Target Condition & Countermeasures SMART Goals Setting Measures (Process, Outcome, Balancing)

A3 Roadmap for Performance Improvement at Penn Medicine

Goal Setting Goals should be SMART Avoid: Specific Measurable Attainable Relevant Time Bound Avoid: Wasting time Frustration Confusion Unmet expectations Example: Penn Medicine’s target performance goal is a 2% reduction from FY12 in observed to expected inpatient mortality by June 30, 2013.

SMART GOALS SPECIFIC Measurable Look at Problem Definition and SCOPE to help with specificity Should Make Sense to Everyone Measurable If you can’t measure it you can’t change it. Metrics can be INPUT or OUTPUT

SMART GOALs Attainable Relevant Time Bound Meaningful but realistic Should be guided by the original problem Relevant Fixes the “What would be better about that” from the problem statement Time Bound Process Improvement needs to have an end date for projects.

Goal metrics Taken from your baseline metrics Should be SMART – Specific, Measurable, Attainable, Realistic, Time-bound Penn medicine will reduce its FY14 observed to expected (O/E) mortality ratio by 0.04 compared to FY13 by June 30th, 2014.

3 Types of Metrics Process Outcome Balancing A measurement of how your process is working - how often you do something, how you do it, etc. Percent of heart attack patients given aspirin on arrival to the ED Outcome A measurement of the effect your process has – the patient's outcome Death rate for heart attack patients who made it to the ED in time Balancing Did your process improvement cause a new problem? Percent of GI bleeds in heart attack patients who got aspirin in the ED

Thinking About Baseline Metrics What kind of metric is this? What would be a process metric for this? What would be a balancing metric? Good baseline metrics will lead you to your target condition goals 0.76 0.72

BEFORE and AFTER metrics Stopped using new process New Process Restarted new process

Translating Root Causes into Countermeasures Countermeasures reduce or eliminate the root causes of problems Good root cause analysis makes countermeasures obvious Link your countermeasures to specific root causes Test all countermeasures to validate them Develop as many countermeasures as possible. For each potential problem identified, brainstorm possible countermeasures. It is important that the team working on these countermeasures is cross-functional to see all expects and create a complete improvement Then, narrow them down to the most practical and effective ones. Use criteria such as cost, time required, ease of implementation and effectiveness. Build consensus with others. Select the ones to test. Create an action plan for implementing them. Lay out a time line with the action steps, roles, responsibilities, and deadlines. Determine the measures you will track to evaluate progress toward improvement.

Connect Root Cause to Countermeasure Drill Down on Possible Causes Problem: Cement is falling from the ceiling because it is being washed several times a week Why? There are lots of pigeon droppings Why? Pigeons come to eat the spiders Why? Spiders come to eat the midges Why? Midges fly to the flood lights of the monument Why? The lights come on before dusk and attract the midges Turn lights on later