Phase 2: Defining the Problem and the Project Outcome Table of Contents Defining the Problem As you assess the problem or opportunity for improvement, you will find it helpful to be able to concisely

Phase 2: Defining the Problem and the Project Outcome

Table of Contents

Defining the Problem

As you assess the problem or opportunity for improvement, you will find it helpful to be able to concisely and clearly communicate the project focus to your mentor, organizational leaders, and other stakeholders. A concise statement to describe the problem and the opportunity for improvement help you to effectively communicate the problem, and its importance.

Concise Description of the Problem and its Importance

Here are some tips regarding the development of a problem statement to convey your points:

The problem statement or statement of need should:

• Represent a problem which can be solved, or a situation which can be improved
• Clearly describe the problem
• Clearly convey the importance to all stakeholders
• Clarify your intention and what you hope to achieve

When writing a problem statement or statement of need, there is no need to worry about defining a specific outcome or output. Those steps will come later in the planning process. The main idea with a problem statement or statement of need is to communicate in a succinct manner the essence of the problem which you plan to address, and why it is important. As you develop the problem statement, keep in mind the scope of your project and timeframe available.

Helpful Reminders

Components of a well-written problem statement or statement of need include:

• Succinct description of the problem (need, or situation to be improved)
• Location of the problem (unit, organization, etc.)
• Timeframe
• Size/scope/implications of the problem

Another way to envision the problem statement is to consider the following:

• Who - who does the problem affect?
• What - what is the problem/need and its impact?
• When - when does or did the problem/need occur?
• Where - where does this problem/need occur?
• Why - why is it important to fix the problem?

Make the Connection

As you read through the examples provided below, think about the similarities that are shared across each one. For example, while they each address a different problem, they contain similar elements to allow for a succinct, clear description of the problem and its impact on health outcomes and healthcare delivery:

Example A

The ACA established new community benefit requirements for nonprofit hospitals which include a Community Health Needs Assessment (CHNA) to be completed every three years. Priority needs must be determined and a strategic plan implemented to address each of the needs identified. Rural County Hospital must comply with this legislative requirement in order to maintain tax-exempt status. As such, a CHNA and strategic plan must be completed by 12/31/2021 in order to submit to the IRS (Form 990) with taxes for fiscal year 2021.

Note - In this example, there is a legislative mandate which serves as primary rationale for the need. Financial bottom line is the driving factor (maintaining tax-exempt status).

Example B

Unit 6 West reported an increase in CAUTI rates from 11% to 27% during the first quarter (January through March 2020). One of the National Patient Safety Goals is the prevention of infection. The increased infection rate results in additional medical treatment, compromised health status, and in some cases prolonged the hospital stays. As a result, a staff development course is needed regarding guidelines to prevent infections of the urinary tract that are caused by catheters.

Note - In this example, there is an increased rate of infection on the unit and compromised health, coupled with the NPSG, to validate the need.

Example C

At Hillside Hospital, Unit 3 South serves a large patient population suffering from chronic congestive heart failure. During the second quarter (April through June 2020), the 30-day readmission rate for this population increased from 9% to 19%. Recent healthcare legislation (ACA) requires the Centers for Medicare and Medicaid Services (CMS) to reduce reimbursements to hospitals with notable readmission rates within a 30-day period. As a result, Hillside Hospital could experience reimbursement penalties due to extensive readmissions within the 30-day period. A strategic plan to address discharge planning, care coordination, and home maintenance to manage CHF is needed to promote health outcomes and prevent reimbursement penalties.

Note - In this example, there is compromised health and an increased readmission rate, which may result in financial penalties, which serve as validation of need.

Defining the Outcome for the Planned Change Practicum Project

In order to effectively direct planned change, it is imperative that the problem or opportunity for improvement be clearly defined. Equally important is the development of a clear outcome statement to convey the desired end result of the planned change project.

Intended End Result

An outcome statement is a comprehensive statement that conveys the intended end result achieved through the work of the planned change initiative. This end result is most often a reflection of the improvement in health outcomes or improved healthcare delivery that will be realized through the planned change initiative.

Scope and Feasibility

In addition to accurately conveying the intended end-result, project outcomes must align with the time available for project planning, implementation, and evaluation. For example, if you have 8 weeks to plan, implement, and evaluate project outcomes, those outcomes must be do-able within that timeframe. To position the project for success, it is imperative that you establish project outcomes that are feasible to be achieved within the scope of time and resources available.

SMART Criteria

Effective outcome statements include SMART characteristics (Specific, Measureable, Action-oriented, Realistic, and Time-specific). A well-written outcome statement will also:

• Define what you intend to accomplish through the planned change project. This clear statement of the desired result will keep the efforts focused on what you hope to achieve.
• State the target date for the accomplishment to be successfully completed.
• Identify who will be involved.
• Clarify the indicator for successful achievement.

Think About It

Take a look at these examples, and consider – do they demonstrate SMART criteria? Can they be measured to determine successful achievement?

• 20% increase in the number of patients receiving the flu vaccine at Mercy Clinic by 12/31/2020 (baseline = 160 patients accepting the vaccine)
• 25% decrease in the number of patients readmitted with CHF at Fairfield Hospital by the end of the second quarter, 6/30/2020 (baseline = 16 patients readmitted during the first quarter)
• 20% decrease in the number of teen pregnancies at Judson High School by 6/1/2020 (baseline = 15 pregnancies)

Helpful Reminders

As you learn about how to write a clear, effective, and accurate outcome statement, it is also important to note that an outcome is not:

• A description of an activity or intervention which the nurse or other health care professional will implement
• A product or output that will be developed by the nurse or other health care professional (such as a new policy, protocol, or staff development session).

Rather, the outcome statement is a description of the desired end-state which will be achieved through the planned change project.

Practicum Application and Activities

As you clarify the problem revisit the PICOT question that you developed regarding this problem. Does the PICOT question seem appropriate? How might that PICOT question facilitate quality improvement at the microsystem level? How can you "move the needle" to improve quality through this planned change practicum project?

After defining the problem to be addressed through a planned change project, it is essential that you define the intended outcome. As you consider the scope of your practicum experience, you will want to identify an outcome that is measurable and feasible within the time available.

Review the Johns Hopkins Appendix B located in the MSN Toolbox area of the course. Proceed with the following activities. Document your practicum-related activities on the Practicum Log:

• Prepare a plan with specific talking points to meet with faculty (and practicum mentor if available) regarding your definition of the problem and the project outcome.
• Meet with mentor to discuss clarification of the problem and the project outcome.
• Complete Johns Hopkins Appendix B.
• Validate your work on Phase 2 with your faculty (and practicum mentor if available) as needed.
• Revise your work as necessary.
• Submit the Johns Hopkins Appendix B document with your time log, once Phase 2 is completed.

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