A Strategy for Continuous Quality Improvement

When implementing a quality improvement program, there are various strategies of program maintenance that can be used.  One specific strategy, introduced in the 1920s by Walter A. Shewart, and expanded upon in the 1950s by W. Edwards Deming, is the Plan-Do-Check-Act (PDCA) Cycle (Arveson, 1998).  Most current models of improvement are based upon this method; and therefore it can be considered a starting point for organizations in need of improvement (Ransom, Joshi, Nash, & Ransom, 2008).

It was Deming’s belief that organizational processes should be routinely evaluated; he thought this necessary to identify the origins of possible failures and inconsistencies in the processes (Arveson, 1998).  The PDCA, also referred to as The Shewhart Cycle, The Deming Cycle, and the Plan-Do-Study-Act (PDSA) cycle, should be a continuous action, on the part of the organization, that helps standardize routine evaluations by using its four elements (Tague, 2004).

In the first phase of the cycle, the planning phase, an organization is encouraged to design a plan for improvement, or revise an existing one (Arveson, 1998).  Here, it is suggested that ideas are gathered, and expectations and objectives are set based upon where you are and where you want to be, using the four W’s (Ransom et al., 2008).  For instance, a company may be having trouble with understaffing, yet has a tight budget. The plan for improvement would be deciding on who, what, when, and where the problem can be fixed. Essentially, in the given scenario, it would be the planning of who, what, when, and where the organization can procure a sufficient amount of staff, without going over budget.

The second step is to do what has been planned, also known as the implementation phase of the improvement (Arveson, 1998). After addressing the expectations of the plan, it is time to take the appropriate actions that will help in the accomplishment of the organization’s mission. For understaffing, and a tight budget, the plan may be to analyze records showing the average peak times of service and subsequently hiring a part-time employee for those times of the day.

Along with implementing the plan, it is important to measure the plans’ success with valid and reliable tools; this is to ensure that the improvement is, in fact, improving.  Using a mix of tools, such as patient satisfaction surveys and budget reports, a company can verify the usefulness of the extra employee, the efficiency of the plan and compare the results with past and/or current situations. Ransom et al. (2008) suggests using valid and reliable measures to ensure consistency in results such as the Consumer Assessment of Healthcare Providers and Systems initiative (CAHPS).  This program is designed to assess the degree to which care is patient-centered, compare and report organizational performance and improve quality of care.

The third step of the improvement is to check your results, also known as the assessment step (Arveson, 1998). The analyzing of results is a process that includes summarizing what was learned from them (Ransom et al., 2008). The summary’s importance is to aid in determining which direction to take for the fourth, and final step, of the cycle (Tague, 2004). In the scenario given, the results will hopefully help to determine if the extra employee is worth the addition to the organization and/or and worth the addition to the payroll. If the role of assessing results is placed upon an individual or individuals, who are not parts of the management team, the final action in this step is to report the results to those who are in the decision-making role.

Last in the cycle is to take action. If it worked, great, if not, further actions to get to the organizations goal should be taken.  It is important to use what was learned from the assessment phase, to make modifications to the current plan, or to change the plan altogether (Ransom et al., 2008). Either way, the idea of the cycle, is to carry out additional cycles until the organization’s goals are met.

Essentially, the PDCA Cycle can be considered a basic method for improving organizational processes.  The continued use of the model is encouraged to get an organization to its end goals and to maintain that position.  As the PDCA Cycle is a basis for most current models of improvement, it can be considered a reliable method for an organizations pursuit of quality improvement.

References:

Arveson, P. (1998). The Deming cycle. Balanced Scorecard Institute. Retrieved July 19, 2012, from http://www.balancedscorecard.org/thedemingcycle/tabid/112/default.aspx

Ransom, E. R., Joshi, M. S., Nash, D. B., Ransom, S. B. (2008). The Healthcare Quality Book (2^nd ed.). Chicago, IL: Health Administration Press.

