“A journey of a thousand miles begins with a single step…” Lao Tzu
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The CaReMe transformation journey begins with an initial “homework” at your desk (Step 0) and working with you Core Team later, (Step 1) defining:
Although we generally follow a sequential step-by-step approach, the reality is that the thought process will be more “circular”; with the need to go back and forth across the different steps and tasks, to integrate new information and insights from different members of the team, as well as identifying opportunities, assess the actual feasibility, and ensure consistency across the overall plans.
Dedicate enough time (probably a few hours every time) where you (and, later on, together with your core team) can concentrate without other distractions. This is not an exercise that can be done while answering to other calls. Also, be mindful that it may, easily, take a few weeks or so to get ready and to engage your broader team –so be prepared for this.
The Setting for Step 0 will be mainly a “self-brainstorming” and Step 1 will be working together with the Core Team.
By completing this task, you will have:
Aim: Define Vision & Mission statements.
Objective: Purpose of the organisation is to inspire, motivate and instil a sense of belonging within the team. To ensure that the team works towards the common goal.
Vision statement: Depicts the future image of your organisation – who you aim to become (“the destination”). A long-term goal to guide the organisation to fulfil its purpose.
Mission statement: Outlines the aims & values, and sets the direction – who you are and serve & how to do it.
By completing this task, you will have:
Aim: Clearly define the specific goals (aspirations, desired outcomes) to be achieved. This is the most important step on this journey.
Method: Set SMART Goals.
I.e.: Goals that are: Simple, Measurable, Attainable, Realistic, Timely.
Be organised: List the goals and prioritise them!
Step 0: Determine the members of your Core Team. Contact them & confirm.
Step 1: Assign team members their responsibilities – who will make it happen, who will ensure effective communication etc.
By completing this task, you will have:
Aim: Define or specify the Target Population of patients.
Objective: Prioritise you Target Patient Population according to your main Goals.
E.g.: Those that will benefit the most, or where the unmet need is more evident, etc.
Take note: IF you do not define and prioritise your Target Patient Population according to your Goals – There is a risk of ending up with a goal-population mis-alignment, which could result in failing to achieve success!
By completing this task, you will have:
Aim: Once your Target population has been defined – it is important to develop a more “quantitative” picture of the epidemiologic characteristics of your current population of patients and their outcomes, to ensure consistency.
Objective: To enable the coherence of the set goals and target population with the current situation and the actual impact of the transformation of care you aim for, and possibly also health economic considerations.
By completing this task, you will have:
Aim: Once the Patient Target Population has been clearly identified with Epidemiology & Outcomes determined – it is vital to track and describe the Current Pathways of Care.
Objectives: Highlight the most critical “pain points” to address. Define the current situation. Start drafting the actual impact of the transformation of care you aim for. For each main “station” on the pathway consider: What are the main behaviours you might like to keep, stop, modify or initiate.
Assign: For each specific behaviour appoint a Core Team member(s) who will be responsible for implementing, tracking & reporting of it.
Aim: This tool is called “W.H.Y.” as it “Will Help You”. A simple brainstorming approach to identifying the root cause of an outcome. Similar in concept to the “5 Why’s template” pioneered by Toyota; it’s based on a sequence of “why is it happening?” questions that will continue until a satisfactory answer and main solution is achieved.
Method: Start by stating what is the main issue you’re facing – for which a solution is needed. It should be stated simply, as it first comes to mind – without trying to overthink or narrow it down. Then ask the first “why is it happening?”; the main explanation provided becomes the next issue to address in the next “why?”. The Q&A continues until you finally, believe to have identified the root cause of the problem as initially stated. The logic here is similar to the diagnostic process in medicine: following the physiopathology of signs and symptoms you identify the main condition (aetiology) and you can decide the best treatment accordingly (i.e., “cure the disease and not the symptoms”). The example template will clearly show this.
For each why-answer: Identify a possible (or temporary) fix and assign who is the most relevant team member that can effectively action the change. Once you get to the last answer (i.e., root cause) reassess the previous steps & solutions identified to check if they still stand as a needed solution or – being interconnected with the main root cause – might end up being solved “automatically” by addressing the root cause (think domino effect), which then doesn’t require any additional efforts.
Finally: Have a clear definition of the solutions and who is responsible to action the change. Also include the overall plans with a clear action plan and timelines, which is fundamental for successful improvement.
By completing this task, you will have:
Aim: It’s essential to define: who your internal & external stakeholders are. E.g. Colleagues who will support different stages of the journey or involved in the approval process (budget holders, HR, etc.), and the everyday implementation of the plans for the clinic (Core Team).
Objective: Focus on ‘How to’ effectively and permanently change the way staff operate in the Clinic – for the better.
Method: Design an effective process which anchors the new behaviours & actions to the Goals; making the transition to the new behaviours seamlessly. This is a crucial component for successful & permanent change.
By completing this task, you will have:
Aim: To design the Ideal/Desired Pathways of Care of your clinic.
Objective: Address the main, unmet needs and “pain points” experienced previously.
Method: Go back to the list of behaviours that define the “how to” of that specific “station” of the pathway of care. Each should be analysed and labelled as per the general intervention you aim for (i.e., KSCS). Consider the different options available and prioritise them in terms of feasibility, probability of success and why. This will be followed by a more detailed implementation plan – to structure the next step.
By completing this task, you will have:
Aim: Develop a timeline overview. The SMART approach when setting Goals will also help you set clear timelines.
Objective: Focus on a desired ‘Go Live’ date for your CaReMe Clinic. At this stage, not necessary to develop a full project plan design (e.g. GANTT chart).
Method: The initial ‘Go Live’ date might change multiple times as the plan is refined – so don’t spend too much time setting a fixed date. Instead, get a sense of the execution time span (i.e. how many months, etc.).
By completing this task, you will have:
Recap: At this stage of the thought process, you have defined the “W’s”.
Aim & Objective: Should move onto the “How” – to achieve your Goal with a structured plan that will bring together, like a jigsaw puzzle, the multiple insights from the previous tasks. However, before being able to do that – it’s worthwhile moving to the next steps to explore some additional opportunities and components.
Method: Start at the prioritised Goals and Actions. Organise them in sequential tasks – identify their interrelation and distribution over time. For each task assign who is responsible for making it happen!
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