The Will to Win - The Virtues of Six Sigma

Listen, as Jack Welch explains the virtues of a six-sigma organization.

Is it reasonable to conclude that hospitals should adapt a similar approach to service excellence and patient satisfaction? After all, the primary customer is the patient.

Brief Bio - Jack Welch

Education: University of Massachusetts–Amherst, BS, 1957; University of Illinois–Champaign, MA, 1958; PhD, 1960

John F. Welch, Jr.—who went by the name Jack—was among America's most recognized and controversial chief executives. During his 41 years at General Electric (GE) Welch rose from his position as an entry-level junior engineer to become the company's youngest vice president and later its youngest CEO and chairman. Throughout his 20 years leading GE Welch garnered a reputation for having a no-nonsense and dynamic style that was at times considered abrasive by employees and the public alike. While the merits of Welch's management tactics were the subject of debate, none could argue with the results produced by his leadership. Welch took GE into international markets at a scale never before attempted while leading the company away from manufacturing and into services. GE's market value grew 40-fold, to $500 million, between 1981 and 2001. At the end of 2001, which was the beginning of Welch's retirement, GE was the most valuable company in the world.

Hospital Quality Program Survey: What's Your Score

This self administered assessment poses statements regarding specific attributes within areas that Maverick Healthcare Consultants has determined to be critical "quality markers." It is designed to help you move beyond a "gut feel" to see how your organization stacks up against a variety of critical dimensions of quality. Hopefully you will learn something that challenges your assumptions about what it will take for your organization to establish a true environment of quality and patient safety.
For each of the following statements, score yourself as follows based on your reaction to the statement:

4 points: Strongly Agree
3 Points: Agree
2 Points: Disagree
1 point: Strongly Disagree.

After recording your reaction to all 15 statements, add up your total and refer to the evaluation at the bottom of the form.

______ The ability to provide demonstrably high quality patient care is a key element of our Strategic Plan.

______ We have a strong imperative for quality improvement in our organization, driven by our Executive Leadership.

______ We have effectively defined what constitutes "quality," and have developed a robust set of objective measures to monitor it on a routine periodic basis.

______ We have an aggressive set of quality performance goals.

______ Our quality measures include consideration of care processes, outcomes and resource utilization.

______ We periodically benchmark our quality performance against other organizations and find that our performance is similar to "Top Performers."

______ With regard to Joint Commission accreditation, we are "survey ready every day."

______ We routinely provide quality performance information to our Board, our employees and Physicians, and to the community.

______ Our employees and physicians believe we have effective and efficient clinical care processes.

______ Our care processes are based on current medical "best practice" evidence.

______ Our We have the organizational skill and capacity to develop and implement effective quality performance improvement initiatives.

______ Our approach to quality assurance incorporates "concurrent intervention" techniques.

______ We have tools and technologies that enhance our caregivers' ability to provide quality care at the point of care.

______ We have a "culture of safety" that is understood and embraced by all employees.

______ Our Physicians understand and are aligned with our Quality Management strategy.


_______ TOTAL SCORE


54 - 60 Top Performer. Your organization understands the core elements of Quality Management and is well positioned to remain a leading quality provider in your market. Quality is inherent in your culture and you are continuously improving your performance. What to do next? Consider developing a Quality Innovation or Accelerated Quality Implementation program to infuse a fresh new level of effectiveness into your quality management organization.

48 – 54 Aspiring Performer. You are a solid quality provider, but the competition is not far behind. What to do next? Assess how your organization rates against each of the five Critical Quality Markers to clearly define your organizations strengths and weaknesses, and develop your Blueprint for Strategic Quality Management Success.

< 48 Challenged Performer. While you recognize that quality is important, your organization's culture, processes and infrastructure do not support effective quality management. Quality performance is mixed, and significant improvements are elusive. What to do next? Consider developing a comprehensive Quality Management Strategy to create a tailored program that will transform your organization's quality and patient safety culture and capabilities.

