Articulate a thorough problem statement

Using the Module 5 outline of current state- gap-future state, I want you to articulate a thorough problem statement. Feel free to use your DNP project idea or just use a hypothesis that you have been thinking about in your practice organization. Be thoughtful about your phrasing and make sure you support your problem statement with data and a value proposition.
I would also like you to upload your fishbone templates to this discussion board for your peers to review.
And remember...a problem well-stated is half solved.
Module 5: Readings, Lecture and Assignments
The quote above is the perfect example of how this module is designed to use your time this week. The readings are intentionally minimal to give you time to really dig in to refining your problem statement. Being thoughtful and meticulous in this module will really REALLY help you down the road- I cannot stress this enough.
As you begin Module 5: Defining the Problem, start by reading the following article:
Are you solving the right problem? (Links to an external site.)
This module will walk through the steps in the article and provide relevant readings and tools for you to define a local problem you would like to solve in your practice environment.
Often times, the first step starts off as a “hunch”- and that’s OK!! Although during this critical first step it is critical to not jump to a solution, or reverse-engineer a problem because you want to implement a certain solution (I call this the solution-in-search-of-a-problem phenomena). Pay particular attention to this phenomenon in your practice sites where sometimes students can be used to implement an intervention without the proper vetting.
One way to start the process of establishing the need for a solution is to use the SixSigma 5 Why's (Links to an external site.). This will help you to flush out your root cause of the problem, so you can target your solution in the right direction. Another part of establishing the need for a solution has to do, in large part, with your value proposition (Module 3). Consider this value proposition as you reflect on not only establishing the need for a solution, but justifying a solution as well.
It is not enough to have identified a problem that needs a solution- even if that problem and solution are a legitimate need. In order to get organizational buy-in that an intervention is needed, consider your Organizational Assessment from Module 2- does solving this problem align with the organizational “True North”? What are the benefits to the organization if we solve this problem? Are the benefits worth the investment (money, human resources, loss of operational efficiency)? We touched on this is Module 3- review the content on value proposition for this step. A useful tool for figuring out whether or not you should move forward with your proposed intervention is the force field analysis (Links to an external site.).
You may have stumbled upon some of this analysis during your Organizational Assessment. A good question to ask your organizational leaders is “who does the organization embrace change?” (I also find this question incredibly helpful during job interviews J). Chances are, there have been many, many, MANY quality improvement projects that have achieved short-term success, but the change never got hardwired. Think about the difficulty around hardwiring change- where has the organization failed in the past? What mechanisms could you put in place to ensure that your change doesn’t get forgotten? Think also about your constraining forces (forces against change) that you identified above- are the constraining forces internal or external? Which are in your control? Can those barriers be reduced or removed to ensure your project is a success?
Please review the following materials to help assist you in answering some of these questions:
RWJF Hardwiring Change (Links to an external site.)
Ontario article.pdfPreview the document
…More to come in Module 7 about hardwiring change
Another key piece of contextualizing the problem is having an understanding all of the inputs that impact the phenomena you are trying to study. Using a cause-and-effect or fishbone diagram is a great visual way to explore the possible causes of the problem you have identified.
IHI Fishbone.pdfPreview the document
At this point we have a solid local context that surrounds your problem and probably a list of potential solutions- remember not to jump to a definite solution just yet… at this point we turn to the literature to learn the lessons of others who have tried to solve this problem. And this is where your Advanced Critique will come in as well as you start to think about potential solutions to your problem.
The final step in defining the problem is writing your problem statement. It is crucial at this step to understand what a problem statement is NOT. A problem statement does/is NOT:
Describe the symptoms of the problem (i.e. Nursing burnout is high the ED because support staffing is low).
Solution-based (i.e. Our infection rate is higher than national average because nursing needs education on how to properly clean a foley)
Correlational/Causational (i.e. Our falls rate is high on medical-surgical unit because our patients are older)
Blame-placing (i.e. Hand-off communication needs to be revised because the surgical nurses don’t have time to give a thorough report)
So what is a problem statement?
A good problem statement gives a clear and concise description of the issue, how it was identified (hopefully through data). It identifies the gap that exists between the current state and the ideal future state you are trying to achieve-ideally your problem statement should be between ½ to ¾ of a page in length. Your assignment for this week’s discussion is to write your problem statement and share with the class. Along with your problem statement, attach a fishbone diagram, using either the IHI template above or a template of your choice, which shows the scope of the problem within organization. As always, constructive peer feedback is required.

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