Tool sites offer quick way to bolster performance improvement
Knowledge sharing moves beyond organization to entire profession
If a single organization can benefit from sharing knowledge through an internal site (intranet), just imagine the possibilities when virtually the entire body of performance-improvement (PI) knowledge can be made available to any quality professional who wants it.
We’re certainly not there yet, but a growing number of professionals are paving the way for such a future with the development of PI tools and other knowledge-sharing sites, many of which are available to the public free of charge. Their sponsors include health care institutions, systems, and public and private agencies.
"From an executive standpoint, I’ve been just blown away by the fact that there has been money lying on the ground, and no one wants to pick it up; no one knows about it," says Duke Rohe, performance improvement specialist at the M.D. Anderson Cancer Center in Houston. "On a personal note, I hate waste. It turns me off when an organization is wasting resources; we should always be honing ourselves to a better state. There is a wide range of tools available — from the really simplistic to the complex," he says.
"What we’re trying to do is to be mentors as well as consultants," adds Bob Skaggs, MEd, academic consultant for the University of Texas Medical Branch in Galveston. "Whenever we have a project with a department, we try to impart to them tools and methods they can use so they won’t have to continually rely on us," he explains.
"We hope that health care providers will use these tools to make their practice more responsive, to provide better quality health care, and to see if they are using the most up-to-date information," says Jean Slutsky, PA, MSPH, who oversees two of the three free web sites currently sponsored by the Agency for Healthcare Research and Quality (AHRQ) in Rockville, MD.
Why share knowledge through these vehicles? "We find sharing knowledge about best practices and improving quality to be a benefit for everyone; that’s why we put our effort into this," she says.
These sites did not spring up full blown, but evolved over a period of years once the need was clearly seen.
"I had a pocket load of tools that I used before computers," recalls Rohe, describing his former "low-tech" tool-sharing approach. "I’d go to nursing areas and put stuff in their little mail bins. Then I’d go around and visit and see a little piece I had put in the bin pinned on their bulletin board. It made me feel good, and it pushed me along to add more value to the culture."
At the time computers became more popular, Rohe was working for the management-consulting firm Holland & Davis in Houston. All of the tools were still on paper, but it was there that he actually learned how to craft a tool. "I learned that anything that can speed you along to success is a tool," he says.
"If I can tailor it so staff do not have to read a whole book, it qualifies as a tool." That principle is borne out by the presence on his web site — "Duke’s Performance Improvement Tools" (www.durationsoftware.com/duke_intro.htm, sponsored by Duration Software) — of a wide variety of tools, ranging from "Basic Improvement Tools," such as checklists, to "Featured Tools" such as Creative Problem-Solving or Finding Waste.
When Rohe came to M.D. Anderson in 1997, he was sold on the idea. "All the tools were by then pretty much computerized, but not organized," he recalls. "My boss’s goal was to set up a tool site; that was my challenge."
Rohe organized the tools into categories that reflect how he thinks. "My categories might be different from yours," he concedes, noting that he selected broad categories such as customer service.
Skaggs’ site is much newer, and grew out of the role of his department, which is responsible for planning and management systems. "We handle the planning operations for the institution, and we are also involved in operations improvement consulting internally," he explains.
How did he grow his site? "One of the things I did was ask Duke’s permission to add some of his dissertations onto the web site," he notes. "In addition to tools, we have some larger documents — for example, we have a page about Baldrige. We have our own form of accelerated re-design methodology, and we provide a high-level overview of that."
AHRQ’s first site (www.guideline.gov) went live in 1998. "When we started, we put out a call for guidelines," Slutsky says. Sixteen different organizations, including medical societies, health plans, hospitals, government agencies, and university systems, have contributed, she adds.
"The site now has about 1,000 evidence-based guidelines that are catalogued and updated weekly." The guidelines cover different care practices, and input is received from all over the world, Slutsky adds. "Guidelines that are no longer current are taken down."
AHRQ’s two newest sites (just opened this month) are www.qualitymeasures.ahrq.gov, a site of quality measures that Slutsky also oversees, and http://webmm.ahrq.gov, which was developed to "educate health care providers about medical errors in a blame-free environment," she explains.
"We use the same mechanism to grow both [the guidelines and quality measures sites]. We sent out letters, and put a banner on the home page asking people to submit materials," Slutsky says.
The sites list criteria for submission. "For example, guidelines need to meet the Institute of Medicine definition; the submitting organization has to have done a systematic review of peer-reviewed literature; the guideline had to have been created under the auspices of an organization; and it cannot be more than 5 years old," she explains. The site gets about 1 million hits a week, she says.
The new quality measures site is designed to be compatible with the guidelines site. "For example, there are links back and forth, so if a measure is based on a guideline, you can go back to that guideline directly," Slutsky says. The quality measures site also has a resource page and a glossary with terms of quality measures. It also contains a section on "Using measures and selecting measures."
Web M&M, the web-based medical journal, showcases patient safety lessons from actual cases of medical errors. Five cases of medical errors and patient safety problems — one each in medicine, surgery/anesthesiology, OB/GYN, pediatrics, and other fields — will be posted, along with commentaries from distinguished experts and a forum for readers’ comments.
