As seen in Healthcare Informatics.
In health care, “innovation” is often thought of in the context of life-changing tools and technology, such as the late 1970s introduction of magnetic resonance imaging (MRI) or the more recent advent of modern telehealth.
Yet the reality in health care – steeped in tradition and entrenched cultural norms – is that “innovation” often initially comes in smaller bits and bursts before widespread, systemic adoption. Consider how often in health care new ideas or workflows figuratively start as mere embers before they spark and catch fire.
That’s why a growing number of hospitals and health systems in recent years have embraced the principles and practices of continuous improvement (CI) as a transformative way to improve or remove waste and inefficiencies from their systems and processes. CI initiatives generally consist of systematic and continuous actions that measurably improve quality and safety, and enable health care organizations to deliver the best care possible to patients and their families.
By adopting a CI culture, health care organizations commit to improving themselves and sending a distinct “you truly matter” message to their patients/customers and workforce. CI helps reduce operational expenses, as streamlined processes require less time, effort and resources. CI signals to your patients/customers that they are the ultimate judge of the quality of your services – a key consideration in today’s consumer-centric era in health care. It also says you care about having an educated, empowered and motivated workforce, as these are the most important factors to the success of a CI initiative.
In this article, you will learn CI best practices, as well as the five most important steps to take when implementing CI efforts:
1. Target specific areas for improvement – Based on statistical and anecdotal input, you should have no problem identifying multiple opportunities for improvement in your organization.
2. Determine what processes/procedures can be modified – Up front, identify what potentially can be changed, what cannot, and proceed accordingly.
3. Ongoing leadership encouragement – Your organization’s leaders should proactively and visibly support CI efforts, to encourage employees to pursue CI.
4. Implement effective CI strategies – No matter what formal or informal CI model you use, ensure that it measurably improves quality.
5. Communicate improvements – It’s not enough to simply adopt improvements made possible through CI; tell your employees about it! By doing so, you’ll reward the original source of the CI idea and encourage others to provide their own CI ideas.
While all of the steps listed above are important, Step 1, “Target specific areas for improvement,” and Step 5, “Communicate improvements,” are often overlooked or shortchanged in action. To emphasize the importance of these specific action steps, see the following two client success stories below.
Targeting Productivity for Improvement
Creating a culture that embraces and applies CI begins with an organization’s leadership being very specific about the areas needed for improvement. Ineffective leaders set vague or distant goals that very few ultimately take seriously. Or these leaders set too many goals resulting in the easiest or most enjoyable goals being completed first, and the toughest ones last or not at all.
Leaders will more likely see CI-related benefits consistently happen by targeting specific areas for improvement, presenting specific goals around these areas in a clear and compelling way, and insisting upon employee efforts to achieve them.
Specificity was the mandate of a large multi-specialty clinic – a client of Freed Associates (Freed) – that wished to increase its productivity based on the volume of patients seen each day. Unsure of how or where to begin by objectively assessing themselves, the clinic’s leaders turned to Freed for help.
Freed began by initiating a time/motion study of the clinic’s most productive physician, a dermatologist, to understand his success. Freed discovered that this dermatologist had trained his team to place every clinical item in every exam room in exactly the same place. He took photos of every drawer, counter, and workspace to train his staff on where he wanted everything placed. Then, he used this same system to develop his par supply levels inside the exam and supply rooms. This way, he never wasted a second looking for anything. He could essentially navigate his exam room blindfolded and still get through a visit quickly, without rushing.
Freed used the same time/motion study process with the clinic’s other high-performing providers, without impacting clinical visits, until all of the clinic’s specialties were covered. Through the productivity insights gained, analyzed, and acted upon, Freed was able to help the clinic increase its overall productivity by 20 percent and reduce its supplies inventory, which lowered the clinic’s operating budget. Providers, staff members and even patients all noted the productivity gains and were pleased with the outcomes.
Based on the clinic’s CI-derived productivity gains, it would not be surprising if this clinic tackles other CI-related changes. By paving the way for the clinic’s employees to identify and implement improvements, the clinic’s leaders made it clear that it’s culturally appropriate – and desired – for employees to take the initiative to improve operations. That’s why well-led and properly executed CI enhancements often beget further CI improvements.
