and
key metrics is they don't always agree with each other.
So, if you have the problem and the problem is maybe time related,
you don't want to have a goal that's maybe defect related.
If the alignment would be that
both the problem statement and the goal had that element of time in there.
Don'ts, highly not recommended.
State multiple goals. You can only have one.
Over under-commit, be realistic about the level of improvement.
You know some people like to set the bar down low and,
you know, super achieve it.
And other people like to raise it too high and they never come close to it.
So, you have to be realistic about what's possible.
Don't cast in stone.
Like everything else, it's going to change over time to reflect what's known.
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