From storybooks to fairs, hospital rewards CQI effort
Recognition raises CQI awareness among staff
The best laid plans of mice and men, or of hospital administrators, are bound to go astray if there is no support from those who have the power to successfully execute those plans. For continuous quality improvement (CQI) administrators, the power of CQI success lies in the laps of hospital employees. Without employee buy-in, CQI projects stand little chance of success.
That is why it is so important to ensure staff embrace a CQI project, administrators say. Employees will balk at taking on projects that mean extra work unless they understand the work's importance to a hospital's continued health, and to their future.
With that knowledge in mind, CQI administrators at the 265-bed Arkansas Children's Hospital (ACH) in Little Rock have established education and incentive programs to ensure buy-in among the hospital's 2,200 full-time employees.
"You have to find something in your program that appeals to everybody if you want buy-in," notes Patti Higginbotham, RN, CPHQ, director of quality improvement at ACH.
Higginbotham and her staff take a multi-pronged approach to put the word out that there is something for everyone in the CQI program. On a regular basis, they run articles in the hospital newsletter that tout CQI team successes, they provide CQI information to new employees, and they hold quarterly, two-day, intensive educational programs on CQI, in which all employees are encouraged to participate.
In addition, Higginbotham's CQI teams are recognized during a week-long, hospitalwide celebration in which awards such as pens bearing the hospital's special CQI logo, and kudos are freely dispensed. (See the challenges small hospitals face to gain employee acceptance of CQI, p. 75.)
Fortunately for Higginbotham, she did not have to struggle to convince management of CQI's importance. She found a CQI champion in the hospital's medical director in 1992 when she first began CQI programs. Soon, the chief of staff began championing the CQI cause, as well, and was joined by administration, nursing, strategic planning, and marketing, Higginbotham recalls.
Higginbotham's efforts to promote the CQI concept have paid off, she says. For example, three CQI teams have successfully completed clinical pathways that are reducing costs while maintaining quality care. A process improvement team has streamlined admissions between outpatient and inpatient, and a billing statement team has successfully worked with the hospital family advisory board to clarify the billing statements after patients and families complained the bills were too hard to understand, she says.
"Teamwork is one of our basic [CQI] values, and one of our basic goals," Higginbotham notes.
In addition, Higginbotham discussed CQI with various department heads and at medical staff committee meetings, she says.
Her message to administrators and employees was, and continues to be, clear: Although the hospital is doing a good job, it could do better. The best route to doing better is through quality improvement, she says. "If we adopt this philosophy, we can maintain or improve the quality of care and services, and be more cost-effective," she says
Teaching staff CQI philosophy, techniques
One important technique for reinforcing the CQI message is through education, Higginbotham notes. An employee who understands the concepts of CQI becomes an enthusiastic employee, so Higginbotham and her staff hold a two-day education program in which she hopes all employees will eventually take part, she says.
In 1992, the first year of the education program, classes were held twice a month. By the end of 1992, 500 employees had been educated about the CQI process, she says. Now, classes are held quarterly.
Each class has about 36 participants, Higginbotham says. Employees attend the class at a hotel near the hospital, where they sit at round tables and spend the next two days learning what CQI is and how it affects them, she says. Employees pay nothing for the classes and are paid their regular salaries for the days they spend in training.
On the first day, participants become acquainted and begin discussing CQI and why it is needed. "I tell them our families [of patients] are much more informed, and they expect us to provide quality and reduce costs," Higginbotham says. Participants also discuss the changing paradigms of health care; the hospital's mission; its focus on customers, teamwork, and science; its strategic plan; and the way CQI can meet all those challenges, she says.
Higginbotham also talks about the hospital's customers and emphasizes the need for teamwork, she says.
Team building also takes place the first day. Higginbotham teaches participants how to build a team, identify the status of a particular process, ways to define goals and gather data, and techniques for obtaining solutions. She also discusses team dynamics such as growth, reporting and minute keeping, and how to brainstorm in a structured manner.
On the second day, administrators teach the basics of flow-charting, and participants perform a flow-charting exercise to help them retain the technique, Higginbotham says. An administrator from infection control teaches data collection techniques, tips for simplifying data collection forms, and steps that reduce bias in data collection.
A nursing administrator teaches bar and pie charts, and simple graphs, she says. The quality improvement nursing coordinator then teaches the Pareto principal, a type of chart used to identify root causes of problems and also shows how to obtain the biggest bang for the buck, Higginbotham adds.
Participants leave with a lot of information and a training manual to help reinforce the classes.
As of March 1996, about 900 employees have taken the classes. Employees from housekeeping and maintenance, to nurses, physicians, and finance employees have participated, she says.
85% of class members use CQI
The most difficult challenge Higginbotham faces is keeping participants motivated after the first glow of CQI training has faded.
To keep participants enthusiastic, Higginbotham stresses the many ways CQI can be incorporated into an employee's daily job, she notes. "CQI is robust. You'll have good outcomes no matter what you do," she explains.
A survey conducted a year ago shows that class participants are retaining and using much of their CQI training, Higginbotham says. The survey showed that 85% of participants in the first class were using some of the tools they had learned. The first class was composed mainly of administrators, so the outcomes were not surprising, she adds. "Now we need to see how the cafeteria worker and the guy from housekeeping and the staff nurses are doing," she says.
"You have to maintain buy-in. People wax and wane in their levels of interest," Higginbotham admits. So regular recognition reinforces the CQI training and helps maintain enthusiasm, she says.
Higginbotham uses a variety of techniques to ensure teams receive ongoing pats on the back for work well done. One technique is the storyboard.
"We put a picture of the team members on the board so they can gain recognition," she says. Besides being placed in departments, the storyboards are shown to hospital committees. One storyboard was even presented to the hospital's board of directors.
Storybooks also are kept containing basic information such as an executive summary explaining a team's mission and its accomplishments.
To make sure new employees feel integrated into the CQI process from the beginning, Higginbotham spreads the CQI word during new-employee orientation. She distributes a brochure explaining the CQI mission and delivers the CQI motto, that TEAM means Together Everyone Achieves Miracles.
Higginbotham then explains CQI using a simple example.
"I tell them everything is a process, like getting to work. If you're late, you have to change something," Higginbotham explains. "That's how it is in making process improvements."
Spreading the CQI message has its fun side, as well. During Quality Week, there's plenty of play and rewards, she says.
"We have games set up. For example, maintenance sets up a ring toss booth and gives away prizes. One department gives away prizes for shredding papers," Higginbotham says.
Besides the games, employees nominate someone who exhibits the characteristics of CQI -- customer focus, teamwork, and progress in making process improvements. "We give them [the winners] a certificate of recognition signed by our chief executive officer and medical director, have photos taken, and write them up in a newsletter. We give them quality pens and tell them how proud we are of them as individuals," Higginbotham adds.
"We try to share our successes, and I think sometimes we have success even when a team doesn't work out the way they think, because we'll all learn something," she emphasizes.
[Editor's note: For more information on ACH's CQI process, call Patti Higginbotham at (501) 320-4394.] *
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