Part of solution: Improve the improvement process
Will a two-month wait for a doctor’s appointment soon be history? It will if Thomas Nolan, PhD, and Marie Schall, MA, have anything to do with it.The co-authors of the Boston-based Institute for Healthcare Improvement’s Breakthrough Series Guide: Reducing Delays and Waiting Times Throughout the Healthcare System are heading up an initiative that is challenging industry practices and traditions throughout the United States.
"Those of us who work in improvement ought to follow our own advice and improve the ways we are advising our organizations to do improvement," says Nolan. "We should constantly be asking ourselves, How can we simplify the process? How can we get results quicker with more impact?’"
In answering those questions, Nolan and his colleague came up with the Model of Improvement for IHI’s Breakthrough Series. Each collaborative focuses on a single topic. For example, the first collaborative on reducing delays and wait times began in 1995 and set a goal of reducing delays or waiting times by 50% or more in 12 months. The second collaborative was launched in April 1997 and will strive for 50% improvement in just six months.
Other past and future collaboratives include reducing cesarean rates, reducing adverse drug events and medical errors, and improving asthma care in children. "We selected these areas because they were ripe for improvement," says Nolan. "We realized that substantial knowledge exists about how to achieve better performance, yet there is a gap between that knowledge and actual everyday practice."
So IHI has cataloged the latest scientific information from literature and examples of what works in organizations that have broken through to unprecedented results, Nolan says.
Then, three-person teams from 20 to 40 health care organizations take advantage of that knowledge and experience during three learning sessions lead by QI experts and medical professionals who have already achieved breakthrough results at their facilities. (Cost of joining a collaborative ranges from $8,000 to $12,000, depending on prior participation.)
But the learning sessions aren’t just another intellectual exercise in improvement theory, emphasizes Schall. "We provide the essential combination of process improvement, knowledge, and subject matter," she says. "If they have one without the other, they won’t have the tools necessary to return to their facilities, create teams, and put what they’ve learned in action."
Practical applications aid learning process
That practical application is what enables participants to leave the first learning session armed with a plan to tackle their specific wait time and delay problems. Then during the action period that follows, team members receive support to implement concepts via formal and informal conference calls with member organizations and collaborative experts. "They share ideas on change, troubleshoot barriers and obstacles to change, as well as brainstorm ways to overcome them," says Schall.By the time the members regroup for the second learning session, each team has tested as many changes on a small scale as they think necessary for them to reach their goal. "Then we give them guidance on how to spread the change from a small scale to a larger one," Schall says. "We discuss issues of communication, buy-in, and how to work with a broader group. We help them understand the barriers to change and how to overcome them."
During the third learning session, the IHI team of experts access the process of the improvement teams. "We help them plan for further spread of change and work on other applications of approach within their facility," says Nolan.
This system of learning sessions, packaged with a sound model on improving the improvement process and followed by action periods of testing both the concepts and the subject matter in normal applications, delivers rapid results, say Nolan and Schall.
This $49.95 guidebook, Breakthrough Series Guide: Reducing Delays and Waiting Times Throughout the Healthcare System, contains detailed description of case studies as well as explanations of theatrical concepts used in the collaborative and can be ordered from IHI at 135 Francis Street, Boston, MA 02215.
[For more information about the Breakthrough Series, or IHI National Congress Reducing Delays and Cycle Times, scheduled Oct. 14-15 in New Orleans, call (617) 754-4800.]
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