If the bar is set too low, we run the risk of underachieving relative to our potential. On the other hand, if the goal is unachievable, we set our organizations up for disappointment and frustration. While "error free" is the ultimate goal in the pursuit of perfection, this is an absolute aspiration, and setting a target of zero defects may trivialize the process by establishing an unachievable objective.
We need to set realistic goals that are attainable but aggressive enough to propel the pursuit of perfection, placing the emphasis on the continuous nature of the pursuit. That's where the idea of the "half-life" comes from.
From Here to Perfection
The half-life concept focuses goal setting around the length of time it will take to reduce defects by 50 percent. Arthur M. Schneiderman introduced the idea in his article, "Setting Quality Goals" (Quality Progress, April 1988, p. 51). According to Schneiderman, "this model has the appealing attribute that it accommodates the notion of zero defects, yet guarantees that it is achievable only in infinite time."
Here's how it works:
If the optimal endpoint in a particular process is zero defects, we would set the goal as the time it will take us to achieve a 50 percent reduction in defects or missed promises from where we are today. For example, if the goal is to eliminate harm from anticoagulants, and the current rate is 2 percent, the half-life is the time it takes to drop the rate to 1 percent. Once that milestone is achieved, the half-life is the time it takes to drop to 0.5 percent.
If the ultimate objective is a non-zero target, we would establish a short-term goal as the amount of time it will take to get 50 percent closer to this target. For example, if the patients in a diabetes registry have an aggregate HbA1c level of 9, and the optimal is 7, how long would it take to get to 8? Then 7.5?
Use Successive Half-Lives to Aid in Planning
The half-life concept can offer an effective framework for long-term planning. Say we're currently at a 30 percent satisfaction rate on a particular measure, and we expect to be at 95 percent by the end of two years. We ask ourselves how many times will we need to cut the defects in half to achieve the goal of 95 percent?
First cycle: 30 + (100 - 30)/2 = 65 percent
Second cycle: 65 + (100 - 65)/2 = 82.5 percent
Third cycle: 82.5 + (100 - 82.5)/2 = 91.25 percent
Fourth cycle: 91.25 + (100 - 91.25)/2 = 95.625 percent
So, it will take four half-life cycles to achieve the goal of 95 percent defect-free. Armed with this information, we can begin setting a pace for change that can be planned ahead of time. Since our objective is to get to 95 percent in two years, we would need to achieve a pace of a half-life defect reduction every six months in order to accomplish this long-term goal. If we set goals with an eye toward the rate of change toward perfection, this allows us to maintain perfection as the ultimate goal while planning an achievable pace of change.
We in the health care industry need to recalibrate ourselves — to learn to set ourselves up to succeed in attainable steps as we reach for ambitious overall targets in our improvement work. The concept of the half-life allows us to set achievable yet far-reaching goals — and ultimately to make meaningful promises to our patients.