Are you just beginning quality improvement initiatives? Maybe you have been trying them for a while, but the results aren’t what you expected. Unfortunately, quality improvement efforts sometimes follow the pattern of those who lose weight; after a couple of years most of the weight that was lost has been regained. So too quality improvement efforts seem to die or become less productive. I was reminded of this recently. I was recently talking with a colleague who reported that the quality improvement efforts at the site he worked with had died out after a year or so. This pattern can also be found in those with chronic diseases; after an initial success in managing the disease, the patient falls back into old habits and the disease worsens as does the life of the patient. Why do quality improvement efforts and management of weight and chronic diseases fail so frequently? A few of the reasons are that QI (quality improvement) takes a lot of effort and people don’t want to expend the effort or they devote their efforts to other new projects; people tend to revert to old habits unless the new habits become firmly entrenched; and no one takes responsibility for keeping the improvements going.
Let me give you a couple of hints at maintaining the inertia of quality improvement. First, though, let me address the thought that some of you may have that QI is a one-time event. Quality improvement is generally thought of in the manufacturing sector as “continuous quality improvement.” That is, one adopts the attitude that there is always room for improvement and there are structured ways to do so, such as lean quality improvement. There are always better ways to eliminate wasteful efforts, find time to get more things done, improve the bottom line and improve client (patient) satisfaction. In other words, perfect quality is a goal but can never be reached.
One way to maintain quality improvement efforts is to have quality leaders supported by good teams. Depending on the number of employees at your healthcare site, there needs to 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(s), which should meet on a regular schedule. This person should be able to effectively prioritize his or her 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 won’t be responding to crisis situations or get distracted by trivial, nonproductive activities.
The leader of QI efforts should be supported by a standing QI team(s). This team should have members with a variety of skills and personality types who bring a variety of ideas to solving problems or creating new solutions. Diversity in thinking is very important to success. Recognize too that teams usually go through several stages of development:
(1) Forming-members come as individuals with their own identity and own perspective.
(2.) Storming-members become aware of the task before them and adopt an attitude that they want to help solve the task but are still thinking as individuals.
(3.) Norming-individuals start to shift from thinking as individuals with personal concerns to thinking of the team as a cohesive unit.
(4.) Performing-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 for maintaining quality efforts is to maintain a record of improvements, much like someone on a weight loss plan keeps a journal of his or her progress. This record could be the minutes of the quality improvement team or could be regularly prepared reports by the leader(s) of the QI efforts. The record or reports should keep track of the measurements of the variables identified as important in tracking the QI efforts. One measurement, for instance, might be the mean time with standard deviation (a measurement of variability) 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 businesses that make their clients wait such long times in rooms whose space could be better used.) Such a record would show a graph or chart which indicates progress toward a mean targeted by the QI team and with shrinking standard deviation.
Another impetus for maintaining the momentum of the effort would be to have a regularly scheduled audit. Manufacturers use outside auditors to come in and examine the records of the QI efforts and comment on possible improvements while documenting successes. In fact, the American Society of Quality certifies such auditors. A healthcare site could use as an auditor a trainer in Lean Quality Improvement or a Black Belt from Six Sigma programs. In fact, if your site has contracted with a group or individual to train employees and leaders in quality improvement efforts you might want to include regular audits as part of the contract.
These four suggestions should help maintain QI activities at your site and should help you reach your goals, which should include patient health and satisfaction, improved use of time and more time to get the important things done, improved bottom line and employees who feel empowered and satisfied with their job. You will need strong leadership, qualified teams, regular records or reports and outside audits. If you study various quality improvement efforts you will also find other factors which will help in your QI journey.
