Last month I talked about keeping your quality improvement changes in place—
using a manual that you develop of SOP’s, standard operating procedures. By the
way, if you missed that issue, you can find it on my website, and several earlier ones
too.

This month I want to address starting a quality improvement project. That is, how
do you decide what project to work on? What issue or process is causing the most
waste, is doing the most harm, is most affecting the bottom line? Maybe you are a
leader at your site and you have an idea of what is generally causing problems. For
instance, you may think that patients with catheters are getting a lot of infections.
Perhaps, checking patients in at your site is taking too long and creating a
bottleneck. Maybe patients are complaining about having to wait too long at check
in at a doctor’s office. It could be that certain departments are running short of
supplies too often. There are many other possibilities. The probability is that
unless you are directly involved in the contentious process, you probably are not
aware of what the exact problems are and are not aware of possible solutions.

This leads us to the conclusion that in order to discover the many problems facing
every organization, especially in terms of wasted effort, time and money, there has
to be in place a mechanism for the problems to surface to the leaders from the front
lines of the organization. There has to be a way for the leaders to hear about the
problems from those who are directly involved. For instance, does anyone in your
organization know what ideas the cleaning staff has for making the organization
better? When I say that there has to be a way for the ideas to surface, I don’t mean
that the only ones with a voice should be nursing staff and other professionals.
Rather, as in the Baldrige Improvement Plans, the entire staff is involved in quality
improvement.

I know of a few hospitals where the leadership—president, CFO, COO, etc.—go out
several mornings every week to talk to staff at all levels and patients to see how
things could be better and to get some positive feedback about what things are
going well. Perhaps at your site you want to start something like this. As time goes
by and as suggestions are implemented, staff will feel safer about making
suggestions.

Leadership needs to make sure that staff feel safe about making suggestions, no
matter what the method of suggesting changes is used. Perhaps you might want to
use an anonymous survey for collecting initial suggestions. After some of the
suggestions are acted upon, the staff will feel like the leaders really want good ideas
and will feel safer making them known. Perhaps you might want to use a consultant
in Lean Healthcare (many of these ideas I suggest come directly from Lean
Healthcare) to teach the staff the principles and processes of Lean Healthcare and
other tools as may seem fit. This approach will help a large organization start
making many positive changes quickly, rather than using the idea of slowly
spreading the means of change throughout an organization, as some prefer.

Whatever your initial process of getting the ideas percolating up in the organization,
after some ideas for quality improvement recommended by the rank and file are
successfully implemented and after the improvements and savings are made known
in the organization, it is time to create ways to get more ideas. Perhaps you want to
have regular meetings with a designated leader and representatives from several
staffing areas that will bring up ideas. That means that the rest of the staff must
feel comfortable about making suggestions to these team members. If your site has
few employees, then perhaps it would be best to have regular staff meetings with all
employees where the agenda always includes time for quality improvement ideas
and for updates on ongoing projects. Whatever method you decide works best for
your site, be sure that an atmosphere safety and security exists for all the staff.
This may mean going so far as to guarantee that no staff will lose there position as
improvements create more time to get things done.

So, once you have a steady flow of quality improvement ideas being generated by all
in the organization, which ones should you act upon? Next month, I’ll address that
issue. This issue I decided to concentrate on the Define step of Six Sigma’s DMAIC
(define, measure, act, improve, control). Next, I will discuss the measure segment.
Sometime in the future I’ll cover team dynamics too.

By: Donald Bryant