The Quality Improvement Challenge. Richard J. Banchs
to provide a work product. When serving patients, the work product is “care and the healthcare experience”; when serving other providers and staff, the work product may be “information, supplies, results, etc.”
Stakeholders want to do a good job. To perform optimally, they need equipment, supplies, information, and resources, on time, every time. They also need standards, updated policies, and proper procedures. If there is a problem with their performance, we need to ask ourselves: Do they have what they need? What are their challenges? Stakeholders’ inability to deliver the service the customer needs and expects may be related to problems with the system: Do needed supplies arrive on time? Is the equipment in working condition? Is the work process standardized? Perhaps frontline stakeholders don’t have the equipment and supplies they need, or the people responsible for supplying them with what they need are not doing so in a timely fashion. In any case, a QI project may need to be launched to find the causes of poor performance and address stakeholders’ needs.
The Voice of the Process (VOP)
The VOP is how the process communicates performance against customer needs and expectations. This communication is done through process measures and in the form of data. Sometimes a QI project is launched to address process performance on a specific metric. This is the case when financial reports, clinical audits, and other types of data show a gap in performance. There may be an increased number of complications or readmission rates. Even if we don’t have a VOC or VOS, the VOP (increased costs, slow response times, miscoded charts, increased narcotic discrepancies in the MICU, etc.) may be reasons why you and your team decide to launch a QI project.
Quotable quote: “If opportunity doesn’t knock, build a door.” Milton Berle
THE PROJECT SELECTION PROCESS
The Goal
The goal of the Project Selection Process is to select a QI project that is important to you and your organization in addressing critical issues of patient care, healthcare experience, costs, and resource utilization. A weak, undefined Project Selection Process makes improvement efforts more difficult and time consuming. A strong, defined, communicated and ingrained Project Selection Process can really make a significant difference in a healthcare organization’s improvement efforts. A strong project selection process has the following characteristics:
Projects are selected from both leadership and the front line (top down and bottom up); anyone can initiate a project idea.
Criteria for prioritizing potential projects has been operationally defined and accepted by key leaders.
Projects are selected based on their relationship to the hospital’s (area, unit, department) strategic initiatives and goals.
Leadership actively supports selected projects and is willing to provide the necessary resources.
Successful projects are those that are important to you and at the same time have the support of the leaders. Spend time during the project selection process to make sure you screen project ideas, focus your approach, and select the project that best delivers on the needs of your organization. If your project is not addressing the most pressing issues, you may not generate the support and get the resources you need. When that is the case, leadership buy‐in may be difficult, mid‐level manager’s resistance may be high, and your team will struggle. The eventual outcome of your QI efforts may be less than ideal.
Project Selection Criteria
For each problem you have identified, define the current state of performance and compare it to the ideal state of performance. Do you have data you can use? What is the gap between the current state and ideal state of performance? How will we know we need to improve if we don’t have data? What issues are critical? Narrow down the list of projects to those that address critical issues or are directly related to them. For each project, write a summary statement that details the current state versus ideal state and the gap between them. Define your project’s desired outcomes.
Consider the scope and complexity of the improvement effort. What resources are available? Choose wisely! Consider your availability as well as the availability of project leaders, team leaders, and team members, especially if their involvement in the project is not part of their primary role. Remember, you still have a full‐time job!
Several criteria are important to consider when selecting your project:
The Aim/ Purpose. Every QI project must be related back to the overall strategic initiatives and goals of the organization (department, unit) via the metrics of the project. Project metrics such as safety, quality, productivity, or costs must be traceable both up and down throughout the organization. What is the gap between the ideal state and current state of the process performance? How do you know? Is the project targeting the internal or the external customer?
Scope. What work process will be the focus of your QI project? What will be the start point and what will be the end point? What performance gap are you trying to close? Is your project overly ambitious for the time allowed? Make sure the scope of your project is realistic and you are not trying to take on too much, often referred to as “trying to boil the ocean.”
Leadership. Make sure senior and local leadership can actively engage in supporting the project and are willing and able to provide the necessary resources (time, personnel, administrative assistance, money). Remember, one of the most important resources is time! Time away from clinical duty is needed to actually be able to successfully complete and implement the QI project.
Timeline. Can the project realistically be completed within a one‐ to six‐month period? A good rule of thumb is for the first couple of projects to set the target to one to three months. If the project duration extends longer than six months, other issues may arise that will make it difficult to complete your project.
Competing priorities. Will any other initiatives be affecting the process targeted for improvement?
What Does a Good Project Idea Look Like?
There are several characteristics of a good project, including the following:
The project is connected to the hospital’s (area, unit, department) strategic objectives and addresses the current priorities of leadership.
The problem addressed by the project is recognized to be of major importance and addresses issues of quality, safety, productivity, or cost.
There is a clear primary metric that the project is trying to improve.
The project scope and boundaries are not too ambitious, and the project timeline is acceptable.
The project will have support from senior and local leadership.
Project Selection Steps
Project selection follows these four steps (see Figure 3‐2):
1 Scan. Generate a list of project ideas. Review the VOC, VOS, and VOP if available. Review your clinical and operational metrics. Discuss ideas with leadership.
2 Select. Select 3 to 5 important issues. Identify your frontline staff’s “pain points” and areas of poor performance based on available information and data. Using the above information, develop a list of potential projects; add any other ideas you may have. Focus on problems of quality, safety, productivity, or cost.
3 Filter. Narrow the list. Get data (if available). What is the current performance? What is critical? What needs to be addressed? Screen your list with basic criteria outlined in the previous section. Sort any of those that do not meet the necessary criteria. Write a concise statement listing desired objectives.
4 Prioritize.