3 I's of Process Improvement (Part 1 of 3)

Healthcare is not new to process improvement, but so much of it is... well... scary. Us normal people get intimidated when we hear about programs called Kaizen, Six Sigma, or Total Quality Management. What's even more intimidating are the names of the people that are well-versed in these methodologies; they call themselves Ninjas, Wizards, and Black Belts. If you came across these people when playing Dungeons & Dragons, you'd run the other way!

And yes, I realize that a Dungeons & Dragons reference outs me as an even bigger nerd.

Instead of years of training, cramming, and shadowing, I prefer to keep things pretty simple when it comes to problem solving and process improvement... I call the process "The Three I's" and it goes a little something like this (channeling my inner Run DMC as I typed that).

The Three I's: Investigate, Interpret, Intervene

You've identified a problem, or maybe leadership plopped the flaming turd of a problem in your lap and it's on you to get it fixed. You're not a Ninja or Wizard, so what do you do next? Not-so-subtle hint: Investigate

Let's use the example of leadership telling you that ED (Emergency Department) wait times are too long, but it can really be any problem in any department. To investigate that, you need to find out as much as you can about the situation without bringing your bias into it, after all part of this framework is to determine if there actually is a problem.

1. Set parameters: Is the wait time issue only for emergency departments, or does it also include outpatient clinics? Is this issue for one hospital or systemic throughout the organization?
2. Establish a timeline: Investigating and monitoring wait times for a day or a week won't give you an accurate view of your ED wait times. The time of year, events happening in the community, even the weather all affect your ED traffic. In a perfect world, your metrics should be continuously monitored so you can easily pull historical numbers. If that's not possible, use at least a 90-day timeframe.
3. Gather qualitative feedback: Read comments that patients leave for your organization and analyze those for overarching themes and specifics. These comments can be from patient experience surveys, online reviews, comment cards, focus groups, PFACs, or community meetings.
4. Monitor quantitative metrics: Ideally you'll have both real-time monitoring and historical trends to see how your wait times compare to previous periods to see if they have indeed increased or if the perception is that they've increased. Metrics to use can include Average Wait Time, Median Wait Time, 90th Percentile Wait Time, and Patient Experience Scores to correlate them to wait times.
5. Staff input: Your staff are on the front line and have a great sense of what's happening with your patients and organization, so make sure to get their input when investigating the issue. You can use surveys, 1:1 meetings, or gather small groups. Be aware of when you ask them and in what setting. If you ask during a peak busy time when they are already stressed, those answers will be skewed. Similarly, if you ask in a group setting, one employee with a strong point of view might rile up the rest of the group and it quickly turns into a bitch session about not only that topic, but other topics that may not even be related. Depending on your culture and staff, using a person from outside your organization might be a useful way to elicit honest and transparent responses.
6. Use focus groups: Focus groups with a seasoned facilitator are a fantastic way to go beyond the question to understand why people feel a certain way and what their ideal outcome is. Focus groups can be done in person or online.

Above are some, but not all, of the ways to investigate what's happening in the ED, but remember you can use this procedure for any problem you've been tasked with solving. Next time we'll focus on the Second I - Interpret.

*Note: I decided to separate this into three different parts for two reasons.

1. This will allow you to fully absorb each step in the process.
2. It provides an opportunity for me to learn from your feedback and add or amend to this as I guide you through the Three I's.

Healthcare and the Presidential Debate

If you're a political animal, you probably watched the Biden vs Trump debate last week. I'm not choosing sides here, that's what the ballot box is for (hint: register to vote).

Here's some questions that were addressed and fact-checked by various sources and highlighted in a Becker's Healthcare analysis found here:

1. Who's really responsible for lowering insulin prices?
2. Are we coming together on abortion laws?
3. Is social security on the chopping block?
4. What should be done about the opioid crisis?

Why Focus on Process Improvement?

1. In 60% of jobs, one-third of the tasks required by employees could be automated - 麦肯锡
2. The median cost of turnover is around 21% of an employee’s annual salary - Center for American Progress
3. Bad data eats up between 20% - 30% of operating expenses for organizations on average - Pragmatic Works
4. 78% of business leaders said they can save 3 hours of work a day by improving processes - WorkMarket by ADP
5. 48% of organizations have a formal business process management program - Cflow