To Launch Is Not Enough

As a leader, one of your key responsibilities is to guide the selection and the launch of new initiatives — new services, new products, new locations, new technologies, new processes, etc.

But once an initiative is launched, how do you know that it is performing well? As the saying goes "trust but verify”; this is a mindset leaders should adopt.

There is a management tool that I'm sure you've heard about many times, that is geared to verifying impact: Plan, Do, Check, Act, also known as the Shewhart Cycle (or Deming Cycle).

Let me walk you through one example that is especially important to healthcare organizations: the performance of their virtual care program (a.k.a. telehealth services).

VIRTUAL CARE and PDCA

Many healthcare organizations have had a virtual care program in place now for four years.

Is it producing the results you need and want?

[ ] Yes

[ ] No

[ ] Not sure

It might be time to dust-off: plan, do, check, act.

Here are some aspects to consider …

(note: Many of these can apply to any new program within your area of responsibility, well beyond virtual care).

PLAN

What was your (initial) plan for your virtual care program? Did you define clear goals and objectives? Were they around access to services, patient outcomes, continuity of care, patient engagement, and/or clinician satisfaction?

What are your expansion plans for your telehealth program? How do you determine expansion success?

Which virtual care modalities best match the needs of those you serve? Video visits (individual and group), asynchronous messaging, remote monitoring, use of digital health apps, and the like.

Which patient types are best supported with your telehealth services? How do you reach them? How do you reduce barriers to accessing services?

In other words, what are your plans and goals for your virtual care program?

DO

Have you fully deployed your virtual care program as planned? Or just parts of it?

Are all of your clinicians comfortable and competent in using this mode of care delivery? Or just a few?

Are you providing telehealth in all the ways that are clinically appropriate?

Are you reaching the patient populations who can most benefit?

Are your front office staff offering telehealth as an alternative when a patient calls to cancel?

Oftentimes we find things are not fully in place as we thought they were.

It is useful to "trust but verify."

For example, an executive I am advising recently validated an assumption only to learn that in "making the improvement," the operations team had ceased the old practice but had not instituted a new and improved step in its place. In other words, they had not deployed the full improvement as the executive had assumed, leaving a gap for patients. Together, they determined where the miscommunication occurred and have shored up the issue.

CHECK

Before we check numerical results, I suggest first validating that we did what was planned; or else we risk drawing improper conclusions.

Using the prior example, if the executive had simply checked results, like patient no-show rates or usage volumes, he might have concluded that the improvement was not effective. Rather, by validating first, he learned that the plan had not been deployed fully. This needed to be fixed first before results could accrue.

I also advise checking the extent of deployment.

For example, the virtual care workflows may be in place in clinic location #I but not being used in clinic #2.

So, in the check phase of PDCA, we are checking two things:

• Did we do what we planned?
• What are the results?

By way of another example, an addiction treatment center, who had moved to a virtual-first approach for "group programs,” has examined their client results. They have found that clients are more frequently completing the intensive portion of the program and enrolling at a higher rate into the second phase of the recovery program when TeleSUD is used, as compared to their traditional in-person program. The stark and positive difference in client outcomes has solidified their commitment to a virtual-first approach for group treatment.

For other organizations, check means looking at the results — trended over time — on dimensions of access, time to first appointment, response time, patient engagement, as well as patient and clinician satisfaction. All in all, examining the results that tie to the specific objectives for your virtual care program.

For example, a behavioral health client implemented a TeleCrisis program in order to improve their response time to patients in crisis who are at four Emergency Departments in their region. In checking their program results, pre- and post-implementation, they have noted a significant improvement in response time to all of the EDs they service.

ACT

And last, but certainly not least, we need to act on what we learn from the check.

So, if we find that we have not yet realized the objectives we intended, we act by making needed workflow adjustments, fully deploying the plan, or undertaking a root cause analysis in another PDCA cycle to uncover what factors are not yet working well.

In other words, we act on what we learn.

Whereas, when we discern that yes, indeed we achieved the results we intended, we can act by asking “where else can we apply this successful approach?”

For example, my client who has achieved greater client recovery rates in their TeleSUD groups is looking at expanding use of TeleServices for youth in their area.

The response time success achieved by implementing TeleCrisis to Emergency Departments, is leading to looking at other locations, like jails, where a similar approach may be beneficial.

Plan-Do-Check-Act: a quality tool worth bringing to your virtual care program.

My colleague, Kari Gali, recently shared that she lives life as a P-D-C-A.

I agree, it’s a versatile and impactful mindset and toolset for continuous improvement of anything that matters to you.

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Kathy Letendre , President and Founder of Letendre & Associates , advises organizations and leaders to create their excellence advantage.

Feel free to contact Kathy by phone or text at 802-779-4315 or via email .