Are you starting with quality improvement initiatives? Maybe you’ve been trying them for a while, but the results aren’t what you expected. Unfortunately, efforts to improve quality sometimes follow the pattern of those who lose weight; after a couple of years most of the lost weight has been regained. So, too, quality improvement efforts seem to die off or become less productive. I was reminded of this recently. I was recently speaking with a colleague who reported that quality improvement efforts at the site he worked on had died out after about a year. This pattern can also be found in people with chronic illnesses; after initial success in managing the disease, the patient falls back into old habits and the disease worsens as does the patient’s life. Why do quality improvement efforts and weight and chronic disease control so often fail? Some of the reasons are that QI (quality improvement) requires a lot of effort and people don’t want to spend the effort or spend their efforts on other new projects; People tend to go back to old habits unless the new habits take root; and no one takes responsibility for keeping improvements on track.
Let me give you a couple of suggestions to keep the momentum of quality improvement going. First though, let me address the idea that some of you may have that QI is a one-time event. Quality improvement is generally considered in the manufacturing sector as “continuous quality improvement”. That is, one takes the attitude that there is always room for improvement and there are structured ways to do it, such as quality-adjusted improvement. There are always better ways to eliminate wasted effort, find time to do more, improve the bottom line, and improve customer (patient) satisfaction. In other words, perfect quality is a goal but can never be achieved.
One way to sustain quality improvement efforts is to have quality leaders backed by good teams. Depending on the number of employees at your healthcare site, there should be at least one person with the responsibility and authority to sustain quality improvement efforts. He or she will be the head of one or more quality teams, which must meet on a regular schedule. This person must be able to effectively prioritize their work and time, a person who understands and applies the third habit found in Stephen Covey’s “The Seven Habits of Highly Effective People”: Put First Things First. This person will effectively plan and report on QI efforts and will not respond to crisis situations or be distracted by trivial and unproductive activities.
The leader of the CI efforts should be supported by a permanent CI team(s). This team should have members with a variety of skills and personality types who come up with a variety of ideas to solve problems or create new solutions. Diversity in thought is very important to success. Also recognize that teams typically go through several stages of development:
(1) Formation members come as individuals with their own identity and their own perspective.
(2.) Storming members realize the task ahead and adopt an attitude that they want to help solve the task, but still think as individuals.
(3.) Normative individuals begin to shift from thinking as individuals with personal concerns to thinking of the team as a cohesive unit.
(4.) Performance: The team has matured to the point where it functions as a smooth cohesive unit and recognizes and works with its leader.
Another method of maintaining quality efforts is to keep track of improvements, much like someone on a weight loss plan keeps a journal of their progress. This record could be the minutes of the quality improvement team, or it could be reports prepared regularly by the leader(s) of the QI efforts. The registry or reports should track measurements of variables identified as important in tracking CI efforts. One measure, for example, might be the mean time with standard deviation (a measure of variability) that a patient spends in the waiting room of a primary care office. (I’ve often wondered why there are such large waiting rooms. I can think of very few companies that make their customers wait that long in rooms where space could be better utilized.) Such a record would display a graph or chart indicating progress toward a QI team’s target mean and with decreasing standard deviation.
Another impetus to keep the momentum of the effort going would be to have a regularly scheduled audit. Manufacturers use third-party auditors to go in and review records of QI efforts and comment on possible improvements while documenting successes. In fact, the American Quality Society certifies such auditors. A healthcare site might use a lean quality improvement trainer or a black belt from Six Sigma programs as an auditor. In fact, if your site has contracted with a group or individual to train employees and leaders in quality improvement efforts, you may want to include regular audits as part of the contract.
These four tips should help keep QI activities on your site and should help you achieve your goals, which should include patient health and satisfaction, better use of time and more time to do the important things, better results and employees who feel empowered and empowered. satisfied with his work. You will need strong leadership, qualified teams, regular records or reports, and external audits. If you study various quality improvement efforts, you’ll also find other factors that will help you in your CI process.
