Having trouble selecting improvement priorities?
It may be a matter of strategic planning
By Patrice Spath, ART
Consultant in Health Care Quality and Resources Management
Forest Grove, OR
To be successful, the hospital’s quality management program must deal with important issues. To do so requires the organization to answer two questions:
• What is important to improve (and how do we know that)?
• How do we improve it?
Before hospital and medical staff leaders can answer these questions adequately, they must have fully dealt with the strategic and operational side of quality planning. Performance improvement can fail when it is managed as a series of projects that stand outside of the organization’s strategic business direction. If your organization lacks a clearly defined mission, vision, and values statement, there is bound to be disagreement over where improvement efforts should focus.
Often, the strategic element of quality management is overlooked in the rush to deal with the persistent "sore thumb" problems that have long frustrated physicians and staff. During the discussions of what project to start next, ask the leaders to consider the strategic implications of each quality improvement project. If they can’t determine how vital a particular project is to the organization, this is usually a symptom of strategic planning problems. Below are some diagnostic questions that can be used in that discussion:
• Do we have a consensus on our vision?
Do medical staff and administrative leaders have a definite picture of where they want the quality process to lead? Does the vision communicate the organization’s values and commitments toward customers, suppliers, and each other?
• Does the organization’s quality plan translate the vision into more definitive objectives and measures of success?
The quality plan should be fully integrated with the hospital’s strategic plan so that it supports and complements it. Shown in Figure 1, below, is a sample of the strategic goals established by one organization and the performance improvement objectives related to these goals.
• Do we have a leadership group for prioritizing improvement needs?
The quality leadership group (often referred to as the quality council) of the hospital should serve as a clearinghouse for interdepartmental improvement projects. They can set priorities based on the proposed project’s contribution to the vision and quality plan. This group should include hospital managers and physicians. In the absence of a multidisciplinary Quality Council, be sure that managers and physicians have adequate input into the priority-setting process.
• Do we have the means of allowing our customers to tell us, through their attitudes and perceptions, where we should direct our improvement efforts?
If you are responsive to customer needs, then your improvement project selection should follow the lead provided by your customers. Of course, this presumes a clear understanding of who your customers are, which may not exist. If this is the case, then your quality leadership group should revisit this critical issue.
Remove hurdles to QI successes
The success of quality improvement projects is also dependent on some operational issues. A project is more than people meeting regularly to discuss a specific issue. The organization must have operational controls in place and provide adequate training for the projects team. Using the questions below, determine if your organization has operational issues that may get in the way of successful improvement projects.
• Are the project teams given well-defined objectives?
Well-defined objective statements are specific. Specific means detailed, particular, or focused. An objective is specific when everyone knows exactly what is to be achieved. Being specific means spelling out the details of the objective. For example:
"Improve patient outcomes" is too general for an objective statement because it does not provide any specific information about what is to be accomplished.
"Decrease the incidence of patient falls" is more specific because it narrows the scope of the desired outcome.
But to be the most specific, an objective statement should say something like:
"Decrease the incidence of patient falls on the medical units by 20% within the next 12 months."
This last statement specifies the desired improvement and leaves no doubt about what is to be accomplished in what time period.
• Do improvement project teams have the training and tools to analytically determine which improvements will yield the best results?
Improvement project teams should present their ideas using "management by fact" to go beyond arguments based on mere opinion. In a clinical setting, working with professionals who are educated in the disciplines of scientific inquiry, it is even more important to state your case using data. When a project is proposed based on an examination of data, the discourse becomes more focused on the interpretation of the data and less on the contending personalities.
• Are we over-controlling the improvement process?
Many quality improvements should not even require a formal approval process. Distinguish between special projects and each department’s continual improvement of their process. Don’t bureaucratize your quality process by requiring burdensome approvals for every process improvement. Many process improvements should be undertaken unilaterally by the work group that identifies the opportunity. A sure way to stifle creativity is to require multiple layers of auditing and approval for what should be a daily self-examination of the work group’s practices and policies.
To get back on track with improvement projects, refocus on these four steps:
1. Agree on what you want to accomplish in the quality process.
Frame your response in terms of what is important to improve and how do we improve it? Let your customers help you make that determination.
2. Decide how your quality improvement objectives "fit" with your business plan.
3. Evaluate proposed improvement projects against their ability to further the aims specified in your vision and quality plan.
4. Allow for some unpredictability and creativity.
Facilitate the improvement process without smothering it. This will lead naturally to agreement on improvement projects that all your hospital’s stakeholders can support.
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