Each month, one of the five cases will be expanded into an interactive learning module featuring readers’ polls, quizzes, and other multimedia elements, and will offer continuing medical education credits.
Using the sites
Because the sites vary in nature, they are used differently by different audiences as well, although Rohe asserts that a common theme should be the development of a cultural expectation that the site will be used.
"We have mirror images of the site on the intranet and the Internet," he says. "Internally, any employee who comes to an M.D. Anderson orientation is told we have this tool site, and if you’re into performance improvement, you can download more than 400 tools.
"The other aspect is that as we work in departments, when we lead, we lead with knowledge that there is this site available." It’s a gradual process, Rohe concedes, noting that, "Not everyone is into improvement."
Nevertheless, he adds, "We are growing an expectation" to use the site. "Our view of leadership is that you’re not just coming here to work, but to make things better," he says.
Staff are told about the site in one-on-one conversations, and new tools regularly are showcased in quarterly electronic newsletters. The bottom line, Rohe says, is "if you are in administration and you have a problem, I’d like to know if you went to the site first for a solution. That’s how you nurture a culture."
Rohe has a distribution list of about 200 (a lot of them are internal), and he sends out at least one tool a week. "For the most part, they are crafted here," he says. "We are in a research-generating mode, and right now our big push is in customer service. Whenever we are stretched, we try to create something new."
Tool resources
There also is a place on the site to send Rohe a tool. "We’ve had the site up for a year," he reports. The actual setup of the site was handled by the IT department. "I just copied and pasted the tools," Rohe notes.
Skaggs recently used his tool resources when some new divisions were created as part of a reorganization of academic support services.
"We did not have an institutional research department before this," he notes. "We went through a process mapping session and then imparted the process mapping tools to the [new] group."
Another new initiative involves working with the newly formed academic resources division. "They’ve put together a library, media production services, and academic computing, and we created a new web site for them, which is intended to be a service access site," he explains.
Skaggs also is looking to put up an enterprise site (dealing with the change control process), which he says is "very unusual for a university." It’s a good example of the initiatives his department will be involved in, he notes, "and we will have to develop tools along the way."
Skaggs says the tool site still is very much a work in progress. "We’re trying to provide information on some fundamental tools, but we want to build a more robust tool site eventually. We want to empower others and provide a site they can go to for these resources."
He adds that PI categories probably will develop themselves as the specific tools are added. "The situation in the industry is that we have this rapid evolution into the use of IT to not only communicate, but to convey knowledge," he observes. "This involves using the web not only as a deployment mechanism but as a business tool itself."
Skaggs says that the main web site (www.utmb.edu/avpplanning) is available to the public free of charge, "and the tools will be, too."
Everyone will benefit
The widespread availability of such sites and tools will benefit a wide range of health care professionals, observers say.
"Any department that’s going to be involved in process-improvement initiatives can benefit. For example, our department covers a broad spectrum, from strategic planning and decision making down to departmental re-engineering," Skaggs says.
"We see health care providers at every level being able to use these sites," Slutsky adds.
"Any organization can access and benefit from them," Rohe says. "From a profession standpoint, I am trying to hit all the organizations I know of. So far, the only national one that is now linked to our page is ASTD; they have a link on their home page."
Rohe says he also is talking with the Houston "point person" for the Association of Quality Participation. "He’s talking about setting up a consortium," he explains. "Some people want to show and tell’ their tools." Any professional group could do the same thing, he concludes.
[Editor’s note: The web address for the UTMB Office for Planning and Management Systems is: www.utmb.edu/avpplanning. To access the methods section of the site, you can either go to the "Method and Tools" navigation link or use the direct address: www.utmb.edu/AVPPlanning/Methods/methodlinks.htm. The web address for the UTMB Web Developer’s Share Group is: www.utmb.edu/webdevelopers. The web address for UTMB Academic Resources is: http://ar.utmb.edu/. The web address for UTMB Office of Institutional Analysis (the institutional research department Skaggs helped to design and implement) is: www.utmb.edu/ia/index.asp.]
For more information, contact:
• Bob Skaggs, MEd, University of Texas Medical Branch, Office for Planning and Management Systems, Galveston. Telephone: (409) 747-9602. Fax: (409) 747-9601. E-mail: [email protected]. Web: www.utmb.edu/avpplanning.
• Jean Slutsky, PA, MSPH, Agency for Healthcare Research and Quality, Rockville, MD. E-mail: [email protected]. (Answers within 24 hours.) Web: [email protected].
• Duke Rohe, Performance Improvement Specialist, M.D. Anderson Cancer Center, Houston, TX 77040. Telephone: (713) 745-4433. E-mail: [email protected]. Web: www.durationsoftware.com/duke_intro.htm.
If a single organization can benefit from sharing knowledge through an internal site (intranet), just imagine the possibilities when virtually the entire body of performance-improvement (PI) knowledge can be made available to any quality professional who wants it. Were certainly not there yet, but a growing number of professionals are paving the way for such a future.
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