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How do you get healthcare employees to embed continuous improvement in their everyday work life? Part 1

Screen Shot 2016-04-16 at 11.52.25 AMGuest Blog

By Mary Grace Gardner, Director of Strategy and Performance Improvement in the San Francisco Bay Area.

What do the following three things have in common: dropping a ping pong ball either into a bucket that says ‘yes’ or ‘no’ at the end of day, checking whether wearing a bright yellow sash during medication administration prevents disruptions, and timing how long it takes to click buttons on a screen in different sequences? They’re all examples of continuous improvement. These three examples are simple ways to collect data on a small scale to inform what list of activities lead to a sustainable solution that gets better results.

Lean, performance improvement, continuous improvement, six sigma…these terms can oftentimes stir up images of complex projects, analyses or an immense amount of work, and this can intimidate or alienate physicians, nurses, administration, support departments and other front line staff. When you boil it down, what improvement work in healthcare is intended to do is assist with making problem solving easier. And, if you want continuous improvement to permeate your culture, it must be embedded in everyday work. I know what you’re thinking: “That sounds easy in concept, but how do you actually do that?” Here’s how:

  1.        Have a way to easily tell what performance is ‘at a glance’: It starts with making it easy for physicians, nurses and staff to identify when performance does not equal a desired standard. That means a standard needs to be defined and a way to measure performance is easily accessible. Say for instance that you are working on an initiative to improve patient satisfaction so that every patient feels that the team did everything they could to make his or her stay the best experience possible. One way you could see performance on a daily basis is to set up two buckets near the unit’s exit, give each patient a ping pong ball during discharge, and instruct the patient, “If you felt that we did everything we could to make your stay the best experience possible, please place this ping pong ball in the bucket labelled yes as you exit the unit. Otherwise, please place it in the bucket labelled no.” At the end of each day, collect and count the number of ping pong balls in each bucket and make a simple chart or, better yet, a graph. Display this data somewhere that staff can see this and have frequent conversations with the team to determine what worked well on days when there were more ping pong balls in the yes bucket and what could be improved on days where there were more ping pong balls in the no bucket.
  2.        Give the frontline the tools it needs to problem solve in the moment or escalate if the issue cannot be quickly resolved:  No one likes the feeling of being stuck, especially when it comes to providing care to patients. When current performance is not equal to a desired standard, staff should know either what needs to be done to get things back on track or how to seek the help of a manager who will assist with a quick fix to keep things moving. Sticking with the aforementioned patient satisfaction example, let’s say you discover that on days when there is a higher percentage of no’s, staff members are having trouble finding enough pillows to fulfill patient demand. When stock is low, staff members should have the process for requesting pillows easily accessible to them. If they do not get a response despite following the process, they should be able to alert their manager to help resolve the issue.
  3.      If the issue is escalated, don’t let the manager or staff use heroics to solve the problem: While quick fixes are appropriate for in the moment problem solving, they are not always the most appropriate long term solution. The best people to solve the problem are usually the ones closest to the problem and experiencing it every day. They usually know exactly what they need to fix the issue. It’s the job of the manager or improvement facilitator to ensure the solution is sustainable and consider the upstream and downstream ramifications of these fixes to inform what should be the best solution.

Part 2 covers the next three steps – test the issue, resolve it, and what to do last.

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1 comment to How do you get healthcare employees to embed continuous improvement in their everyday work life? Part 1

  • Vanessa Rodriguez Diaz

    This article presents an important lesson bout making changes in life or in a company. It is necessary to know that failure is expected, but we have to make sure that it doesn’t happen in critical situations; also, there might be different ways to solve a problem, but just one is the best choice to improve the current situation; finally, celebrate when the issue is solved, it helps motivate people involved.

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