Eli's Hospice Insider

Know three types of measures to keep your changes on-track.

Process improvement keeps your hospice running smoothly and your patients and families content. Could your method for creating process improvement projects use a tune-up?

Three questions pave the way to a well-planned process improvement project (PIP), says Charlene Ross, MBA, MSN, RN with R&C Healthcare Solutions in Phoenix, AZ.

1. The aim -- What are you trying to accomplish?

2. The measure -- How will you know that a change is an improvement?

3. The change -- What changes will result in an improvement?

Define Your Aim Statement

The aim statement identifies what you are trying to accomplish, Ross says. A good aim statement sets the goal for your PIP and:

• Defines what will improve
• Specifies the target goal in numerical terms
• Identifies the specific population that will be affected
• Defines when the improvement will happen

For example: Your aim statement might be "By December 31, 100 percent of all admits will have an initial assessment within 48 hours of electing the hospice benefit." In this case, it's the initial assessment that will improve, Ross says. The target goal is 100 percent, and the patient population benefits. The improvement will happen by December 31.

Caution: 100 percent isn't always a reasonable target, Ross cautions. In this case, it makes sense because the target is a regulation -- something that you are required to do 100 percent of the time.

Before you get to work on your PIP, you should make sure your aim statement measures up, Ross says. Assess your aim statement by asking the following questions:

• Is the aim specific enough to be accomplished in the defined time frame?
• Do you have the right team to accomplish the aim? The team should include staff involved in the process.
• Are the goals and population consistent with the focus of the PIP?

A good aim statement keeps you focused and prevents you from going down rabbit trails, Ross says. For example, suppose your aim statement was "To reduce after hours calls related to medication refills by 10 percent by January 1st."

Suppose that as you review the after-hour call logs, you also discover that you are receiving a number of calls from patients and family wondering what staff will be visiting and when, Ross suggests. Your aim statement should keep you focused on the goal at hand -- reducing medication refill calls. Reducing the number of staffingrelated calls could be the focus of another PIP.

What gets measured gets addressed, Ross says. So being able to measure the PIP change you make is vital to improvement. There are three types of measures you should consider when conducting a PIP, Ross says:

1. Outcome Measures. What is the impact of the PIP changes on the population identified in the aim statement? Outcomes are most useful as quality indicators if they can be linked to specific process measures that, if altered, change the outcome, Ross says.

Example: The percentage of admissions whose initial assessment was completed within 48 hours of electing the hospice benefit.

2. Process Measures. How will you know if the changes are being used or followed? Did you make the change you set out to make? Process measures are most useful as quality indicators if changes in them can demonstrate improved patient outcomes, Ross says.

Example: The percentage of patients with documented initial assessments completed within 48 hours of election.

3. Balancing Measures. Were there any unintended consequences of the changes?

Example: The percentage of patients complaining that the initial assessment was too long or too overwhelming at the time of admission. Or the amount of information being duplicated between the initial and comprehensive assessments. In the end, measures are just a means to an end -- it's improvement that is the goal, Ross says.

Once you've established your aim and measurement methods, testing and implementing the change are your next steps, Ross says. Ross recommends the following process:

1. Plan and conduct the test. Define the data to be collected and make some predictions about the results. Then run the test on a small scale.

2. Look at the results of the data collected to see if there was a difference.

3. Study the results of the test. Was the change effective? Were the results what you expected?

4. Act on what you learned. If the change was effective, you're ready to roll it out organizationwide. If not, improve on it.

5. Plan for the next test or put the change into practice.