Effective Meeting Management: An Essential Skill of the HQP

Hospital quality professionals (HQPs) often find themselves participating in numerous meetings within the hospital. In fact, as part of the roles and responsibilities of the HQP, they will chair (or share leadership) a half dozen of these hospital-wide committees. Obviously, managing these monthly (or quarterly) meetings takes significant time and energy. Some committees are required by accreditation bodies, while others are simply a product of historical operations and "we have always done it this way" mentality.

However, there are essential questions the HQP must bear in mind in order to determine whether the committee is effective.

Does the committee have a clear purpose (charter) and scope of work? Is the membership lean and appropriate or does it contain superfluous members that provide little value? Does the committee efficiently guide work product forward, aimed at achieving strategic objectives? Is the frequency of meetings aligned with the needs of the hospital?

If there is more than one "no" to this set of questions then stop . . . reevaluate. . . and consider discontinuing the work. Anathema to quality is meeting, just for meeting sake.

One of the worst possible offenses that the HQP could contribute to is wasting clinicians' time on ineffective meetings and discussions. Every minute extracted, from a clinician's schedule of caring for patients, should be prized and properly respected. Start on time, end on time. Otherwise, the HQP will have additional challenges in obtaining buy-in on core quality matters.

In synthesis, the HQP should incorporate the skill of effective meeting management into their repertoire. Please click on the underlined link, above, for further instruction.

The Commonwealth Fund - A Wealth of Information

One does not have to venture far into the Healthcare Quality literature, before coming across the first-rate research of The Commonwealth Fund.

In determining the best approach in developing and sustaining a Hospital Quality Program, I refer the readership to a paper published in July 2004 (Meyer, Silow-Carroll, Kutyla et. al.). Another paper published in November 2003 (World Health Organization) also outlines the essential ingredients for success.

_____________
The Commonwealth Fund is a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.
The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. An international program in health policy is designed to stimulate innovative policies and practices in the United States and other industrialized countries.

Pivot Points: Bringing the Conference Back Home

Generally speaking, the healthcare quality professional (HQP) looks forward to attending national and regional conferences. Often, these annual events serve as the greatest opportunity for the HQP to interact with peers and like-minded folks. By the time general session begins (i.e. Press Ganey, Institute for Healthcare Improvement, Greeley Co.) there is a high degree of enthusiasm, zeal, and thirst for new intellectual content. The "can do" attitude is palatable and contagious.

Yet, as the HQP returns to the airport and awaits for their flight to board, there is a question that inevitably passes through their mind. . . "How do I take this learning and get it implemented at work?" --- within the hospital setting.

Indeed, to be successful, the HQP must possess skills in influence, communication, and change management. Most importantly, the HQP must be adept in identifying pivot points within the organization. These pivot points provide the greatest potential for productive and meaningful change. However, effective leadership is required to usher the potential toward a best practice metamorphosis.

For example, I attended both the 2008 Press Ganey and IHI national conferences (Dallas, TX and Nashville, TN respectively). I submit that the HQP could play a role in implementing the following items; identified as best practice:

- Surgical Safety Checklist


- Designing a process where physicians are notified when patients site them, positively, on survey comments; patient satisfaction


- Raising awareness of service excellence (via clinical unit staff meetings) and teaching how to apply techniques proven by Disney World and Ritz Carlton.


- Increasing the time and raising the substance spent on the Quality & Patient Safety agenda at hospital board meetings


- Establishing an effective communication mechanism between the Quality Director, CNO, and CMO.


It is safe to assume that the current economic challenges will truncate the travel education budgets and therefore limit 2009 opportunities for HQP's.

Yet, for those who plan on attending another refreshing and meaningful conference, think carefully how you and your team can bring back learning, attach it to pivot points, and implement best practice. This is the exercise and discipline required for the HQP to provide optimal organizational value.

The Program - Hospital Quality

Much the same way collegiate athletics structure, measure, and define their respective programs, hospital quality professionals can benefit by following a similar approach.

For example, a typical college football program consists of standard domains of work and accountability. The program continuously strives to improve the areas of work and levels of effectiveness so that it may achieve a comprehensive, robust and sustainable product; that is not personnel dependent. The program measures its success via outcome measures such as: graduation rate within 4 years, transfer rate, NCAA violations incurred, conference titles, and overall winning percentage, to name a few.

