When Dr. W. Edwards Deming, the father of the Quality Management process, was asked how he would know when the transformation to quality was successful he gave the same answer: when it is adopted in healthcare.
Clearly there were significant barriers to the growth of quality in healthcare. The structured environment in hospitals and other facilities, rigid silos between departments, time constraints on employees, and the egos involved in the process served to hamper the development of Total Quality Management in this environment. Today, however, data based decision making and teamwork are making head roads into healthcare.
One of the forces driving the quality process is the encouragement for healthcare providers to transform patient records from paper to electronic. The technology offers a great opportunity for quality improvements in patient care. It provides practitioners with alert systems that identify allergic reactions to medication or inappropriate medication. It also alerts doctors to lab results that require quick attention.
Providers have immediate access to patient records instead of indefinite wait times that could delay or prevent recovery. The ability to electronically transfer records from one practitioner to another permits important information to be passed on quickly. Another important function of electronic records is the elimination of the guessing game of handwriting, making it easier for others to read doctors’ orders or notes.
Additionally, medical coding data is being implemented that is more specific about illnesses and diseases which is beneficial to both diagnosis and prevention. When health information management professionals manage data from electronic records, it allows practitioners to review processes and procedures which improves patient and population outcomes.
For the first time, data is readily available for problem identification, diagnosis of root causes, and tracking the effectiveness of efforts to improve medical care. The outcomes have proven to be positive for doctors, nurses, patients, and others involved in the process.
One of the leaders in this transformation is the Kaiser Permanente health care network. KP has actively involved their employees and the unions representing them to form strong partnerships aimed at improving patient care. This has created an environment where nurses and others feel free to speak up regarding their concerns and ways to improve the work system, resulting in keeping patients safer and making KP a better workplace. As a result, they report their teams have high morale, low turnover, and its patients suffer fewer hospital-acquired infections. While nurses and other medical professionals work in a stressful environment, teams report decreased stress levels as a result of their efforts.
In any organized environment, the commitment of strong managers and strong unions is essential to build a team based system where everyone feels safe to speak up about their concerns and ideas. KP notes the importance of the role of managers in fostering this environment, “because when health care workers know their voices will be heard, patient outcomes improve.”
KP is not the only organization encouraging total quality management and teamwork in health care. Dr. John Haughom, senior advisor at Health Catalyst, lists five Deming principles he believes will create the biggest opportunities for healthcare process improvement:
- Quality improvement is the science of process management. He
He suggests “If we focus on the processes of care one at a time, we can fundamentally change the game and deal with the challenges facing healthcare. Now, this may seem like a tall order, but Pareto’s principle tells us that there are probably 20% of those processes that will get us 80% of the impact. So the challenge of every organization is to identify that 20%, roll up their sleeves, and begin the important work of addressing those challenges.”
- If you cannot measure it…You cannot improve it. Dr. Haughom believes meaningful quality improvement must be data-driven. This is particularly true in healthcare. You’re basically dead in the water if you try to work with healthcare providers and you don’t have good data… So, data is critical if we’re going to have a meaningful impact in healthcare.
- Managed care means managing the processes of care, not managing physicians and nurses. You need to engage clinicians in the process because they understand the care delivery system and they are best equipped to figure out how to improve the process of care over time.
- The right data in the right format at the right time in the right hands.
- Engaging the “smart cogs” of healthcare. Dr. Haughom believes “if we are going to realize value, it means we have to engage clinicians. They are the frontline workers who understand and own the processes of care.”
Transforming healthcare using quality principles and teamwork is not an easy process. We salute Kaiser Permanente, their employees, and their partner unions, as well as others who have begun the process. If you work in healthcare and want help in implementing or improving your process, contact CALMC.