Crafting a SMART Aim

Transcription

1 Crafting a SMART Aim Munish Gupta MD, MMSc Quality Improvement Director Department of Neonatology Beth Israel Deaconess Medical Center Boston, MA Munish Gupta MD, MMSc is a staff neonatologist and the Quality Improvement Director for the Department of Neonatology at Beth Israel Deaconess Medical Center in Boston MA. He is also co-chair of the Neonatal Quality Improvement Collaborative of Massachusetts. Annual Quality Congress Special Preconference, Friday, October 2, 2015 Jump Starting Quality Calling All Fellows! Strategies to Launch a Successful Quality Improvement Project Crafting a SMART Aim Objective: Draft, critique and refine a SMART Aim that includes the 5 key components (specific, measurable, achievable, relevant, and time-bound).

2 Disclosures Crafting a SMART Aim: Laying the Foundation for Improvement I have no relevant financial relationships to disclose. October 2, 2015 You re a NICU fellow. You re told you have to do a QI project as part of your fellowship. You happen to also think QI is important. At a meeting with your fellowship director, she asks you, so what do you want to work on for your QI project? Where do you begin? Model for Improvement Setting Aims Establishing Measures Selecting Changes Testing Changes Foundations are Important! What are We Trying to Accomplish? Three steps: 1. Identify an improvement area 2. Narrow the focus 3. Create an Aim statement Blogs.wsj.com, Ogrinc et al, Fundamentals of Health Care Improvement, Joint Commission and Institute for Healthcare Improvement, 2012 October 2,

3 Ideal health care: Safe Effective Patient centered Timely Efficient Equitable Institute of Medicine, Crossing the Quality Chasm, Look at your systems! What practices don t seem ideal? What does the data show? What frustrates you? You are frustrated by the number of preterm infants that are stuck on ventilators in your NICU. You decide you want to work on respiratory care as your QI project. Where do you go from here? Step 2: Narrow the Focus FINER Feasible Interesting Novel Ethical Relevant You re talking with some of the RTs and NNPs in your NICU, and ask what they think can be improved with respiratory care. Immediately, they respond with a long list: earlier surfactant, avoiding intubation, better CPAP, oxygen targeting, etc. etc How can you focus your project? Ogrinc et al, Fundamentals of Health Care Improvement, Joint Commission and Institute for Healthcare Improvement, 2012 October 2,

4 What is an Aim Statement? An aim statement is a clear, explicit summary of what your team hopes to achieve over a specific amount of time including the magnitude of change you will achieve. The aim statement guides your work by establishing what success looks like. NICHQ Why is an Aim Statement important? Provides clear direction Avoids wasted time and effort Helps keep a project on task Aligns multiple stakeholders Insures buy in from key participants Aids in identifying appropriate measures Defines scope and breadth of project Some is not a number; soon is not a time. Here is what I think we should do. I think we should save 100,000 lives. And I think we should do that by June 14, months from today. Some is not a number; soon is not a time. Aim statement, first draft: We will reduce the need for mechanical ventilation in preterm infants in our NICU. Here s the number: 100,000. Here s the time: June 14, a.m. Don Berwick December 14, 2004 October 2,

5 Aim statement, second draft: We will reduce the percentage of preterm infants under 30 weeks requiring any mechanical ventilation in our NICU. Aim statement, third draft: By the end of 2016, by improving the use of CPAP in the delivery room and initial stabilization, we will reduce the percentage of preterm infants under 30 weeks requiring any mechanical ventilation in our NICU from 50% to 30%. Laying the Foundation: Project Charter Laying the Foundation: Driver Diagram Take Home Lesson All of this (and more) should be done BEFORE considering changes to test. Most common mistake in doing quality improvement work (in my opinion): jumping to changes before specifying aims and measures. October 2,