Tague, N. R. (2004). Plan-do-check-act (PDCA) cycle. The Quality Toolbox (2^nd ed.). (pp. 390-392). ASQ Quality Press. Retrieved July 19, 2012, from http://asq.org/learn-about-quality/project-planning-tools/overview/pdca-cycle.html

Important determinants to whether or not an adverse medical event has occurred

When adverse medical events occur, there can be many determinants as to their happening.  Factors such as protocol compliance, staffing and safety levels and even patient perception can play a role in the uncovering of, or contribution to, an adverse medical event.  However, if an unfavorable event should occur, some such determinants may be considered more important than others. 

It is one’s opinion that the factor of patient perception is important when determining if an unfortunate medical event has happened; however it is not the most important.  On one hand, the patient’s intuition may tell them that something is wrong, for instance, internally.  In a major mishap, perhaps a surgical instrument was left in the patient.  In a situation like this, the patient perception can play a huge role in the determination of error.  However, on the other hand, some patients may have a cognitive illness and therefore not be a legitimate source of perception.  Thus, one feels that when using patient perspective as a motivator, for examining a possible adverse event, it should be approached on a case-by-case basis.

One factor that can be deemed as more important than patient perception is protocol compliance.  Following protocol, for example, in a surgery, is important each and every single time a surgery is performed.  If a protocol checklist is not completed after a procedure, situations such as instruments being left in patients can occur.  The checklist can be a huge indicator of something having adversely occurred.

Another determinant that may be considered more important than patient perception is the level of safety that is enacted within an organization.  Clearly if safety is not at optimal levels, accidents can occur.  For example, if bed linens or physician robes are not cleaned daily, they can be breeding grounds for infectious bacteria.  Implementing a checklist and keeping track of it can be a very important determinant as to whether all safety measures are being used when re-using materials.

A last, but certainly not least, example of an important determinant as to whether or not an adverse medical event has occurred is the level of staff that is present during such an event.  To exemplify, ensuring that the proper amount of nurses are always available in the intensive care unit and controlling for their presence can prevent a disastrous event from taking place.  If such an event should occur, having controls will give an insight into where a mistake has taken place.

Overall, there are many, many determinants that can be reliable indicators as to whether or not an unfavorable event has occurred.  Patient perception is one of those, however there are others that can be considered more important.  Listening to patients and respecting their thoughts is always good practice; yet taking their overall situation into consideration, when entertaining a move toward investigation of an adverse event, is even better practice.

Elements to patient safety

As an administrator of healthcare, ensuring quality is one of the most important tasks that we accept to fulfill.  Along with quality, it is important to maintain an exceptional standard of patient safety.  I think that most of us would agree that patient safety is an element of quality that portrays the standard to which your organization performs; and this particular element can only be successful with a committed management staff.  According to Matthew Lambert, MD, senior vice president of the healthcare consulting firm Kaufman Hall, to be able to conserve the patient safety element in healthcare, there are six steps that must be accepted by all who work within the organization (Oh, 2012).

The first element pertains to management, as it is suggested that the patient safety culture begins with those who are in the leadership role (Oh, 2012).  This is where the phrase, actions speak louder than words, is applicable.  As a manager, it is necessary for your staff, patients and other leaders to see that you live by the program you implement for there to be full trust in the system.

Secondly, it is suggested that, as an administrator, you must be able to visualize what patient safety is for your organization and get your organization to that vision, if you are not already (Oh, 2012).  Performing a gap analysis will help management to see where your company stands in terms of where you are and where you want to be (Oh, 2012).  Presenting this analysis to staff is a visual way for all to understand how to get to a superior level of safety.

The third suggested step is that everyone within your organization, at every level, must be in appreciation and compliance with your concept of patient safety (Oh, 2012).  For your strategy to be successful it is crucial that every level of your staff is comfortable with your strategy, they understand it fully and they appreciate what your goals are.  Employees who are not comfortable with implementing certain protocols will lead to a breakdown of your vision and can ultimately lead to its failure.  Having open doors of communication with all levels of employees will help to secure their ability to implement your plan.

