Richard J. Banchs - The Quality Improvement Challenge

Gap. What is the gap between our current state and the ideal state? What needs to happen?

A problem statement is often supported by a goal statement. The goal statement should be brief and specific, use the same metrics as the problem statement, and include a specific date by which the project should be completed successfully. A goal statement often accompanies the problem statement and defines the targets of the QI project.

Imagine you walk into an elevator and the CEO of the hospital comes in right after you. He politely greets you and then asks you about your project. He has heard from your chair that you want to launch a QI project to improve the current situation in the cath lab. What are you going to say? Well, here are some of the questions you may want to address: What’s the problem? How is the problem affecting your patients? Why is it important? Why address the problem now? What are your goals? You may have a clear idea of what you want to improve, but you should be able to articulate it in a succinct and clear fashion.

Quotable Quotes: “A problem that is poorly defined has an infinite number of solutions but a problem well defined is a problem half solved.” Wally Davis

The problem statement may include a “burning platform” or statement that provides a brief explanation of the reasons why we should address the problem now. The burning platform establishes what makes this project a priority now, versus, let’s say, something else. The burning platform or business case should answer the following questions:

Why are we addressing the problem now?

What benefits can we expect for our patients, staff, physicians, and healthcare organization?

How does this project support /relate to the overall strategic goals of your department?

How is it aligned with the strategies of the hospital?

The burning platform may also include a statement about the consequences of not addressing the issues now, and a statement that establishes a clear link between the project and the strategic business / clinical priorities of the hospital (or area, unit, department).

The Problem Statement

Ideal state: First‐case on‐time start accuracy should be above the 50th percentile of cohort performance. One hundred percent of the causes of delay should be appropriately documented in our EMR .

Current state: Data from Surgical Compass® Cohort Benchmark analysis shows a first‐case on‐time‐start accuracy rate of 16 percent (160/1000) (< 25th percentile of cohort performance) in our operating room. Delayed on‐time‐start is the cause of decreased quality, loss of productivity, and ongoing dissatisfaction among our patients, surgeons, and OR staff. Preliminary data reveal that in up to 65 percent (546) of the delays, the appropriate cause is not well documented, which is preventing our efforts to address the situation .

Gap: 25 percent difference between ideal state and current state, with 546 causes not being fully documented .

After the problem has been clearly defined with a Problem Statement, it is time to agree on the nature and specifics of the project. The Project Charter is the most important document of your project.

The Project Charter is a document that serves to gain agreement between the Primary Sponsor and the QI team as to the nature, scope, goals, and timeline of the project. The Project Charter concisely delineates the who, what, when, where, how, and why of the project.

The Project Charter is key to helping the QI team achieve the goal of the project because

It helps everyone understand the aim, scope, and goals of the project.

It serves to gain agreement between all parties.

It authorizes the project’s initiation and use of resources by the QI team.

The Project Charterserves as an informal contract between the Primary Sponsor and the project team as to the scope, roles, responsibilities, and nature of the project. An initial draft of the Project Charter must be complete at the beginning of the project. It must also specify who the Project Sponsor, physician sponsors and project manager / leader are. Once the team is formed, the Project Charter can include the project team members, team leader, and key stakeholders when they become known.

The Project Charter can be referred to throughout the project’s life cycle when questions arise regarding expected project performance, deliverables, and timelines. It is a living document that should be updated throughout the project as new information becomes available.

A Project Charter is not a project management plan. It is not a comprehensive document detailing all the steps and actions necessary to complete the project. Instead, the Project Charter is the compass that sets the direction for the QI team, clearly outlining the participants, scope, metrics, and goals of the project.

Quotable quotes: “To solve a problem or to reach a goal, you don’t need to know all the answers in advance. But you must have a clear idea of the problem and the goal you want to reach.” W. Clement Stone

The Project Charter must have the following six important components:

1 A Problem Statement. A Project Charter must have a problem statement to clearly define the focus of the project; What’s the problem? Reasons for action? What’s the background? A burning platform may be a part of the problem statement. The problem statement provides the reasons for prioritizing the project at this time, the anticipated consequences if the project is not undertaken, and the project’s financial or clinical implications if known.

2 The scope and boundaries. What are we going to improve?, and very importantly, what is not going to be addressed now? What is in‐scope and out‐of‐scope? The scope and boundaries of the project help the team focus on the work that needs to be done, the areas or issues that will not be addressed at this time, and the expected deliverables.

3 Key metrics. What are we going to measure? How will we know we have improved? This section describes what will be measured and how the project success will be defined and evaluated.

4 Goals and objectives. What do we want to achieve? What will success look like? This section defines the proposed project goals. Remember, goals should be SMART: Specific, Measurable, Attainable, Realistic, and Time‐Bound. If the current baseline performance is not known, specific project goals can be set at a later date after the current process performance is defined (see Chapters 14– 17). Project goals should be agreed upon with the Primary Sponsor and Key Stakeholders.

5 Milestones and timeline. By when do we want to achieve it? Estimate the dates when specific deliverables will be produced. There are numerous tools to estimate timelines. A great way to visualize a project’s timeline is by creating a Gantt chart, a type of horizontal bar chart that outlines all the tasks involved in a project shown against a timescale that serves to give the reader an instant overview of the entire project, together with information on the order of the tasks and when each task needs to be completed.

6 Signatures. Who are the parties involved? A Project Charter should bear the signature of the key parties:as a sign the project has been approved by the Primary Sponsor;as a sign of commitment by the team leader and the members of the QI team; andto establish a clear agreement on the nature, scope, goals, and timeline of the project.