Revitalize your quality council
Set ground rules during first meeting
By Patrice Spath, ART
Consultant in Health Care Quality and Resource Management
Forest Grove, OR
The Quality Council plays an important role in setting the tone of the facility’s performance improvement program. If this leadership group becomes complacent, the attitude can ripple down to all levels of the organization. Establishing ground rules and evaluating the value of the Council’s processes are two tactics that will reduce member apathy.
Ground rules are the behavioral expectations and operating procedures by which a group or committee agrees to manage itself. It is very common for a performance improvement team to set these rules during its first meeting. Ground rules also can help the Quality Council spend its time and energy most productively. Rules allow the council members to know what the organization expects of them.
Shown below is an example of the ground rules established by an organizationwide Quality Council. Similar rules could be applied to lower-level committees.
The following Council Operating Rules are agreed to by all Council members:
1. We will meet the first Thursday of each month in the 3-East conference room.
2. No substitutes or alternates will attend in the place of members.
3. A quorum exists when more than half of our members are present.
4. Our meeting agenda will always be quality-focused. Non-quality issues will not be discussed.
5. Our decision method is consensus. If one of us is opposed to a proposal, we will continue to talk until we arrive at a proposal acceptable to all. The meeting chairperson will ask for consensus on decisions. Thumb up means "yes"; thumb down means "no"; thumb sideways means, "Well, OK. I can live with that." The meeting cannot proceed until all have indicated their preferences.
6. We may at times invite non-members to attend and observe our meetings, and even participate in them.
7. At the conclusion of each meeting, we will critique our performance.
8. The agenda for each meeting will be prepared by the chairperson in consultation with all members and will be sent in writing to all members one week in advance of the meeting.
9. The medical staff secretary will keep minutes and distribute them to appropriate committees/ groups after approval by all members.
10. Minutes should be published as soon as possible after the meeting, after five working days at the most.
11. We will establish a repository of records for our minutes, the records of performance improvement teams, and other quality work. The repository will be maintained by the Quality Management office.
12. Most important, both within our meetings and in our daily work, we will become quality models, living out the principles we are asking everyone in the organization to practice.
13. Our Quality Management staff will be responsible for helping us with expertise on total quality management matters and handling administrative matters connected with our quality work.
To complement the ground rules, the Quality Council can establish principles by which the group operates. Examples of principle statements for the Council are listed below:
• Quality is our first priority. All members will be expected to attend the meetings and to make all other priorities secondary except in case of an emergency.
• Our meetings will not be interrupted. Phone messages and drop-in visitors will have to wait. We will adhere to the 100 Mile Rule: No one will be called from our meeting unless the reason is so important that the disruption would occur even if the meeting were 100 miles away from the workplace.
• We will not appear at meetings to only represent our individual constituencies. We will work together as a performance improvement team responsible for the whole organization. In other words, turf defense has no place in our meetings.
• We will treat each other with respect. We will be prompt, we will attend all meetings, we will observe common courtesies of conversation with one another (e.g., no name calling, no interrupting), and we will listen to one another.
• As members of the Quality Council, we recognize our responsibility to act as quality models, both in our individual behavior and in our group behavior, for everyone in the organization to emulate.
Evaluate the council’s value
Busy professionals don’t have time to waste. It’s important to ensure that Council members feel their time is being well-spent during Council business. When drudgery sets in, indifference will soon follow. Check in with the Council members periodically to determine if their needs are being met. Like most customers, the Council members are not likely to voice their concerns unless they are asked.
The survey shown on pp. 152-153 can be used to formally solicit Council member feedback. This questionnaire can be distributed within one week following a meeting. It’s important that members not view the survey process as an interrogation. Explain that surveys are part of performance improvement initiative and their input won’t be used to assign blame. It’s the system that’s being judged, not the people who work in it. The spirit of the project should be reinforced by allowing the respondents to remain anonymous.
Summarize the results of the survey and present it at the next meeting of the Council. If there already are plans to improve some of the support aspects (e.g., secretarial services, etc.), let them know what’s happening. Ask the Council members to discuss those areas that may require changes in the Council’s make-up, ground rules, or guiding principles.
If you want enthusiatic support from the Quality Council, you must get them into the act. Members too often view their role as tedious or "something we have to do for the Joint Commission." This attitude does not advance an organization’s performance improvement initiative. If the warning signs of an apathetic Quality Council are evident in your facility, start making changes now. Ground rules and meeting evaluations can be useful first steps toward a revitalized Quality Council.
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