CQI - Eliminate the Buzzwords and Get Back to Work

I spent the last two days pleasantly tucked away at Rotterdam's Novotel Brainpark with some of my new Dutch coworkers, modeling implementation of a targeted CQI theory in the healthcare setting.

Six Sigma, Toyota Lean manufacturing, and pulling CQI processes and initiatives from other industries are items I've addressed here before - in US healthcare we've cobbled together a convoluted cocktail of improvement programs to address larger systemic issues.

At hospitals, we tend to jump somewhat blindly on the latest bandwagon approach. Disney "Be Our Guest" initiatives have scarcely gone out of fashion before we're looking at airline best practices (and anyone who has traveled more than once in the past year doubts the validity of pulling system design from luggage handling).

You can take your pick from a multitude of currently popular manufacturing adaptations, creating hospital focused factories of care where patients and providers are inputs to whom we must deliver service lines (products) as quickly and efficiently as possible (not to say that there's anything inherently wrong in this approach...).

Hospitals end up with a patchwork quilt of initiatives, each piece requiring different staff training courses and management action teams to knit the new process into existing organizational fabric.

Those of you looking for more examples of sensible, 'global' approaches to improving your environment of care (or replacing your current patchwork system), check out the following resources:

1. The IHI's International Forum 2008: Ahhh, Paris. There's nothing better than munching a chocolate croissant strolling the streets of the City of Lights in the spring, unless you're on your way to the IHI Intl. Forum to hear top-notch speakers and bring home results-oriented research.

Two of this year's featured themes are leadership and whole system transformation. Presentations are offered in English; some are available with French translations.

Presenters include IHI President/CEO Donald Berwick, Joint Commission President Emeritis Dennis O'Leary (who gave a great keynote at JCAHO's Hospital of the Future conference last spring in Florida), Current Joint Commission International President/CEO Karen Timmons, VP and Chief Strategy Officer - Blue Cross Blue Shield of Massachusetts Vinod Sahney, AGIS Health Insurance (Dutch firm) Consultant Piet Stam, Director of the Dutch Institute for Healthcare Improvement CBO and researchers, practitioners, and staff from hospitals and healthcare systems all over the world.

Read the brochure here. Register your team by Feb. 29th for an early bird discount - for fee/registration info click here.

2. For those seeking information on process improvement (liberally distributed among commentary on many other issues), check out Clarke Ching's blog, a Bigger Glass please. Clarke also hosts a Yahoo! Group discussing Goldratt's Theory of Constraints in healthcare.

3. Finally your hospital is looking good - but does your daily presentation speak for itself? For wardrobe CQI and engineering your own look, nobody says it better than Life as a Healthcare CIO John Halamka. John, I'm tempted to toss my entire wardrobe and start over.

As hospital management teams, we've begun to trumpet our quality initiatives to press, patients, and providers (sometimes unfortunately in that order).

Quality goals are often ambitious, bold, and seemingly unreachable articulations of our desire to make safe, effective patient care the norm.

Let's be honest with ourselves though, and our patients - going 'where no hospital has gone before' with quality initiatives presents us with a win-win. Patients and hospitals become partners in quality and partners in care.

More patients can be treated with lower variance levels/adverse events, but we can also treat more patients, and deliver care that distances our performance from that of our peer facilities.

Optimizing quality allows hospitals to achieve high marks for both service and safety. Optimizing quality allows hospitals to become the kinds of places we'd recommend to family and friends.

Aggressive quality goals are win-wins for patients, providers, payers, and professionals. But how to get started?

Step 1: Define what quality means for your facility - use simple, brief language that details exactly what you'll achieve (no charge for 28 never events? Joint Commission International accreditation? Top 10% of hospitals domestically? Internationally?).

Step 2: Share your plans with internal constituencies - get feedback. Publish them. This is a time for total transparency. No one picks out the holes in your theory quicker than those who have to put it into daily practice.

Step 3: Get going. We can plan elaborate campaigns and spend half our time around the conference table, or we can quickly articulate an aggressive plan and then authorize employees to 'just do it.' Quality initiatives will evolve when released into the work environment - let your babies go!

After all, quality is what you succeed in doing, not what you succeed in saying is important.

When we look at developing really audacious quality initiatives, what's holding us back? The fear that we won't succeed, or the fear of what problem we'll tackle after the biggest constraint is gone?

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