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Target Condition & Countermeasures. SMART Goals Setting Measures (Process, Outcome, Balancing). A3 Roadmap for Performance Improvement at Penn Medicine. Goal Setting. Goals should be SMART Specific Measurable Attainable Relevant Time Bound Avoid: Wasting time Frustration Confusion

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target condition countermeasures

Target Condition & Countermeasures


Setting Measures (Process, Outcome, Balancing)

goal setting
Goal Setting
  • Goals should be SMART
    • Specific
    • Measurable
    • Attainable
    • Relevant
    • Time Bound
  • Avoid:
    • Wasting time
    • Frustration
    • Confusion
    • Unmet expectations
  • Example:
    • Penn Medicine’s target performance goal is a 2% reduction from FY12 in observed to expected inpatient mortality by June 30, 2013.
smart goals
    • Look at Problem Definition and SCOPE to help with specificity
    • Should Make Sense to Everyone
  • Measurable
    • If you can’t measure it you can’t change it.
    • Metrics can be INPUT or OUTPUT
smart goals1
  • Attainable
    • Meaningful but realistic
    • Should be guided by the original problem
  • Relevant
    • Fixes the “What would be better about that” from the problem statement
  • Time Bound
    • Process Improvement needs to have an end date for projects.
goal metrics
Goal metrics
  • Taken from your baseline metrics
  • Should be SMART – Specific, Measurable, Attainable, Realistic, Time-bound
  • Penn medicine will reduce its FY14 observed to expected (O/E) mortality ratio by 0.04 compared to FY13 by June 30th, 2014.
3 types of metrics
3 Types of Metrics
  • Process
    • A measurement of how your process is working - how often you do something, how you do it, etc.
    • Percent of heart attack patients given aspirin on arrival to the ED
  • Outcome
    • A measurement of the effect your process has – the patient's outcome
    • Death rate for heart attack patients who made it to the ED in time
  • Balancing
    • Did your process improvement cause a new problem?
    • Percent of GI bleeds in heart attack patients who got aspirin in the ED
thinking about baseline metrics
Thinking About Baseline Metrics
  • What kind of metric is this?
  • What would be a process metric for this?
  • What would be a balancing metric?
  • Good baseline metrics will lead you to your target condition goals



before and after metrics
BEFORE and AFTER metrics

Stopped using new process

New Process

Restarted new process

translating root causes into countermeasures
Translating Root Causes into Countermeasures
  • Countermeasures reduce or eliminate the root causes of problems
  • Good root cause analysis makes countermeasures obvious
  • Link your countermeasures to specific root causes
  • Test all countermeasures to validate them

Connect Root Cause to Countermeasure

Drill Down on Possible Causes

Problem: Cement is falling from the ceiling because it is being

washed several times a week

Why? There are lots of pigeon droppings

Why? Pigeons come to eat the spiders

Why? Spiders come to eat the midges

Why? Midges fly to the flood lights of the monument

Why? The lights come on before dusk and attract the midges

Turn lights on later