If you are unable to find benchmarks for comparison, consider the results that


may be obtained through a successful intervention. Be realistic and set a goal that can be achieved if your intervention works, but not one so modest as to be inconse- quential to patients. For example, if 65% of patients in your facility are experiencing weight loss, a reasonable goal might be to develop interventions so that only 40% of patients experience weight loss.


Stakeholder Analysis


A stakeholder is any person, group, team, or internal or external customers affected by your product or service. Internal customers include those with whom you work, colleagues in different departments, and departments that support your work. External customers include patients, families, visitors, suppliers, health care reg- ulators, and auditors. Stakeholders can provide valuable input when identifying and defining the problem. When starting a project, always assess the needs of your stakeholders; never assume you already know what their needs are.10 A stakeholder analysis compares how much vested interest a stakeholder might


have in a situation and enables you to plan the type and amount of communication they will require throughout the initiative. The first step in identifying stakeholders is to list all people touched or influenced by your project or process. This list should include names and titles of specific individuals. You will use this information when you start analyzing performance and then again when you begin to develop your communication plan.


Gathering Customer Voices


Once you have identified your customers in the stakeholder analysis, it is important to consider what your customers expect from your product, service, or process. Gathering voices of your customers captures their requirements and confirms their expectations.12


This feedback helps you determine what is critical to quality: things


that customers see as nonnegotiable and believe they cannot do without. One simple way to discover this information is to gather feedback from your internal and ex- ternal customers through online or printed surveys, focus groups, comment cards, or one-on-one meetings in which you ask for feedback directly (eg, “In your opinion, how could we improve?”). In our example of patients losing weight, ask your nursing staff whether they are concerned and what they believe they need to help prevent this unwanted weight loss. Similarly, ask the medical team what they think might be contributing to this trend. Ask your food suppliers and other vendors for their input, as appropriate; perhaps they have valuable insight into trends they are seeing across the industry.


Process Improvement Step 2: Measure Current Performance


A successful process improvement project starts with measuring current process performance by collecting as much baseline data as possible. Current performance is measured to identify improvement opportunities and, once improvements have been implemented, to evaluate whether these changes have in fact improved the


CHAPTER 13: Quality Management and Improvement 271


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