Table 1

Illustrative hospital project using strategic problem solving

Step	Description	Example
Problem	All coalitions began with the same problem statement.	AMI mortality is too high.
Objective	Coalitions then generated a mirroring objective that was meaningful and measurable within their operating context.	Reduce unadjusted 30-day AMI mortality for all payer classifications by 3% from Fiscal Year 2014 baseline (6.69%) by 31 December 2015.
Root cause analysis	Coalitions used multiple sources of data to identify and prioritise root causes of AMI mortality in their context.	Lack of standardisation of care, complex patient population with multiple comorbidities, inconsistent transitions in care.
Strategy development	Coalitions adapted evidence-based strategies and generated novel strategies, tailored to address their prioritised root causes.	Structured form for pharmacy rounding on patients and review discharge medications; introduction of real-time risk stratification using two tools; creation of an AMI follow-up clinic.
Results	Coalitions created evaluation plans to match their strategies and evaluate progress towards their SMART objective.	Increase in number of pharmacist interventions; improved reliability of risk stratification; decrease in proportion of patients lost to follow-up; decrease in unadjusted mortality from 6.7% to 2.7%.