Quickly Improve the Quality of Your Healthcare Site
Recently as I was working with various representatives from healthcare sites involved in designing a new process, the term rapid cycle improvement was mentioned. The term sounded a bit strange to me, a quality improvement engineer. I had not heard it used outside the healthcare field before, either in manufacturing or service quality improvement fields. Being curious, I googled it and found that most uses of this phrase were in the healthcare field. After a bit further investigation, including seeing if the glossary of quality improvement terms on the American Society of Quality’s website included rapid cycle improvement (it does not), I decided that the term most closely resembled the Lean tools kaizen and kaizen events, which are very well described in the February 2007 Quality Progress journal of the American Society of Quality. In the interest of standardizing the use of terminology I will define and illustrate the ideas of kaizen and kaizen events as used in the Toyota production system.
Kaizen typically refers to continuous, methodical improvement in an organization. It is best carried out by a team whose members are representatives of users of a process being improved. For instance, an emergency room team trying to improve the handling of patients who are under the influence of alcohol along with some sort of trauma might consist of physicians from the ER, a nurse who handles triaging of patients, a representative of staff who make initial contact with patients waiting for treatment in the ER, and a representative of the county mental health department that manages treatment and funding of facilities of those with alcohol addiction.
read moreEffective Communication and Leadership at Health Care Sites
Recently I was reading an online posting of an ER physician about a quandary he occasionally experiences. A patient had come to the ER and was complaining of acute pain. The patient wanted a prescription for a schedule 2 controlled substance. The first difficulty for the physician was to determine whether the patient was asking for the medication because he was an addict and wanted it to get high. This situation is not uncommon. The second difficulty was a situation that, while not surprising, should not have happened. The physician felt pressured to prescribe the substance in order to please the patient. Why would that matter The hospital administration had been pressuring staff to work hard to improve patient satisfaction scores on the CAHPS Hospital Survey. Turning the patient’s request down might lead to a poor response on the survey if the patient was asked to take it.
It is my opinion that the quality of the service to the patient as measured by a satisfaction survey should not impact the clinical decision process of the physician, nurse, or any other clinician. Any quality program should measure the quality of support services, such as hospital environment, waiting time for the patient, access to service, etc. This point of view is emphasized in The Toyota Way to Healthcare Excellence by John Black. It seems that this confusion of clinical decisions with quality improvement is not all too uncommon. When clinical staff hear of standardized work in quality improvement confusion about what is to be standardized can occur. In all of the quality programs-Baldrige, Six Sigma, TQM, Lean-the quality efforts focus on processes, not clinical decisions. It is assumed that clinical staff will make the best medical decisions that benefit the patient and that the patient should be involved in the decision making process.
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