Hi there, Friend! This is the third in a six-part series of short, actionable articles. This week, I’m tackling another issue I’ve seen repeatedly in healthcare Quality Improvement (QI) projects: realistic time frames for follow-up.
The Issue: Realistic Time Frame for Follow-up
QI programs require precious resources in time and money, and the requirements vary depending on the complexity of the problem.
You can test out a procedure to alert nurses of a patient going septic in a hospital relatively quickly. In this case, your outcome and the intervention are both highly targeted and clearly defined.
In contrast, interventions aimed at improving population health are often more complex. Such interventions often require changes in large sections of healthcare systems. Additionally, the context of patient care is often less controlled than in a hospital setting.
The more complex your contexts, outcomes, and interventions become, the longer you’ll likely need to see a result.
Frequently though, planners base evaluation time frames on budgetary and political cycles rather than on realistic assessments of how quickly results can be obtained.
An Example Program without a Realistic Time Frame for Follow-up
A health plan wanted to improve care coordination for their sickest patients. It was a laudable goal.
The project would require substantial costs and an additional layer of care management. However, the potential long-term improvement in member health and return on investment were worth it.
Project directors put all of the necessary policies, procedures, communication requirements, and payment mechanisms in place. They chose the targeted member population carefully. And they implemented the program.
The planners’ final decision would end up tanking the program: the evaluation needed to be completed within one (1) year.
They chose one year for the evaluation because of political pressures between the organization and the state. However, the program was unlikely to have significant impacts in reducing overall costs and improving health within a year.
The targeted patients were very sick, with many having become much sicker over the previous six-month period. All of their disease conditions and comorbidities indicated that better care management could turn things around.
After a year in the program, the results did not show net cost savings. Nor did the evaluation discover that the patients had become noticeably healthier during that time.
The health plan killed the program, and all patients continued to receive care management at their original levels.
The most disappointing part of the project for me as the evaluator was that the results after one year were very promising. The patients in the program may not have been healthier, but the program helped stabilize the severity and complexity of illnesses. There were even early signs of improvements. Additionally, healthcare costs outside of the program administration had also stabilized and were beginning to improve.
The targeted population consisted of individuals with highly complex health issues. Many of the targeted patients also had economic and social challenges, complicating their context of care delivery.
Had the health plan given the program two (2) years for a follow-up, it is likely they could have achieved significant improvements. Unfortunately, that time frame was too long for the powers that were.
Planning a Realistic Time Frame for Follow-up
I wish there were an algorithm to determine the time frame necessary to determine whether a QI project was going to be successful. Unfortunately, there isn’t.
Still, understanding the clinical and operational complexities as they relate to your outcomes can help make the determination.
Here are a few important questions to help frame the context:
- How quickly is feasible to make the desired change in your targeted outcomes?
- How much control can you exercise over the environment and context of the project?
- Are your target population active participants (i.e., do they need to do something specific)?
- Are there operational complexities that can prevent successful implementation?
- Are there factors outside the control of the program implementation that can hinder success?
Take the time when planning your next QI project to consider these questions. Use the answers to develop an estimate of how long you might need to see a successful result.
It is even more useful if you do this exercise without consideration of any budgetary or political constraints. Once you have a time frame estimate, if your QI context won’t allow it, adjust the project for better alignment.
Conclusion
In the QI world, we often spend so much time dealing with operational and evaluation complexities that it’s easy to overlook realistic time frames for follow-up.
How many projects have you worked on that might have been successful if it weren’t for an artificially short timeline.
With QI resources being a scarce commodity, make sure your projects are given the best chance they can get to be successful.
Other Articles in This Series
If you found this brief article useful, see the other articles in the series here:
