PI studies that reflect problems more credible
Look at clinical/nonclinical issues
Want to impress your accreditation surveyor? Want to make sure you meet standards associated with performance improvement?
Then make your studies focus upon real problems that affect your same-day surgery program’s efficiency, patient or staff satisfaction, quality of care, or financial success, say experts interviewed by Same-Day Surgery.
A good performance improvement study should not focus on an easy-to-solve problem, such as replacing a single piece of equipment, says William H. Heron, MD, medical director of the Center for Ambulatory Surgery in Washing-ton, DC, surveyor for the Wilmette, IL-based Accreditation Association for Ambulatory Health Care (AAAHC), and a member of the AAAHC accreditation committee.
"The most impressive studies are those which address significant problems, but that is not to say the study process cannot be used for less serious problems," he says.
Even when used for a less serious problem, a study should focus on a problem or issue that requires collection of data to identify potential causes of the problem and potential solutions, he says. "You also have to be able to measure the results of any solutions you implement."
You can’t simply say that people are happier with your facility because you made some changes, Heron explains.
For example, structure a study so you can report that scores rating a patient’s satisfaction with his or her overall experience rose from 3.5 to 4.5 on a scale of 1 to 5 after you made specific changes, he suggests.
Choosing an issue for a performance improvement study is a problem for some same-day surgery managers, says Betty Bozutto, RN, MBA, CASC, executive director of Naugatuck Valley Surgical Center in Waterbury, CT.
"A good study doesn’t have to be a major undertaking as long as it identifies and addresses a problem for your program," she notes.
Too many managers believe that a good study can only address a major issue such as wrong-site surgery, Bozutto says.
"In fact, I’ve seen successful studies address issues that may seem as minor as a waiting room couch," she adds.
Bozutto says she likes to start identifying issues for performance improvement studies by looking at complaints received from patients, staff members, or physicians.
"When 30 people complain that my waiting room couches are uncomfortable and too difficult to get off, I need to consider a study that looks at these complaints," she says.
If the family members of your patients are older, they will have trouble rising out of a very low couch, Bozutto points out.
The cost of new couches must be justified, especially if the couches are not old. Looking at who will use them and what they need for comfort will improve your visitor satisfaction, she suggests. "This will ensure that you don’t waste money on more uncomfortable couches," Bozutto adds.
Studies can change behavior
A more serious study that Bozutto’s facility performed actually changed behavior, she says.
"We had one physician who was consistently late for surgery, and this affected the facility’s schedule and other physicians’ schedules," Bozutto explains.
"Rather than approach the individual doctor with complaints about his behavior, my staff conducted a study that showed which doctors arrived on time and how that affected the schedule when they didn’t," she notes.
Because the surgeons were identified by number rather than name, a graph showing the results of the study was posted in the lounge.
"We didn’t identify the poor performers, but we did award candy bars to the top few performers each month," Bozutto explains. "Amazingly, the candy bar became a point of pride for the surgeons, and even our poor performers, including the one physician who was always late, now arrives on time."
Surveyors like to see studies that incorporate national or regional benchmarks, says Bozutto, who has served as a surveyor for AAAHC.
"Organizations that use a patient satisfaction survey company that can provide reports on a national or regional basis can use those reports to identify areas in which they can improve," she says. Other benchmark studies such as those conducted by the AAAHC’s Institute for Quality Initiative also can provide benchmarks by which same-day surgery programs can judge their efficiency, she says.
Other topics for study might be driven by accreditation standards themselves, Bozutto continues. For example, with the requirement for a timeout to ensure proper identification of patient, procedure, and surgical site, important to all surgical programs, many organizations routinely study their performance on an ongoing basis to make sure timeouts are performed and documented properly, she says.
"Even when you choose a popular topic that many other same-day surgery programs are studying, make sure it applies to your center, is helpful to your performance improvement goals, and is not a one-time study that is soon forgotten," she says.
It’s not sufficient for a study to identify a problem and suggest solutions, Bozutto says. "You must show that you monitored results of changes you implemented and that you made additional changes if needed," she says.
While not all of the issues you study will involve every area in your outpatient surgery program, you should get away from having only one person do the study, Heron recommends.
Performance improvement is a process in which all members of your staff should participate at some time, he says. "Even if the issue doesn’t obviously affect other areas, you should include representatives from other areas in some way, even consulting them individually to see if the issue or changes in protocol will affect how they do their job," Heron adds.
When the performance improvement process works well, it empowers your staff, Bozutto says.
"My staff members love working on performance improvement projects because they get a chance to participate in decisions affecting our jobs," she says.
Even staff members not directly involved in a project benefit from the presentation of study results at staff meetings and the graphs and information posted in the lounge, Bozutto notes.
"This communication with all staff members is also important to a surveyor," she adds.
Sources
For more information about effective performance improvement studies, contact:
- Betty Bozutto, RN, MB, CASC, Executive Director, Naugatuck Valley Surgical Center, 160 Robbins St., Waterbury, CT 06708. Phone: (203) 755-6663. E-mail: [email protected].
- William H. Heron, MD, Medical Director, Center for Ambulatory Surgery, 1145 19th St. N.W., Suite 850, Washington, DC 20036. Phone: (202) 223-9040. E-mail: [email protected].
For information on participation in or purchase of benchmark studies produced by the Accreditation Association for Ambulatory Health Care’s Institute for Quality Improvement, go to: www.aaahc.org and click on "AAAHC Institute for Quality Improvement."
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