Establish General Aims

Set general goals and a timeline

Setting a goal is a great way to help the team stay focused and communicate with stakeholders. For clarity of purpose and to overcome initial inertia, in the early stages the team needs only to agree on general goals (e.g. reduce cases of hospital-acquired VTE).

The general goal also should be a “stretch,” one that is aggressive enough to mandate a change in design from the current process in order to achieve it (e.g. eliminate preventable cases of hospital-acquired VTE).

In addition to setting a stretch goal, at this early stage it helps also to be clear about the initial and eventual scope of the effort. Will the focus be on medical patients, surgical patients, or both? Initially it is reasonable and even advisable to “take small bites” by piloting interventions on a small scale (e.g. eliminate preventable cases of hospital-acquired VTE from medical floor 5G).

Try to be as inclusive as possible about the eventual scope. Why improve care for just a sub-set of patients? Serial testing and learning on a small scale can make even very large projects more manageable. Improvement strategies can be spread to other areas (e.g. eliminate preventable cases of hospital-acquired VTE from all medical and surgical floors and all ICUs).

Lastly, the team needs a deadline to hold itself accountable. The timeline should be ambitious but also realistic. For piloting a single improvement intervention on a single medical floor, a timeline of 12 weeks is reasonable. For spreading a series of improvement changes across an entire system, 12-18 months may be more appropriate.