Many wish to start and lead a successful CDI program. More than not, they have been tasked to do so without defined steps. The problem is that most organizations work backwards. They know what they want in the end but are not sure how to start or what is involved in attaining the results. They get started quickly and with a lot of hope but see little progress, which eventually leads to an end without crossing the finish line.
This issue is not exclusive to CDI of course. Many initiatives in life work a bit backwards. Someone may want to lose weight but is not sure how to do it, or may wish to retire a millionaire, with no clue how to save or invest. With a lack of direction and little perseverance, many fall short of the goal. However, a few will be successful. But how do they do it? What makes them different? The answer is in the process. Sure, there is a lot to be said for pure grunt force and being in the right place at the right time, but most will tell you that having a defined, yet nimble plan to accomplish the goal is what works best.
Luckily, there is a plan and it’s not just trial and error but instead involves a dedicated and thought-out plan with defined and agreed upon goals throughout the entire process. Dr. Don Goldmann, of Harvard School of Public Health said, “Tampering and failure to adapt are the main reasons the vast majority of innovations are ineffective when deployed at scale”. He helped create improvement processes for creating scalable and sustainable outcomes for The Institute for Healthcare Improvement (IHI).
I’d like to share with you the first step below, with some of my CDI specific additions and interpretations. I have found that when planning a CDI program, starting with these few questions helps lay the groundwork and can give you the advantage in building a lasting and successful program.
The below tasks are completed during the beginning stages and work well when only given the end goal.
What is your aim?
- Identify your target population.
- This may be based on demographics or geographics depending on workflow.
- Decide which sites and providers will eventually be involved.
- Even if you do not identify from the beginning pilot, you will want to think about the future – but don’t get stuck there. Remember this is a process.
- Start gathering relevant ideas and agree on what best practices and guidelines may look like, based on evidence as much as possible.
- Once again do not get stuck here. Processes change with workflow progression.
- Decide what should be measured and how, including outcomes of processes.
- This may consist of simple pre and post pilot surveys just to see if you have made impressionable changes but ensure whatever mode you decide upon is measurable.
***HINT*** If the process is seen as hurtful rather than helpful, it will not succeed! Trust me on this one.
- Describe your ideal system. How will it be delivered? Identify major gaps between this and the current system if you have one.
- This is sort of like a recipe. Be careful to describe the “how”.
- Develop a preliminary picture of how all the elements work together to get your desired result; note the most important elements.
- This should be an actual visual of some sort – a process map or chart/graph.
- Finally, write your formal aim statement: “How much, by when, for whom?”
- This will define your next steps!
There you have it – a plan to start a successful and sustainable CDI program.
Give me a shout if you want to discuss more. Until then, happy program building!
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Chris Petrilli is the Medical Director of Strategic Initiatives and Operations at NYU Langone Health. He’s an…