Efforts to improve the quality of healthcare have failed to achieve a meaningful and sustainable improvement. Patients continue to experience fragmented, inconvenient, and unsafe care while providers are increasingly becoming overburdened with administrative tasks. The need for change is clear. Healthcare professionals need to take on new leadership roles in quality improvement (QI) projects to effect real change. The Quality Improvement Challenge in Healthcare equips readers with the skills and knowledge required to develop and implement successful operational improvement initiatives.
Designed for healthcare providers seeking to apply QI in practice, this valuable resource delivers step-by-step guidance on improvement methodology, team dynamics, and organizational change management in the context of real-world healthcare environments. The text integrates the principles and practices of Lean Six Sigma, human-centered design, and neurosciences to present a field-tested framework. Detailed yet accessible chapters cover topics including identifying and prioritizing the problem, developing improvement ideas, defining the scope of the project, organizing the QI team, implementing and sustaining the improvement, and much more. Clearly explaining each step of the improvement process, this practical guide:
- Presents the material in a logical sequence, gradually introducing each step of the process with clearly defined workflow templates
- Features a wealth of examples demonstrating QI application, and case studies emphasizing key concepts to highlight successful and unsuccessful improvement initiatives
- Includes end-of-chapter exercises and review questions for assessing and reinforcing comprehension
- Offers practical tips and advice on communicating effectively, leading a team meeting, conducting a tollgate review, and motivating people to change
Leading QI projects requires a specific set of skills not taught in medical school. The Quality Improvement Challenge in Healthcare bridges this gap for experienced and trainee healthcare providers, and serves as an important reference for residency program directors, physician educators, healthcare leaders, and health-related professional organizations.
Table of Contents
Why This Book? x
About the Authors xi
List of Stories, Examples, Exercises, and Case Studies xiii
About the Companion Website xv
Part I The Basics 1
Chapter 1 The Problem with Healthcare 3
Chapter 2 We Need to Improve the Way We Improve 11
Part II The First “R”: The Right Project 21
Chapter 3 The Project Selection Process 23
Chapter 4 Frame Your Challenge: The Problem Statement and Charter 36
Part III The Second “R”: The Right People 45
Chapter 5 Don’t Go at It Alone: Find a Primary Sponsor 47
Chapter 6 Organize Your QI Team and Select the Team Leader 51
Part IV The Third “R”: The Right Problem 61
Chapter 7 What is the Scope of the Project? The SIPOC Diagram 63
Chapter 8 Who Are the “Customers,” and What Do They Need? 68
Chapter 9 Who Are the “Stakeholders,” and What Challenges Do They Have? 81
Part V The Fourth “R”: The Right Cause 87
Chapter 10 To Understand a Process, You Need to “Go See” and Create a Map 89
Chapter 11 Get a Quick Win: Identify and Eliminate “Waste” 109
Chapter 12 Measure What Matters: Choose the Right Project Metrics 124
Chapter 13 Practicalities for Planning and Collecting Baseline Data 137
Chapter 14 Define Baseline Performance: Is the Process “Stable”? 147
Chapter 15 Tools to Characterize the Type of Variation: The Run Chart 176
Chapter 16 Tools to Characterize the Type of Variation: The Control Chart 186
Chapter 17 Define Baseline Performance: Is the Process Capable? 207
Chapter 18 How to Identify and Prioritize the Most Likely Cause of the Problem 222
Chapter 19 Before Proceeding, Confirm the Cause-and-Effect Relationship 242
Part VI The Fifth “R”: The Right Solution 253
Chapter 20 Develop and Prioritize Your Improvement Ideas 255
Chapter 21 Test the Effectiveness of Your Ideas with a Pilot 280
Chapter 22 Improve “Flow” and Work Conditions 288
Chapter 23 Now Roll-Out Your Improvement Ideas and Make Them “Stick” 310
Part VII Additional Things You May Need to Know 331
Chapter 24 How to Prepare and Conduct a Tollgate Review 333
Chapter 25 How to Communicate Effectively to Engage the Frontline 339
Chapter 26 How to Lead an Effective Team Meeting 354
Chapter 27 How to Help Your QI Team Become a High-Performing Team 369
Chapter 28 Steps and Strategies to Effective Decision-Making 393
Chapter 29 What Neurosciences Can Teach Us to Motivate People to Change 403
Chapter 30 How Does it All Fit Together? The MRI Suite at St. Mary’s Hospital 421
Appendix 449
Appendix I Common Improvement Tools and Techniques 451
Appendix II Glossary of Improvement Terms 457
Appendix III Additional Resources 460
Index 463
