[MUSIC] Welcome to Module 5, Targeting Your Aim, Choosing a Specific Focus For Your Improvement. In this module, we're going to be looking at specific improvement in healthcare quality. And the reason for healthcare quality improvement are many. It may be that you're frustrated with the process, or maybe that there's a piece of evidence based practice that you would like to implement. What we'll be particularly going through in this module is, how to make this improvement. And specifically related to narrowing that global problem or that global kind of frustration that you're experiencing in your practice, and narrowing it down for a specific aim. But before we get into the specific aim component, I'd like to just review the components of quality improvement. These are the four components that we will be going over in the ten modules of this course. We've already looked at knowledge of a system. Next we'll be going over knowledge of variation, where we're going to be looking at data. The third area is knowledge of psychology, and the fourth is the theory of knowledge. As you recall, our knowledge of the system is related to creating fish bone diagrams, looking at the context of the care that you're delivering, and identifying and using the tools of quality improvement to better identify the specifics of the context. So this is just a graphical review of those four components of of quality improvement. As you remember when we looked at the knowledge of a system, we used the tool of a fishbone diagram in order to capture what's happening in the context, so that you're better able to understand what's exactly happening in the process you're trying to improve. The next pieces that we will be covering in the course, are the psychology of change, and also data and variation of the data, and last the theory of knowledge or the model for improvement. We're going to talk a little bit about the model for improvement today. Also in the past, module one, we had you create a global aim. And that's again what you're interested in general about what you would like to improve. An example of a global aim is that we just want to increase the number of diabetic patients who are receiving aspirin in our clinic. So it's just an issue or a frustration or an evidence based practice that you're interested in implementing. In a prior module, you also looked at the current evidence backing up your problem or issue that you're interested in improving. You did a literature review and an industry assessment. And then you also did a fishbone diagram or a process diagram that looked at the system of care in which you're trying to improve. We also talked in prior modules about teamwork, and that it was so important to have a clear goal in mind, and that the roles of your team members were clear. And then a lot about relationship building. That in your team you are able to have clear expectations of who's doing what. And also that you're able to provide feedback to your team members. And lastly the model for improvement, which we will be covering each week as we go along. And in the model for improvement, it's really looking at what are we trying to improve as the first step? And that's actually the content for the module for today. The background reading for the module today is chapter four, Targeting An Improvement Effort. And the outcomes or the goals for this chapter are to specify areas to be improved. Base your choice of improvement project on your patient's needs. And then learning to narrow the focus of your improvement work. And then to write a smart aim statement. For identifying improvement areas, you can cover three main points. And that is, what could be changed at the point of care? Maybe there's an evidence based practice piece that you would like to see implemented into care. Or maybe there's a quality indicator in your unit or in your clinic, or in your practice that is indicating that there's a problem with your practice. Or maybe you're just frustrated with one piece of the system, that you would like to see improved. Maybe patients are waiting too long to get into your clinic. There's ways to narrow your problem, and these are the ways, looking at Feasibility, Interest of the problem, Novelty, Ethics, and Relevance. We'll go over each of these in the following slides. How to focus your aim: one area is to really look at the feasibility of your project. Assess your position or your authority in the system. If you don't have authority to change that process, or to implement that improvement, probably the study or the quality improvement idea isn't that feasible. So you want to make sure that you have the power of authority to make the change. The next criteria for how to focus an aim would be your interest level. You really want to match your personal passion with the institutional priority. There's nothing better than having passion and determination to improve a process, or to improve a part of your practice. And then to have that institutional priority matched with your passion, in order to relate to success. A third criteria for how to focus your aim, would be the novelty of the idea. And that is, to really specify the action to optimize at the local system level. Fourth is Ethics. You must ensure that there's no threat or harm to your patients, and that the IRB policies will be followed. And the last criteria to consider for how to really focus your aim, is the relevance. Is this particular improvement project relevant for your patients, relevant for staff, and then also relevant for administrators? You really need the buy-in of all these different