7 Features of Highly Effective Outcomes Improvement Projects

衡量责任的项目主要关注基于个人是否遵守某些过程和程序的奖励或惩罚。一个典型的例子是，根据某位医生是否遵守某一医疗机构的临床计划，向他/她支付奖金(或罚款)。那些被测量的焦点很快转移到特定的数据点是否对特定的个人准确。这个项目陷入了繁琐的细节中。当这种情况发生时，人们会担心负面的聚光灯和随之而来的惩罚。有了这种方法，就没有水涨船高了。当然，底部的一些异常值可能会改善，但个人兴趣优先，而不是检查过程和关注将有助于推动整体平均值的干预措施。结果改善被延迟或永远无法发挥其全部潜力。不要误解我的意思，衡量责任有它的位置，但是评估你的项目是否需要它，或者它是否应该专注于衡量改进是很重要的。

Ok, so what does measuring for improvement really mean? It’s the concept that we focus on the process and not on individuals. It’s the concept that interventions to improve outcomes focus on the inliers and not on the bad outliers. It’s the idea that in looking to improve the process, we don’t waste time getting every data point 100 percent correct, but get the information and level of accuracy of information needed to move forward and evaluate if interventions are working or not. Instead of punishing the three individuals who have the worst outcomes for a particular surgery by denying them privileges to perform that surgery, focus on what causes the bad outcomes in the process and implement actions to ensure those outcomes don’t occur for all providers. It should be no surprise that the project that actually measures for improvement, improves the targeted outcomes much more quickly and more dramatically because all participants know the focus is on the system and the process rather than on people. Fear is removed from the project, which is one ofDeming’s 14 Points for Management, “Drive out fear, so that everyone may work effectively for the company.” Productivity rises when individuals can assume positive intent during every interaction. The environment becomes collaborative instead of combative (in most cases) and more creative solutions come forward when the focus is on the process.

The Joint Commissionpublished a journal on quality improvement article titled “The three faces of performance measurement: improvement, accountability, research.” In it, the authors make this statement: “We are increasingly realizing not only how critical measurement is to the quality improvement we seek but also how counterproductive it can be to mix measurement for accountability or research with measurement for improvement.” Although this article is almost 20 years old, you can see how it is still relevant to illustrating the concept that we need to measure differently for accountability than we do for improvement.

2.Define Your Goal and Aim Statements Early and Stick to Them

Who hasn’t been part of a project where the scope increases dramatically over time? It usually starts innocently enough. For example, a group comes together initially to improve asthma outcomes, but then sees that patients are being referred outside of their group practice. The focus then shifts to this leakage, and so on, and so forth. Before you know it, the original goal of improving asthma treatment disappears, is severely delayed, or gets lost in a dashboard that now is the “one dashboard to rule them all.”

To keep the project moving forward, the project team should define the SMART (Specific, Measureable, Attainable, Relevant, Time-Bound) goal up front. I’ve found that defining this in the first or second workgroup meeting is usually the best timing. Establishing these parameters puts everybody to work on efforts that will return the best bang for the buck. It becomes clear when work is heading down a sidetrack and, therefore, not beneficial.

At Health Catalyst, we encourage a focus on a clear goal that the team expects to make from its improvement efforts. Then we outline our aim statements, the tactics to achieve this goal. Aim statements are written, measurable, and time-sensitive descriptions of the goal. They represent important quality topics that can stimulate enthusiastic team support. Aim statements:

• Are outcomes-focused (directly implies measurement)
• Contain specific achievable goals and stretch goals
• Include a timeline
• Clearly state the target population
• Are succinct
• Provide value (humanistic and/or financial)

Aim statements are a great tool for project managers to rally discussion and get a lot accomplished. Without them, projects become bloated, are less agile, and end up floundering instead of delivering value quickly. This isn’t an indictment against project flexibility. Aim statements, and even goals, can morph as data is excavated, but as a guiding principle, it is best to focus on one goal and between two and four aim statements for the initial scope of a project.

3.Assign a Knowledge Manager of the Analytics (Report or Application) Up Front

One of the best experiences I’ve had on an outcomes improvement project was largely due to a stellar Knowledge Manager being assigned. We implemented our Key Process Analysis (KPA) tool to help the physicians identify areas of highest variation and resource consumption in their practice. We then targeted these areas for our improvement efforts with great success. Three factors made her participation a critical success factor to the project overall. First, she was assigned up front. This way, she knew everything going on with the project from start to finish. She was able to champion the project as the permanent owner and coordinator of the team after the initial round of outcomes improvement. All the key stakeholders in the project knew her and trusted her as a result of her participation throughout the project. Second, she was not purely technical, but instead had a bit of technical background and was a subject matter expert in the process and clinical environment. Too often a purely technical resource is assigned, which risks making the project “another IT project” that gets little adoption. By having someone who could relate to both the technical and the clinical side, the Knowledge Manager was able to translate clinical concerns to the technical team and technical challenges to the clinical side. Third, she was someone they knew, trusted, and was an innovator. Choose the right Knowledge Manager and you’ll be well on your way to a successful project. If the Knowledge Manager doesn’t have the three attributes mentioned above, then the probability of long-term success decreases.