- Coaching
- Recruiting & Retention
- Scheduling
- Academic Counseling
- Housing
- Conditioning and Weight Lifting
- Athletic Facility Management
- Alumni Relations
- Transportation
- Media & Communications
- Contracts & Apparel
- Graduation Rate - outcome measure
- Winning Percentage - outcome measure

Yet, a program doesn't truly exist (nor does it reach levels of sustained success) until all domains of work, expectations, and accountability are connected and aligned to one central mission. The mission must be transparent and embraced throughout. Until such a time, the program more accurately resembles beads on a table without a string. Of course, depending on the levelness and frictional surface of the table, the beads could roll and drop to the floor.

You may recall in my previous postings the acronym STEEPE: Safety, Timeliness, Effectiveness, Efficiency, Patient-Centered, and Equity.

The Program - Hospital Quality
Mission: Continuous Improvement for the betterment of the patient
Domains of Work (in no particular order):

• Joint Commission/State Accreditation (continual readiness) -- STEEPE
• Core Measures -- Effectiveness, Timeliness
• Hospital Outpatient Measures - Effectiveness, Timeliness
• Never Event Reporting -- Safety Hospital Outpatient Program -- Effectiveness, Timeliness
• Patient Satisfaction (HCAHPS & Press Ganey) -- Patient Centered
• Hand Hygiene -- Effectiveness, Safety
• Hospital Acquired Infections (SSI, UTI, VAP, CLBSI, Sepsis) -- Safety, Effectiveness
• Near Miss Reporting (Medication Administration) - - Safety, Effectiveness, Efficiency
• Patient Falls -- Safety
• Medication Reconciliation -- Safety, Efficiency
• Never Event Reporting -- Safety
• OR Quality (Surgical Checklist, On-Time Starts, Turnaround Time) -- Safety, Efficiency, Effectiveness
• Percentage of Patients Leaving AMA -- Equity
• Average Wait Time in ED -- Timeliness, Efficiency, Patient Centered
• Medical Staff Quality (OPPE, % Medical Case Reviews Deemed Appropriate, Medical Record Delinquencies equal or greater than 30days) -- Equity
• Risk-Adjusted Mortality (O/E ratio) -- outcome measure
• Readmissions (15 day, 30 day) -- outcome measure
• Scorecard/Dashboard reporting -- competency measure
• Regular Reporting to the Board of Directors --competency measure

The healthcare quality professional must be relentless and connect these beads to a centralized string.

Does your hospital have a Quality Program?

The Eeyore Mentality Can Stymie Performance Improvement

In the work place, you will often interface with an array of personalities. In most cases, this diversity brings strength and stimulation to the work place environment. However, if you are a quality professional in a hospital, you must be watchful and aware of one personality in particular. . . . .the Eeyore.

Using industry jargon, we refer to these individuals as "late adopters" or "non-believers." Anywhere you find pivot points for change, there will be those that want to move forward and those few that remain fixed upon "what can go wrong," "it will not be successful," and "it takes to much of my time," and "we have always done it this way, why change."

You might think that these individuals can be conveniently isolated from the continuous improvement town hall. How untrue, my friends.

In practice, if we apply the Pareto Principle, the 20% can have a meaningful and stymieing impact on the remaining 80%. The quality professional must be able to interact effectively with Eeyores and diligently work to dilute the mentality's toxicity. For if unchecked, it can spread.

Organizations that are successful posssess a culture that appropriately curbs the doom and gloom while promoting the positive and productive elements of the Eeyore Mentality.

A Description of Eeyore's character traits:

• Eeyore is a favorite amongst most admirers of Winnie the Pooh characters and he is a lovable donkey who is dismally gloomy for almost eternity. But that’s not Eeyore’s perception of himself, according to him; he doesn’t expect too much of himself and therefore remains quiet for most of the time. That in no ways means he isn’t an intelligent animal, he is actually quite knowledgeable yet he confines his knowledge to himself. This is the reason why he is very quiet most of the time and a bit depressed. Eeyore, a very gloomy, blue-gray donkey, is stuffed with sawdust. His appearance is highlighted by a small light pink bow on his tail; this reflects well on this animal when there is an occasional hint of joy that surfaces in Eeyore.