A series of activities that are part of a program/pathway will have to be defined. There will be many components depending on the size of your program.

Activities will include:

• which staff will come on board and what they will be doing (work plan),
• training them,
• the different steps in your program/pathway that have to be taken,
• the tools (forms, documents, material for patients, etc.) that have to be developed or any existing ones that can be used or modified.

Measurable and achievable short term targets

It is important to have a description of the program's activities, the staff work plan and program operational plan (target dates for completion, deliverables, progress reports). They may need to be revised and the work plan modified.

• This is why it is important to have short-term targets that are measurable and achievable. Often this can be done as part of a pilot project to allow people and administrators to judge the results and decide on the long-term plan.

 

Table 2: Examples of possible interventions and work plan*

Intervention	Target date	Person responsible	Deliverables	Progress report
COPD Care Map (training)	May 7 (2007)	Specialized nurse clinician	70 % of the day shift nurses have received the seven training sessions	Focus group one year later to evaluate needs and feedback
D/C planning tool	May 14 (2007)  (draft) May 14 (2008) (final version)	COPD network case manager	All COPD patients admitted for exacerbations into the medical or respiratory units get a D/C tool to be completed	Collect data (# of COPD admissions into the targeted units) versus # of D/C tools completed (target is  80% )
Collective order to facilitate spirometry order by nurses	November 2007	Respiratory department manager in collaboration with the RECAP CUSM committee	Allow specialized nurse clinicians to order spirometry tests on the internal medical unit for COPD patients admitted for exacerbations	Collect data from the use of the collective order and evaluate the process with the RECAP CUSM  committee

* Tools, forms/formularies and training programs will have to be decided and developed or adapted depending on existing resources and local needs.

By identifying obstacles to adherence, and including healthcare professional perspectives on potential barriers and their solutions to bridge the gaps in care, a more successful intervention can be achieved.