Maintain your quality improvement achievements

Are you starting with quality improvement initiatives? You may have been testing them for a while, but the results are not what you expected. Unfortunately, quality improvement efforts sometimes follow the pattern of those who lose weight; after a couple of years most of the lost weight has been regained. Also, quality improvement efforts seem to die or become less productive. I was reminded of this recently. I was recently speaking with a colleague who reported that the quality improvement efforts at the site I was working with had died down after about a year. This pattern can also be found in people with chronic diseases; After initial success in managing the disease, the patient reverts to old habits and the disease worsens as does the patient’s life. Why do quality improvement and control efforts for weight and chronic diseases fail so often? Some of the reasons are that QI (quality improvement) requires a lot of effort and people do not want to spend the effort or dedicate their efforts to other new projects; people tend to revert to old habits unless new ones take hold; And no one takes responsibility for keeping improvements going.

Let me give you a couple of suggestions to keep the quality improvement momentum. First though, let me address the idea that some of you may have that the MC is a one-time event. Quality improvement is generally considered in the manufacturing sector as “continuous quality improvement”. In other words, the attitude is adopted that there is always room for improvement and there are structured ways to do it, such as improving lean quality. There are always better ways to eliminate wasted effort, find time to do more, improve results, and improve customer (patient) satisfaction. In other words, perfect quality is a goal, but it 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 in your healthcare facility, there should be at least one person with the responsibility and authority to maintain quality improvement efforts. He or she will be the head of a quality team, 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 “The Seven Habits of Highly Effective People” by Stephen Covey: Putting 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, non-productive activities.

The leader of QI efforts should be supported by a permanent QI team. This team should have members with a variety of skills and personality types who bring a variety of ideas to solve problems or create new solutions. Diversity of thought is very important for success. Also recognize that teams often go through several stages of development:

(1) Members in formation come as individuals with their own identity and perspective.

(2.) The members of the assault become aware of the task before them and adopt an attitude that they want to help solve the task, but continue to think as individuals.

(3.) Normative individuals begin to move 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 is working as a smooth cohesive unit and recognizes and works with its leader.

Another method of maintaining quality efforts is to keep a record 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 periodically by the leaders of the QI efforts. The log or reports should track measurements of variables identified as important in tracking QI 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 whose space could be better utilized). Said record would show a graph or chart that indicates progress towards a mean that the QI team points to and with an increasingly smaller standard deviation.

Another boost to keep the effort going would be to have a regularly scheduled audit. Manufacturers use external auditors to come in and review records of QI efforts and comment on possible improvements while documenting successes. In fact, the American Society for Quality certifies such auditors. A health care site could use a lean quality improvement trainer or a Six Sigma program black belt as an auditor. In fact, if your site has hired 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 in place 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 satisfied with their work. You will need strong leadership, qualified teams, regular records or reports, and external audits. If you study various quality improvement efforts, you will also find other factors to help you on your QI journey.

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