levels, in order to have a successful project. I'd also like to first now review the global aim. In a global aim, it's a general statement for what’s the problem that you're interested in studying. We created a template for you to use in order to determine your global aim. The first is to answer the question: “We aim to_____” and insert the name or the process that you're interested in improving here. And then you put an “In”. Insert the clinical location in which the process is embedded, or where you're going to be doing your improvement efforts. Next is the “Process begins with____”. So where's the starting point for your project? And then the process ends with: where does the process end? These are the important components of a global aim. Also important in the global aim, is by identifying what you expect as the outcome. So you answer the question “By working on this process, we're expecting to_____”, and then we'll list the benefits for what will happen after the improvement project is implemented. And then the last part of the global aim statement is to consider why is this important to work on? “It's important to work on this now because_____”, and then you list the imperatives as to why this is an important piece. Structuring your global aim here will be a clear way to send your message to your patients, the staff, and then also to the administrators. Here's an example of a global aim. We aim to improve the efficiency of the discharge process on 4 North, beginning with patient admission and then ending with discharge. The benefits of this project, are that we'll have higher patient satisfaction. Everyone will be happy with that. The patients, the staff and also the administrators. And the importance of this work is that we will have improved patient outcomes, and a more coherent discharge process. I want you to go back now and look at your global aim from step one from module one. Is your global aim feasible? Is it interesting to you and also interesting to your healthcare institution or your clinic? Is your global aim novel? Is it ethical? And is it relevant? Now we're going to move on to taking that global aim and narrowing it down to a specific aim statement. This rubric will help you to narrow your aim down. When you narrow your aim down, you will be better able to measure the outcomes of your improvement project. The specific aim statement needs to be specific. That's the S in the smart rubric. Then your specific aim needs to be measurable. Third, the aim needs to be attainable. Fourth, reasonable, and fifth, there must be a time frame associated with your aim statement. Now we're going to take the global aim example that we had listed before, and then create a more specific aim for this global aim. So remembering that we're trying to improve the efficiency of the discharge process on 4 North, beginning with patient admission and ending with discharge. And our goal really is to have better patient satisfaction. We're going to use the specific aim statement, then, for this global aim to create a very smart aim for this project. We're going to use this rubric. And the rubric consists of these particular components. So you answer the first question with “By”. So by what date will this project be achieved by? And then you write in what you aim to do. Are you aiming to increase, or decrease? And then what specifically you're going to increase or decrease. Then you need to add into your specific aim, “in”-- what population that you're going to include. And then “by” how much are you going to change in order to achieve an outcome? And that is, that you state your percent goal for the increase or decrease. And then “through”, so state how you're going to achieve this improvement. And those are the interventions that we're going to get to in module seven and eight. In the book it lists many different examples of aim statements. Some good ones and some not so good ones. And if you go back to the page in the booklet and re-look at these, you'll see that when the Aim Statement is not good, it's missing a time frame, or it's missing a way to measure the outcome. Here's a little bit of case study then to help us to formalize how we would create our specific aim statement. So you're a nurse at an improvement team to reduce the deep vein thrombosis on your unit rate. And in your team, they reviewed the unit's data. You identified that the DVT rate is 10% higher than the national average. The physician on your team is very frustrated because she is very diligent on ordering a DVT prevention on all the patients but for some reason, we're still having a high DVT rate on the unit. So the unit nurses are wondering about compliance with the DVT protocols. They then conducted an audit to find out how often are the nurses using and implementing the preventative prophylactic. They found out that only 50% of the patients are observed with having their SCDs on. The team then develops a global aim statement and also a specific aim statement. Now, I'd like for you to take a minute to write a global aim statement for this case study and then, write a specific aim for this case study. So in summary, in chapter four, we targeted your improvement effort. We went from your global aim, that you created for module one, and then used some of the pieces and suggestions in the chapter then to narrow it down. In this chapter you specified areas that you wanted to be improved. You looked at best choice of improvement project on the patient's needs. And then you narrowed your focus for your improvement work by creating a smart, specific aim statement. [MUSIC]
