Last month I talked about keeping your quality improvement changes in place- using a manual that you develop of SOP's, standard operating procedures. By the way, if you missed that issue, you can find it on my website, and several earlier ones too.

This month I want to address starting a quality improvement project. That is, how do you decide what project to work on? What issue or process is causing the most waste, is doing the most harm, is most affecting the bottom line? Maybe you are a leader at your site and you have an idea of what is generally causing problems. For instance, you may think that patients with catheters are getting a lot of infections. Perhaps, checking patients in at your site is taking too long and creating a bottleneck. Maybe patients are complaining about having to wait too long at check in at a doctor's office. It could be that certain departments are running short of supplies too often. There are many other possibilities. The probability is that unless you are directly involved in the contentious process, you probably are not aware of what the exact problems are and are not aware of possible solutions.

This leads us to the conclusion that in order to discover the many problems facing every organization, especially in terms of wasted effort, time and money, there has to be in place a mechanism for the problems to surface to the leaders from the front lines of the organization. There has to be a way for the leaders to hear about the problems from those who are directly involved. For instance, does anyone in your organization know what ideas the cleaning staff has for making the organization better? When I say that there has to be a way for the ideas to surface, I don't mean that the only ones with a voice should be nursing staff and other professionals. Rather, as in the Baldrige Improvement Plans, the entire staff is involved in quality improvement.

I know of a few hospitals where the leadership-president, CFO, COO, etc.-go out several mornings every week to talk to staff at all levels and patients to see how things could be better and to get some positive feedback about what things are going well. Perhaps at your site you want to start something like this. As time goes by and as suggestions are implemented, staff will feel safer about making suggestions.

Leadership needs to make sure that staff feel safe about making suggestions, no matter what the method of suggesting changes is used. Perhaps you might want to use an anonymous survey for collecting initial suggestions. After some of the suggestions are acted upon, the staff will feel like the leaders really want good ideas and will feel safer making them known. Perhaps you might want to use a consultant in Lean Healthcare (many of these ideas I suggest come directly from Lean Healthcare) to teach the staff the principles and processes of Lean Healthcare and other tools as may seem fit. This approach will help a large organization start making many positive changes quickly, rather than using the idea of slowly spreading the means of change throughout an organization, as some prefer.

Whatever your initial process of getting the ideas percolating up in the organization, after some ideas for quality improvement recommended by the rank and file are successfully implemented and after the improvements and savings are made known in the organization, it is time to create ways to get more ideas. Perhaps you want to have regular meetings with a designated leader and representatives from several staffing areas that will bring up ideas. That means that the rest of the staff must feel comfortable about making suggestions to these team members. If your site has few employees, then perhaps it would be best to have regular staff meetings with all employees where the agenda always includes time for quality improvement ideas and for updates on ongoing projects. Whatever method you decide works best for your site, be sure that an atmosphere safety and security exists for all the staff. This may mean going so far as to guarantee that no staff will lose there position as improvements create more time to get things done.

So, once you have a steady flow of quality improvement ideas being generated by all in the organization, which ones should you act upon? Next month, I'll address that issue. This issue I decided to concentrate on the Define step of Six Sigma's DMAIC (define, measure, act, improve, control). Next, I will discuss the measure segment. Sometime in the future I'll cover team dynamics too.

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