In a recent blog post for Johns Hopkins' Armstrong Institute, health services researcher Jill Marsteller, PhD, outlines steps that care teams can take to plan for success when designing quality improvement projects, in order to better understand why an idea succeeds or falls short, and how to effectively repeat it.
"Care teams often come up with innovative ideas to prevent local harms, only to realize after some encouraging results that their intervention is something that might be spread beyond their walls," Ms. Marsteller writes. "Yet too often, weak study designs can make it hard to know why it worked, if it worked at all. The flaws can come in a number of forms, such as neglecting to consider and measure key variables, introducing too many interventions at once, and failing to collect sufficient data."
Here are the five steps outlined by Ms. Marsteller to guide project design from the beginning, rather than as an afterthought.
1. Identify a conceptual framework. The framework should describe the system you hope to improve and take into consideration all of the factors that might influence your success.
2. Create a map of the process you aim to improve. Trace all of the steps required to make the goal outlined in the conceptual framework come to fruition. Be sure to consider the pre-existing characteristics of the system you hope to change. Review the current systems that may make the task easier or more difficult.
3. Match interventions to variables. Make sure the ideas for interventions are designed to directly meet the variables and potential issues that may arise. This can be done through interventions over time, where incremental changes can be measured to determine the effectiveness of a variable, or the interventions can be enacted simultaneously in controlled segments within a system.
4. Don't just measure the main outcomes. Keep in mind to not only measure the success of the primary objectives, but to gather as much data as possible across the board.
5. Get assistance from a team. Involving the employees, whether administrators, physicians or frontline staff members, who will be affected by the design from the beginning is critical. Teams can help with measurement, and those directly working with the variables and interventions being tested know better than anyone the existing workflows and barriers to improvement.
"Even if you don't plan to publish your results in an academic journal or seek a grant to spread your success across many hospitals or clinics," she writes, "developing your conceptual framework and measurement plan from the start can help you to avoid second-guessing. And if you do choose to share your success with the world — or the unit down the hall — you will have a better sense of what worked and why."
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