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“This method not only provided excellent tools, it also helped us build the habit of criticizing our own process so we can make it better.”

David Scronce,
Director Strategic Initiatives
University of California, Berkeley


How do you get healthcare employees to embed continuous improvement in their everyday work life? Part 2

Guest Blog

By Mary Grace Gardner, 3D Character and FriendshipDirector 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.  Part 2 lists 3 more elements of an ongoing continuous improvement program.

  1.        Test the ideas and set expectations on failure: If the stakes are high and failure is not an option (e.g. an emergency situation may not be the best time to test new ideas), let that be known. Otherwise, be explicit that when improvement work is taking place, failure is expected within certain parameters. Perfection shouldn’t be expected the first time around, and each failure brings you closer to a solution. Continuing with the patient satisfaction and pillow shortage example, since the stakes are pretty low, it would be reasonable for the manager to declare that it would be acceptable to test out different solutions over the next eight weeks. Let’s say that the nursing unit works with materials management to try out a potential solution over the next two weeks: when there are ten pillows left in stock, the materials department will refill the stock. After a week of testing, the team finds that too much stock is left in inventory and there is no space to house the extra pillows. The team regroups and sets up a new test: instead of the trigger for a restock of inventory being ten pillows, the team decides to move the trigger to two pillows. After another week of testing, the team finds that they still keep running out of pillows and decide to adjust the trigger from two to six. After another week of testing, they find out that six pillows is the perfect trigger number so that the linen storage area is not overcrowded and the unit never runs out of pillows.
  2.        Agree on the best way to resolve the issue: The best solution is one that can be performed by all those who need to implement it (Remember, heroics is not a sustainable solution). Let’s say all nurses on the unit identify there is a pillow shortage issue except for one nurse named Sebastian. Upon observing Sebastian one day, you notice that when there are no more pillows on the unit, he goes upstairs to other units and brings back pillows for his patients. While he does resolve the immediate issue of his patient’s request for more pillows, this solution wouldn’t be sustainable if everyone followed suit – the other units would quickly also have a pillow shortage problem to deal with.
  3.        When the issue is resolved, celebrate: We can get so preoccupied by what needs to be fixed that we forget to celebrate when things go well. There are many ways to celebrate solving a problem: posting it on a success board, having leadership spend time with the team to hear the success, featuring the solution on an internal website, or simply saying, “Thank you for a job well done.”

When continuous improvement is framed as everyday problem solving intended to make work easier to do (who would say no to making work easier?), it can be more readily embedded into daily operations. However, it cannot happen in a vacuum. In order for it to be sustainable, it requires a system that surfaces improvement opportunities and a culture that supports continuous learning. That’s right, continuous improvement doesn’t have to be rocket science (but sometimes, it can be).

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