The forth step suggested is that the organization continually changes with the demands to which patient safety is needed (Oh, 2012).  Yes, you may have visualized where you are going with your plan for patient safety, but if part of your strategy is not meeting your safety requirements, it will need to be adjusted.  For instance, if employees do not seem to be regularly following safety protocols, maybe a method of monitoring employee actions could be put in place.

Next, it can be interpreted from Dr. Lambert, that the fifth part of ensuring patient safety culture is to provide a standard level of commitment to it, for all who are involved in an organization’s vision (Oh, 2012).  For example, this implies that a manager cannot let one mishap slide and another occurrence be punished; nor can a they decide to use fewer antibacterial soap stations in one wing of their hospital because that wing it not as heavily utilized.  Cutting corners doesn’t fulfill your commitment to patient safety and your employees can be misled in the implementation of your strategy that way.

Last, but not least, of importance is implementing a patient safety program that surpasses the need for management to enforce it (Oh, 2012).  Having a strategy that thrives on its own is the marker for its success.  For example, when the manager who everyone fears is not in the building and your patient safety vision is still at its highest level of performance, that is an indication that all members of the organization are on board and are committed to the safety of all.

Obviously these six steps are not the only means to ensure the safety of patients, staff and management, but it has proven to be effective by Dr. Lambert; as well as by representatives of The Joint Commission’s Center for Transforming Healthcare.  It is my hope that this is viewed as a simple outline for what can be a complex road to the fulfillment of exemplary safety measures.

Reference:

Oh, J. (June 4, 2012). 6 Elements of a true patient safety culture. Retrieved June 4, 2012 from Becker’s Hospital Review.  Website:  http://www.beckershospitalreview.com/quality/6-elements-of-a-true-patient-safety-culture.html

Quality: What does it mean to you?

Defining quality can be somewhat of a daunting task because perception is a main factor into how one deems the quality of something.  It can be both of a good nature and a bad nature, and sometimes, even a little in between.  For me, quality lacks a cut and dry determinant because it can generally be measured on a spectrum.  Its tendency to be black, white, and everywhere in between, makes it difficult to define with specificity.

Although there is the ability to place quality on a spectrum, when I think of the word, without ties to anything specific, Quality denotes something good, or positive.  It is something that is strong, enduring, and has a reputable name.  It can be an attribute of people, places, things, ideas and/or services that place them in a hierarchy, relative to their surroundings.  For instance, two cars may have the same attributes; say a sunroof and stereo-system.  However, it is the degree of quality, of those attributes, that is important; as well as the degree of quality to which consumers look when purchasing.  A Rolls-Royce Phantom is, more than likely, going to have a sunroof of greater quality, and a stereo-system that is superior, in comparison to a Honda Accord.  This can reasonably be considered fact amongst most, because of the reputation that a Rolls-Royce Phantom has in comparison to a Honda Accord.

All in all, cars are cars, and it is not essential to their existence that they receive the upmost quality of care.  Some might dispute this claim, but that is neither here nor there.  However, for health care patients, high quality care is generally something that they are not willing to forgo every other time they go for an “oil change,” or check-up.  From personal experience, even in seeking preventive care, the degree in quality of care received is extremely important.  For example, when visiting a dermatologist, to check lesions on your skin, it is important that the degree in your quality of care is tremendous, while screening for possibly cancerous cells.  If care, of a superior quality, is not utilized in this situation, malignant cells may be overlooked, as well as go undiagnosed.

Not unlike patient care, those who embark into the field of health services administration must also exhibit great quality in their work and actions.  It is my belief that the actions, and work, of administrators are what set the tone for an organization; and should, as well, be the markers of service quality that is superior, not only in the perceptions of their consumers, but also in their care.  Customer perceptions, and experiences, are ultimately what will determine an organization’s failure or success.  Letting the quality chasm fall, at any point of service, could lead to the loss of patients, and ultimately the loss of an organization.