4.Get End Users Involved In the Process

Outcomes improvement projects aren’t science experiments developed in a lab with “eureka!” moments. End users need to be involved in the process. A successful outcomes improvement team cannot be just executives or individuals who aren’t on the front line. When choosing the end users to participate, it is important to think long term. Which end users do the rest of the staff trust? Which end users will be able to champion the outcomes improvement project? Often these individuals are quite busy. Successful projects choose these individuals to participate and make time in their schedules to help iterate through the application and drive adoption of the outcomes improvement project. Amazing projects get their buy in and support before even kicking off the project.

Practice iterative development of the visualizations so end users can modify the analytics to suit their needs, to something that they will actually use. Involving end users creates project buy-in and develops trust in the data because the champions have been validating it throughout implementation.

最后，一种包容的心态会带来接纳，因为你会产生内置的超级用户和冠军。

5.Design to Make Doing the Right Thing Easy

首先，分析工具必须简单易用。

For example, I work with one healthcare system that used to run reports by pressing a figurative “start button,” then would return from lunch to see the output. That is, unless the computer crashed while they were out enjoying their chicken lettuce wraps. The mechanism wasn’t easy to use and—you guessed it—reports were minimally accessed and adoption dropped dramatically in the ensuing months. Ensure a basic level of usability. Remove barriers to accessing the information needed to make improvements. Otherwise, it gets costly to create workarounds tosimplify the process.

The second design element in making the right thing easy to do involves interventions that are built into the workflow. Interventions that require more work (for example, requiring handwashing documentation every time a caregiver enters the room) are often unsuccessful. The burden is too great. If physicians are required to place three new orders (e.g., flu shot, a lab, and a script) that require five extra minutes with a patient, then this is an intervention that won’t be successful, unless there is serious buy-in.

Contrast this with example projects that focus on ways to make doing the right thing easy:

• Creating an order set that makes it easy to order the right thing vs. the old way of hunting down four disparate orders.
• Designing the right interventionsandtaking the time to think them throughandtesting them with end users (another plug for involving them throughout the project).
• A recent project to decrease central line associated blood stream infections (CLABSI) built into a nurse rounding list the prioritized patients who were at the highest risk of infection so the nurses could visit them first.

6.Don’t Underestimate the Power of One-on-One Training

Outcome improvements only happen when analytics and interventions are adopted. I’ve seen many projects flounder because key stakeholders didn’t know enough or had forgotten their training on how to access reports and analytics related to the outcomes improvement project. It’s so key that I’ll mention it again: these champions and super users need to be the subject matter experts, those who know the process well, who others trust, and who, optimally, are early adopters. Where possible, train super users and key champions one-on-one for 20 minutes on the analytics tools. This has proven to be so much more effective in getting adoption than group sessions. This isn’t to say that group training doesn’t work, but there is something magical about sitting down one-on-one with key stakeholders. It’s a safer environment to ask questions, it builds the relationship should questions come up, it often results in insights absent from the group situation, and it shows the importance of the project, particularly if the organization doesn’t do a lot of one-on-one training. Adoption improves when this happens.

7.Get the Champion Involved

我参加过项目启动会议，并让小组成员问了一些很棒的问题，比如我们为什么要做这个项目。没有人知道我们为什么选择这个特别的项目，项目的发起人甚至都没有出席。事实上，他们甚至质疑是否存在一个需要解决的问题，因为他们目前的系统提供了他们需要的东西。不用说，这些项目没有取得任何进展。

高度成功的结果改进项目的任何其他特性都不能弥补项目缺少一个主题领域的专家并且已经买好了的领导者。我参与过的最成功的一个项目中，有一位倡导者阐述了这个问题及其对个人和组织的影响。冠军需要向团队传达项目的“为什么”，并确保这些原因与所有级别的参与者产生共鸣。最好的拥护者从本质上激励整个团队和其他人朝着共同的目标努力。这是让每个人都参与解决问题和创造改进的原因。冠军定期分享愿景，鼓励和庆祝所有参与者和利益相关者，并确保结果改进项目的进展。

Outcomes Improvement: A Continuous Journey

医生、护士、管理人员、IT专业人员、分析师、管理人员——任何正在阅读这篇文章的人——都是忙得不可开交的人。质量改进项目通常是我们所有生活和呼吸保健的额外责任。但让我们面对它，提高和提供质量，无论是临床护理还是手术，是我们做我们所做的。当一切顺利的时候，你可以很明显地说，这个项目通过降低感染率拯救了生命，或者今年防止了十几例糖尿病患者截肢，或者通过减少等待时间改善了患者的体验——成为其中一员是多么棒的体验啊!那些被分配到结果改进团队的人需要积极意图的保障。他们需要明确定义的目标和目的陈述。团队需要一个所有者、一个冠军、最终用户和超级用户参与每一步，通过一对一的培训来帮助采用。最后，工具和干预措施的设计必须便于做正确的事情。当永久的团队持续关注改进并使其随时间推移时，结果改进才有效。当所有这些元素都就位时，您就知道您已经养成了一个高效结果改进项目团队的习惯。

---

PowerPoint Slides

你想使用或分享这些概念吗?下载此演示文稿，重点突出。

Click Here to Download the Slides

7 Features of Highly Effective Outcomes Improvement Projectsfrom世界杯葡萄牙vs加纳即时走地