How SMART is your QIA?

The American Board of Optometry’s Maintenance of Certification (MOC) program is a four-part process based on the American Board of Medical Specialties model. The quality improvement activity (QIA), the final part of this four-part process, is arguably the most important piece of this model, as it demonstrates a Diplomate’s ability to apply new knowledge or new clinical skills to improve the quality of patient care. Advancing the quality of eye care for the benefit of all patients is the ultimate goal of ABO’s board certification program.

Change is necessary in order to improve the quality of patient care or clinical practice, but change can be difficult to implement and even more difficult to maintain over time. A change-management tool that many business consultants and life coaches recommend is the use of SMART goals. SMART is an acronym for Specific, Measurable, Achievable, Relevant and Time-bound, and a SMART goal is the ideal basis for a QIA.

The QIA should be relevant to your practice and based on a gap that you identified through one of your MOC activities, such as a CE course, a self-assessment module, or a CAP assessment. Once the gap is identified, you can pinpoint the specific improvement that you wish to make. In order for an improvement goal to create effective change, it needs to be specific – think about what you want to accomplish, the steps you need to take, and who will be responsible for each step.

A common mistake when establishing improvement goals is setting goals that are not achievable. Unrealistic goals will lead to discouragement rather than motivating change, so carefully consider how high you will set the bar. Look to your starting point for guidance: if your baseline is low, a moderate increase will be an attainable goal and your success will motivate you to continue improving.

In order to track your progress and recognize when you’ve achieved your goal, it’s critical to have measurable criteria. A baseline measurement is important in order to compare your pre- and post-implementation results. The metric that you select to track needs to be directly related to your goal and simple enough to track easily. Record audits, patient and/or staff surveys, or EHR data reports may provide easily-trackable metrics.

Once you’ve determined the metric to use as a progress indicator, decide how often you’ll check your progress. Depending on your goal, you might set a specific deadline for reaching the goal, as well as benchmarks for measuring your progress. Goals that are time-bound have a sense of urgency and that provides motivation to change. Setting benchmarks at weekly, monthly or quarterly intervals creates accountability and keeps you and your staff motivated. Once a goal is met, consider continuing to track your metric at regular intervals to ensure that the results you achieved are maintained over time.

If you’re interested in more information about implementing change, the AMA STEPS Forward program offers several modules, each earning 0.5 CME credits.

Change Initiatives: Produce Meaningful, Sustainable Change  https://edhub.ama-assn.org/steps-forward/module/2702749

Plan-Do-Study-Act (PDSA): Accelerate Quality Improvement in Your Practice  https://edhub.ama-assn.org/steps-forward/module/2702507

Change Management and Organization Development: Enhance Organization Efficiency and Effectiveness https://edhub.ama-assn.org/steps-forward/module/2702744