Quality Center Update
What top-performing EDs do
Lean, Six Sigma and Toyota Production System applications have simply not proven sustainable in health care. While a number of stand-alone projects dot the case study landscape, only a few can point to strategic impact beyond 18 months. Six differentiators emerge as vital in increasing the probability of sustainable gains in health care strategies:
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Black belts/change agents require the engagement of senior leaders.
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A “big quality” three-year strategic sequence of projects versus a “little quality” one-project-at-a-time plan.
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An “implementation-first” approach.
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Embed a monthly organizationwide, disciplined implementation framework to ensure the rate of change is on track.
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Embrace the accelerating impact of lean.
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Ensure each project achieves a hard cost return-on-investment versus soft cost.
Engagement of senior leaders
Believing that training alone drives success is a recipe for suboptimal results. At a Georgia medical center, after two consecutive 100-Day Workouts achieved double-digit length-of-stay reductions, the chief operating officer thought the ED-bed management strategy team was self-reliant and reduced his involvement. At the end of the next 100-Day Workout, results were unremarkable. The COO’s conclusion: Department-level managers are less willing to put risky ideas on the table in the absence of a supportive senior leader.
A three-year strategic sequence of projects
The traditional approach involves thinking of the desired end result as a project. Such approaches lack the rigor of other key strategic initiatives like revenue growth or operating margin improvement, in which a detailed three-year plan representing a sequential multiproject plan is adopted, complete with monthly or quarterly milestones.
An implementation-first approach
Successful organizations begin with an implementation-first approach, securing an action orientation in advance of analysis. Senior leaders set the agency for change by kicking off the initiative with action planning. While some black belts will fault this, the practical observation is: Top quartile performers are masters of change and implementation.
Embed a framework
Organizations must rely on their own creativity to construct macro-system tools. The following implementation model characteristics appear among top quartile performers:
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Two or more departments work in collaboration. The ED can influence about 33 percent to 50 percent of the causes of excessive LOS and “leave without being seen” incidents.
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Success is visible. For each strategic initiative, a monthly check-in is necessary to validate implementation and quickly uncover barriers to implementation.
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Require evidence that changes to ED subprocesses demonstrably impact LOS and LWBS improvement. Two tools help:
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Require a connect-the-dots approach. That is, if Change A is proposed, answer “What ED LOS will then result?” This relational logic goes a long way toward ensuring that ideas lead to meaningful change versus rewarding busyness.
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Rapid cycle testing. For every Change A, demonstrate how the change produced the expected result.
Embrace the accelerating impact of Lean
Much of the logic of lean can dramatically accelerate efforts to achieve ED LOS improvement versus a more traditional “trial-and-error” process.—The authors will present the concepts from this article in an upcoming webinar. For information, visit www.asq.org
Greg Butler is a faculty member of the American Society for Quality. Chip Caldwell, FACHE, is faculty member of the American Society for Quality. Nancy Poston, FACHE, is a national thought leader in the use of lean principles in growth strategies and service-line excellence.
Visit the AHA Quality Center at www.ahaqualitycenter.org to explore these and other topics.
This article 1st appeared in the July 2009 issue of HHN Magazine.
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