It’s also why, if you wish to undertake a significant cultural change using CI, it makes sense to first achieve multiple “smaller” CI gains. In this way, you can break past political or cultural resistance to change and reassure pertinent parties that CI can indeed make positive changes possible.
Communicating CI Successes
Communication was crucial to the CI improvements that Freed recently achieved on behalf of an HMO’s IT department – and to the department’s long-term adoption of a CI-centric culture. The process improvements achieved by a single team in the IT department – subsequently communicated to the rest of the department – proved so compelling that it changed how the entire IT department now conducts all of its business.
This HMO’s IT business intelligence (BI) team had been experiencing several challenges related to business team reporting requests. The BI team had seen huge growth in demand for services due to the Affordable Care Act. The BI team had not added resources to support its efforts, and its limited resources were bogged down with business team requests, due to new regulations and requirements. Despite the BI team’s name, due to staff attrition, there were no true business analysts on the team.
Instead, all business unit requests for reports went straight to the BI team’s developers. They created and delivered what they thought was requested, yet often found that their outputs were not what was desired. As a result, the BI team’s work needed to be redone. The team’s morale declined. Freed was brought in to help.
Through stakeholder interviews, Freed learned that the BI team developers were not asking the right questions upon receiving business team requests, and therefore, did not understand the full requirements and underlying business needs. Similarly, the business teams did not understand who was responsible for different parts of the process, especially for user acceptance testing (UAT). Lastly, there were no clear guidelines for estimating the time and resources required to deliver the reports.
Freed was able to add value quickly for the client by tackling these challenges incrementally. First, Freed addressed the incomplete requirements by creating a tool to help the business leaders better define their data needs and help the developers with their requirements-gathering and design documentation. Once this step was implemented, Freed updated overall process expectations, so that all parties would understand their service level agreements, and educated the business teams on UAT. Lastly, Freed created a tool to estimate the time and resources needed for a BI team project, based on the perceived complexity of various project stages. The BI team communicated the usefulness of this tool to all of the IT department’s employees, who soon adopted it for their own use.
Adopting CI Best Practices
Through your gradual adoption and implementation of CI, you will likely gain a set of best practices to replicate for CI initiatives in the future. Some of the most common CI best practices include:
• Start small – As noted earlier, create small CI “wins” to pursue larger CI initiatives later. Starting small will give you the chance to iron out any wrinkles in your CI processes.
• Emphasize mistakes – Not only expect mistakes, encourage them! While mistakes may be anathema in health care, the reality with any CI initiative is that trial and error is often a must to achieve a greater long-term good. Learn from your mistakes, improve on them, and emerge with something better.
• Encourage widespread participation – Employees are a wellspring of ideas for CI as long as you take their ideas seriously, respond to them appropriately and act on them as needed. If you receive a great idea, that’s terrific! On the other hand, if you get an idea that is not feasible, let the source know why you will not move forward with the idea.
• Document “lessons learned” – Create a means for parties involved with CI to document their lessons learned throughout the initiative. Don’t wait until the project is over to document this information, as participant memories are often unreliable.
• Schedule a formal “lessons learned” session – Immediately after a CI initiative, convene all pertinent parties to have them share all lessons learned for future reference. This session will be easier if participants bring their documented lessons learned.
• Communicate frequently and broadly – Besides discussing and determining CI-related improvements internally, share them externally with colleagues from other departments or units as well as with relevant business partners and vendors.
• Identify and incorporate improvements – Based on the lessons learned, use this information to improve future CI efforts. The goal is to enable all involved with the success of your organization to learn new ways to help it improve.
Do not be afraid to introduce CI successes from other industries. For example, the baseline benefit of air traffic control systems – to allow users to track the location and status of airborne planes – was successfully translated to a health care system to allow clinicians, staff, and even family members to track patients and patient flow in real time.
Finally, be sure to consider the human element and impact of CI. Specifically, strive to ensure that any CI-related changes also benefit the people doing the work. In addition, consider providing incentives or rewards to employees who present successful CI ideas. You want to encourage others to share their CI inspirations!
Creating a CI culture that improves your patient/customer processes and empowers your employees to better your business with their ideas is the ultimate win-win for any health care organization. Couple these people-centric benefits with the fact that CI leads to distinct business advantages, including higher-quality service outputs and less re-work, and you have the ingredients for a more productive and successful organization. CI can truly be a difference-maker.