Step 7 - What Changes Can We Make That Will Result in an Improvement?
We now know what we are trying to accomplish through defining a SMART aim and by using data over time we’ll know whether we reach that aim. The next question is what changes we’ll actually make to bring about the improvement we are seeking.
Notice all we’ve already worked through to get to this point. Probably the most common pitfall the TIPSQI team encounter in the sessions we run is that people have an idea for an intervention from the start, but haven’t taken a step back to think about the problem that intervention is actually looking to solve and how it impacts patients. This results in all eggs being put in one basket – that particular intervention. If that intervention doesn’t work it can be disheartening. As we will discuss, it is better to rapidly test many different approaches on a small scale to figure out what works best.
A typical situation this misunderstanding is seen in projects revolving around delivering a ‘teaching session’. Having an aim that states “To teach 90% of FY2s how to perform a fascia iliaca block in 3 months” is an average QI project. Having an aim that states “To reduce the average pain score of patients presenting to A&E with confirmed fractured neck of femur by 2 points in 3 months” is a good QI project, where a teaching session on how to perform fascia iliaca blocks could be one of multiple ideas used to meet the aim. Note 2 things, first – how the SMART aim is more directly focused on the patient rather than the staff, and second – how the second aim gives room to try other ideas alongside the teaching session.