Lean, Six Sigma, and the IHI model all begin with the same step: identifying the problem that needs to be solved. Regardless of the improvement methodology used at your health care setting, you need to first succinctly identify and describe the problem. The following are steps to help guide the improvement implementation process.
A problem statement is a concise description of the problem you want to impact. It is used to focus your efforts and to keep you and your team on track for improvement. A problem statement should be specific and describe the nature and significance of the problem.
Here is an example of a problem statement:
Laboratory testing in the ED for acute coronary syndrome includes the use of tests that are no longer considered standard practice (e.g., CKMB), leading to unnecessary testing for the patient, wasted processing and review time by providers, and ultimately increased cost to the health care system and possibly also the patient.
Here is another example:
Internal Medicine discharges from General Hospital are delayed for hours after discharge orders are placed, leading to wasted time of clinicians and delays in getting patients home from the hospital in the afternoons. We will continue to explore process improvement using this example.
What do you aim to do with project to impact your problem statement? This goal should be specific and measurable. One way to help structure your aim statement is to make it a SMART goal. A SMART goal is Specific, Measurable, Attainable, Relevant, and Time-bound.
Let’s go back to our one of our problem statements from before:
Internal Medicine discharges from General Hospital are delayed for hours after discharge orders are placed, leading to wasted time of clinicians and delays in getting patients home from the hospital in the afternoons.
Initial goal statement:
Increase the number of discharges from our hospital in the mornings.
IS THIS SPECIFIC?
IS IT MEASURABLE?
IS IT TIME BOUND?
SMART aim statement:
Increase the number of patients discharged and out of their hospital room by 1pm from the acute care floors of General Hospital by 20% (baseline: 10%) within the next four months.
What do we already know works to address the goal you have in mind? Could one of these approaches work in your clinical environment? Could an adapted version work? Is something new needed?
These are all important questions to ask before diving into implementation, something we all want to do! It is first worth your investment to truly understand the current state and frame a structured approach. While it may seem like busy work initially, you will not regret the investment of a literature search, and you’ll likely discover new information that will further refine your proposed intervention. You can also reference these materials with stakeholders and project members.
Though a common place to start your review is PubMed, remember that not all research is published by academic journals. Gray literature include reports, working papers, government documents, white papers, and evaluations. Check out UPenn’s curation of grey literature resources for the health sciences.
Once you have a SMART aim set, it is tempting to move straight to implementation, meet your goal, and complete the project! But, it is important to first understand all of the possible reasons and factors contributing to the problem you want to solve. This not only helps to focus and prioritize your efforts, but may also help to identify components you had not previously seen that could lead to unexpected and unintended stalls and waste.
Below we will cover three different tools to use to help you to understand the problem you want to impact. Which one you choose to use will depend on the nature of your project and proposed intervention.
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Whichever tool you decide to use, outlining the contributing causes of the problem you want to impact allows you to understand it and begin to develop a theory of change moving forward. This process sets the stage for the development of your improvement framework.
ARTICLE
Visit this site for additional information about the DMAIC process and associated tools.
Want a free tool to make the process maps we’ve discussed? This Google application is handy and customizable for just that.
This software is an add–in for Excel that makes creating the tools discussed here and more simple.