Intervene - 3 I's of Process Improvement (Part 3 of 3)

The last two articles have focused on my real-world process improvement framework entitled The 3 I's. In case you missed those articles ?? here's what you missed as well as links to them to catch up:

The first 2 I's were Investigating and Interpreting:

Investigate: gather all the qualitative and quantitative data you can by gathering insights from patients, staff, and consumers - link to original article

Interpret: analyze the data to see what the actual underlying issues really are - link to original article

Intervene

I thought about naming this step Implement instead of Intervene, but intervening feels a bit more disruptive. Either way, this is the step that you're likely most excited about. You get to put your plan into action.

We've been using wait times in the Emergency Department as an example. You've spent the last few months collecting and analyzing data and now you get to create a plan to affect change and improve your process.

Step 1: Create a Plan

It seems rudimentary, but many people try to make changes without a plan. This plan doesn't need to be an all-out Gannt chart , it can be as simple or complex as you choose. I like to use a one-pager that outlines the following:

• reason the change is being made
• the goal of the plan
• who's included
• what resources are needed
• timeline

The simpler your plan is, the more likely it will take hold.

Step 2: Find a Champion

Maybe you're the champion, but most likely you're looking for other people to carry the torch. The first person most people go to for a champion is an executive, and this is a mistake. While an executive can sponsor your plan, they're probably not the most effective champion. Instead, you're looking for someone who's in the trenches, is respected, and who will help own the change. In our emergency department example, this champion could be a charge nurse, administrator, or even a volunteer.

Step 3: Communicate

Communicate with leadership why you're doing this, communicate with your peers about how you can work together on this using the same language and actions, and communicate with staff about the why. Making your why about the patient, not the hospital, after all that's why we all got into healthcare. Actually, don't just communicate your plan... overcommunicate it.

Step 4: Action

Kick off your plan with a bang. Make it fun. Make it visible.

Step 5: Monitor

All that data you collected while Investigating the problem doesn't just disappear. Your ultimate goal is to improve those wait times, so monitoring that data on a regular basis will be crucial to determining if your process improvement plan is working. No need to spent tons of money on software or outside resources at this point, your goal is to see if the plan works. If it does work, then you have justification and can ask for additional funding or staff to ensure the change is permanent and continuously monitored.

Step 6: Celebrate!

The success isn't just yours, so get everyone involved in the celebration and don't forget to thank them for all their hard work. A bit of gratitude and praise goes a long way. Throw a pizza party or post the team success on your intranet. Get marketing involved to highlight your accomplishment.

Using a reliable and easy framework for process improvement makes it accessible for literally anyone in your organization to become a change agent. No need to call in the ninjas!

*Note: This is the final article in the series of utilizing a simple framework for process improvement and we've been using the example of rectifying the issue of long wait times in the Emergency Department.

If you missed the first article focused on Investigating, you can find it here.

The second article was about Interpreting findings, here's the link to that one.

Ideas for Reducing Emergency Department Wait Times

As we've been discussing the process for the past few articles, you may want to see what others are doing for reducing wait times in the ED.

1. Transparency: Health systems put it wait times on their apps, website, and even billboards. If there's a 4-hour wait time advertised, patients may be more likely to seek alternative options or evaluate whether it's really considered an emergency.
2. Activities for Families: Children get antsy when waiting, using some distractions like games or even a separate room with windows (so parents can see them) to hold craft classes for kids.
3. Teletriage: Using telemedicine for initial triage can help in quickly assessing patients' conditions and directing them to the appropriate level of care, potentially even before they arrive at the ED.
4. Regular Communication: Simply checking in with people every 15 minutes or so reduces their anxiety and they appreciate that you've recognized they're waiting.
5. Clinical Decision Units (CDUs): Creating observation units for patients who need more than an ED visit but not a full hospital admission. This can free up ED resources and beds for incoming patients.
6. Smaller Waiting Rooms: Taking large waiting and separating them into smaller rooms can help make things a bit more intimate and if a patient is loud or agitated, it affects a smaller number of people.
7. Setting Proper Expectations: If you tell someone they'll be seen "shortly", that is a vague term that could mean 2 minutes to one person and 60 minutes to the next. Use timeframes and over-communicate on any delays.
8. Mobile Health Units: Deploying mobile health units to manage minor injuries and illnesses in the community can reduce the burden on EDs, particularly during peak times.
9. Community Paramedicine Programs: Some areas are training paramedics to provide care at home for non-urgent cases can prevent unnecessary ED visits and reduce wait times.
10. Patient Education and Self-Triage Tools: Providing patients with tools and information to help them make informed decisions about when to visit the ED versus seeking care elsewhere. This can be gamified in your hospital's app.

Olympic Facts

1. Olympic Rings: The Olympic symbol was designed to include everyone. The Olympic rings were first produced in 1913, from a design created by the Games’ modern founder – Baron Pierre de Coubertin! Their five colors (along with the white backdrop) reflect colors found on the flags of all participating nations, so everyone is represented. The overlaps also represent international cooperation, and the coming together of athletes from all over the world.
2. Unique Events: Previous Olympics have had running deer shooting, tug-of-war, chorus singing, and dueling with pistols!
3. You Go Girl: The 2012 London Games were the first Olympics in which all participating countries sent female athletes.
4. Go For Gold: Until 1912, gold medals were made of real gold.