Hello. Today, we're going to talk about the focus of your quality improvement effort. It's critical that we select the right effort to begin our initiative because we all know we don't have the time, energy, and resources that we'd love if we could wave a magic wand and magically make everything just materialize so no more problems. Well since we can't do that, it's very very critical that we select our focus that's going to maximize our effort and maximize our results in the end. It all begins with a problem. So some of you might say out there that, no, there are no problems. We only have opportunities. Well, I disagree with that respectfully because I say it all starts with a problem. In quality improvement circles there's a saying, "No, problem is the problem." Opportunities I would say come later in terms of how are we going to resolve those problems. There are six domains of healthcare quality set by the IOM, Institute of Medicine and they are as follows, safe, timely, effective, efficient, equitable, and patient centered. Each one of these domains unto itself could be your Quality Improvement project surrounding each one of those. However in most cases, something that's a safe, issue a safety issue it could result in effective care or perhaps patient centered care, perhaps timely care. So it's important to understand with your problem that you're identifying which one of these domains does that line. The next thing you want to do is you assess the impact on three different stakeholder entities. One would be the patient, first and foremost, we always start with a patient. Sometimes, something so benign as a piece of paper that causes some confusion in a clinical setting can result in a patient issue or maybe there's some uncertainty on the part of the patient in terms of what the care plan is or something along those lines. Next in line is the family. The family has a large impact on what the patient sees and feels. In some cases, our patients can speak for themselves due to their medical condition. So the family is the surrogate and they're assessing the impact perhaps through a slightly different lens. And then last but not the least is the staff. The staff assesses impact and sometimes the staff is even unaware that the patient is experiencing the impact. Largely, we focus on what we're feeling and sometimes ignore what the patient and the patient's family might be feeling. So what type of solution is required? Well, there are two types of solutions out there. One would be more of an implementation project, we call those that, just do it, where there's a known solution that we're trying to go after perhaps putting in place a best practice that's already been out there and we know it works based on other institutions, other hospitals, in other patients. However, we haven't done it here yet so we want to integrate that and implement that here. Project management is absolutely essential in terms of projecting a timeline about when these things are going to happen and we need an implementation team to put those things in place. That's the focus is on implementation. So you want the key stakeholders, the doers if you will that can go ahead and put these in place. The second type of solution is what we call discovery and this discovery isn't just solving a mystery. There's so many unknowns out there that we can't predict. So for example, let's say we want to reduce our nosocomial infection rate. Well, we may not know exactly how we're going to do that yet therefore it's a little bit of a discovery, it's a mystery. However, we project what we think the outcome will be. So for example, we might say, we want to reduce that rate by 5%. Without having the data and really understanding if 5% achievable, is just an estimation at that point. So therefore, that data is going to be key in various central in terms of solving these types of problems. And last but not least, in order to do this rather than have any implementation team, we now need a team of problem solvers to go after this. So, who selects the area of focus? Well, there are usually two different possibilities. If you're fortunate, you are choosing the area of your focus. So this is an area where you know there's a problem, you've witnessed the problem, you've dealt with a problem, and you get to choose from the, maybe several possibilities about what you want to focus on. However, the next one happens quite frequently in our world where perhaps your boss has a wonderful idea for what you should be working on. So more or less, you're voluntold. Each one of those represents some specific issues. However, in both cases, you need to investigate to determine, is the problem really a problem? Sometimes, what we perceive to be the problem isn't the problem. So later on we're going to collect data and identify that. Do others care? So in other words, you're going to need some help to solve this problem. You can't go it alone. Your boss needed to care. Your colleagues needed to care in order for you to be successful and get a long lasting solution. People have got to care. And last but not the least, am I the right person to lead this effort? We'll talk a little bit more about that. You need to have that passion, and the will, and the drive to solve this problem. Initial selection criteria. So, this is a little bit of a checklist that we're going to go through. and we're going to talk about each and every one of these issues moving forward. But the first one is, are we aligned with the organization's mission and strategy? So if the organization isn't aligned, how will anybody else be? How will you receive top-level support to move the barriers that might be in your way? Are you yourself passionate? And that's a strong word passionate but you need that in order to fix that problem because you have to put that time, energy, and effort into doing that. Does it address a meaningful problem in a realistic timeframe? Two key words there first ones meaningful. Is it something important that's going to really make a difference of all the things you could select? Is this the one we want to go after? And the second one is, it might be something great but if you can't achieve it within a certain period of time it's going to be a problem. We often say that a 50% solution today or maybe within three months is far better than a 70% solution a year and a half from now. So it needs to accomplish both those goals. And last but not the least, is you need high level champion sponsors support. We'll talk more a little bit later about what that means. Data to assess baseline and performance. We have situations where we have problems that we need to address. However, we cannot find data. We don't even know how to articulate how we'd measure performance. Anything quality improvement and safety related we need to understand, what is our baseline condition the way it's performing now? What is it going to be like as we're working through the problem process? And last but not the least, at the end, did we accomplish our goal? And the only way to understand that is through data.