Setting the course

There are so many similarities to travel and journeys in health care improvement. As an improver and innovator, as well as an avid traveler, it’s one of the appeals of this work. I love the big ideas—thinking about new routes to take together, throwing caution to the wind at times, and coming up with new approaches to reaching the destination. But I also understand the importance of a rigorous, time-tested QI process—a road-map if you will—to ground these adventures. So I wholeheartedly embrace the use of measurable goals, especially the 90-day variety. 90-day goals are the way that ImproveCareNow center teams shape and quantify their improvement ambitions—they help them set the course, assess whether they are on the right path, and finally, whether they have arrived in the right place.

90-day goals have been part of ImproveCareNow since the Network formed in 2007. In years past, they were largely focused on the chronic care model that provides the foundation for our work: data quality and enrollment in the registry, pre-visit planning, and population management. Our attention to these fundamental components of excellent care delivery have enabled us to achieve a remission rate exceeding 80% across the 90 care centers currently participating Network. 

However, over the past year or so, more and more quality improvement teams in this community have set 90-day goals around engagement and partnership with parents and patients. Some of these goals are big, some are small, but all are a step toward ensuring that our improvement journey brings together everyone who has a stake in this work and role to play—including patients, parents, clinicians, researchers and others. 

I wanted to share a few examples of goals set for June-September 2016, not only because I think the teams that set them are doing great work, but also as inspiration for others. I hear so much about how hard it is to get started involving patients and families in improvement work. And it is hard. But we all have to have to start somewhere—to move beyond the “what if”—and while taking that first step may be the hardest, those of us in a collaborative health community like ImproveCareNow have the benefit of learning from those who have done it before us. And that's a great place to start!

By the way, it's important to mention that anyone working in any health care setting - whether they are part of a collaborative health community like ImproveCareNow or not—can set goals like this today.

• By September 30, 2016 we will have set up a meeting with our identified parent partner
• Complete New Patient Handbook by September 30^th in collaboration with our parent partner
• Recruit at least one more parent partner by September
• By September 30, 2016 we will have set up a meeting with our identified parent partners
• Increase number of parents signed up for newsletter to 40% of our population (approx 65 patients)

Some of these goals may sound very, very small, especially to teams that already have vibrant partnerships established with patients and parents and already involve them closely in their improvement work. And a few may indeed sound like a big stretch to those who have not been accustomed to thinking about patients as partners. The trick is finding the sweet spot that’s right for where your team is.  

Will each of these teams achieve these goals in within 90 days? Almost certainly not. This is hard work in systems where improvers are juggling many priorities, pressures and norms related to who does what in healthcare. But because they took the time to examine where they are now and where they want to be, I am 100% sure that:

• They will learn something about their team and their current care processes
• They will learn about cultural barriers to partnership within themselves, their team, and the system in which they are working
• They will have moved beyond talking in the abstract about partnering with patients and parents by holding themselves accountable to working toward it

Finally, as part of the ImproveCareNow community, they are not traveling alone. They are making these goals visible to hundreds of peers who are eager to learn along with them as they go and to celebrate with them when they reach their destination.

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