Quality studies and improvements have much more value than merely meeting a cancer program standards requirement. If planned well and properly conducted, quality studies can energize the members of the team, reduce inefficiencies, increase cost effectiveness, and deliver value to the organization and patients it serves.  

Read Part 1 of this article series HERE. 

The Commission on Cancer (CoC) encourages developing of a culture of collaboration to analyze and implement strategies based on data to drive the quality improvement process. In the first post in this series, we talked about creating a team of subject matter experts. In this post we will talk about the second step to conducting a quality study, identifying the problem.  

Now that the team is assembled and ready to act, you need to identify a quality-related problem to study. The study topic and problem statement serve as the foundation by which the study is conducted. It begins with identifying an actual problem and should not confused with conducting an audit or review of an idea to determine IF there is a problem.      

Implementing solutions to solve a problem requires setting clear goals and intention. The goal of the study should be time-specific, measurable and define the specific population or group of patients that will be affected. Everyone on the team should agree on the goal, understand the role they will have on the team, and be willing to work toward achieving the desired outcome. This requires a shift in thought process and group behavior. Albert Einstein summed this up when he said, “We cannot solve our problems with the same level of thinking that created them.”  

In 2001, the Institute of Medicine (IOM) released a report “Crossing the Quality Chasm: A New Health System for the 21^st Century.” In the report six “Aims for Improvement” were identified for use in health care quality studies. The aims for improvement can be used by the group to identify and test problems or gaps in the healthcare delivery system:

• Safety: Is the health care delivered at your facility safe? Are adequate controls and processes in place to ensure that a patient is never harmed by the system, services, or treatments the facility offers?
• Effectiveness: Is it effective? Is care offered in accordance with the evidence-based guidelines? Does the healthcare delivery process make best use of the available technology and science to deliver safe and effective care?
• Patient-Centric: Are you delivering patient-centered care? Are services, programs and therapies given that consider the patient’s culture, social context, and specific health needs? Are the patients playing an active role in making decisions about their own care?
• Timely: Are patients seen in a timely manner? Are there any delays or gaps patients may experience that delays their access to care?  
• Efficient: Does the organization strive to reduce waste, or the cost, of supplies, equipment, space, capital expenditures, ideas, time or take advantage of new opportunities for improvement?
• Equitable: Are all patients, regardless of their race, ethnicity, gender, or income given opportunity to access high-quality care? Are the advances in science and medicine offered equally to all patients in your community?  

To stimulate the conversation, ask “What are we trying to accomplish?” Use leading questions to guide the group as they explore processes, programs, and services, such as:

• Gaps in the delivery process,
• Barriers or gaps in the technology used to deliver high-quality care,
• Patient expectations found in feedback forms, surveys, or other mechanisms,
• Delays in scheduling or starting treatment that impacts expected outcomes,
• Educational or training gaps for the staff,
• Performance rates from the National Cancer Database (NCDB) or other national or evidence-based benchmarks or quality measures.

Continue testing, or vetting, problems and issues identified during the group session(s). Look for specific processes or data variables that can be collected and used to measure the impact of the problem. A baseline picture or description of the problem is needed to formulate a strong problem statement.    

When you have identified two to three suitable proposals, draft a problem statement, supported by the baseline data, to determine if it is suitable for in-depth analysis. The problem statement should include the following components:

• Study goal. What would it look like if this problem were completely resolved, and everything is working as it should?
• Expected outcome(s). What value or benefit would the patient or facility receive if the problem were fixed?
• What process or data variables are used to identify the problem and then monitored throughout the study to measure the outcome?

If the problem statement can be developed using the above variables, you are ready to move to the next step. If the proposed problem cannot hold up to testing, you should consider evaluating another problem or process. Only when the entire team agrees should you proceed.  

Planning for a study requires time, patience, and practice. Do not be afraid to test several ideas before finalizing the study topic and problem.     

Part 3 coming Thursday, May 13th! In the next installment of this series, we will discuss how to define the study to be completed using the problem statement you identified above.    

• Part 1: Creating a Team of Subject Matter Experts
• Part 2: Identifying the Problem 
• Part 3: Planning and Methodology
• Part 4: Conducting the Study According to the Methodology
• Part 5: Preparing the Summary Analysis
• Part 6: Benchmarking to Measure Performance
• Part 7: Corrective Action Plans for Lasting Improvement