Healthcare is one of the most crucial industries in our country, and indeed our world, because it directly affects the health and wellbeing of our citizenry, which in turn weighs heavily on the success of business, relationships, families and so much more. Thus, ensuring that healthcare quality improvements are always moving forward, there is a necessity to find out where it is lacking.
For decades, experts have scratched their heads in an effort to find health quality improvements within the industry, streamline its services, minimize painful bureaucracy and maximize the health and happiness of the people who rely on it (not to mention work in it!). Increasingly, thought leaders in healthcare have noted that to improve the process overall, it is necessary to improve it at a systems level – that is, to weed out smaller processes that don’t work and replace them with better ones.
A Page Out of Deming’s Book
W. Edwards Deming was a preeminent speaker, author and teacher in the United States and overseas for much of the 20th century. His quality improvement ideas are numerous and varied, but one of the most powerful is the idea that statistical variance drags processes down. In other words, even if a process itself is good, if it isn’t executed well at certain stages, or its users don’t follow through reliably on the steps involved, then the overall system will suffer.
This is no less true for healthcare than it is for, say, the automotive industry, which is where Deming’s primary focus was centered. When healthcare providers do not reliably follow processes (or don’t have them in the first place) that improve patient health, keep excellent records, and so forth, they fail to maintain a high level of efficacy in the healthcare system.
Mine the Process
Let’s face it: Sometimes the people participating in the process lack the vision of the big picture. In fact, too often in healthcare, no one involved has the ability to step back and see the forest for the trees. This is a problem, because when the "careflow" (as the healthcare process is dubbed by the Eindhoven University of Technology) is out of control, it cannot be corrected or bettered.
In this case, it can be helpful to “mine the process.” This amounts to figuring out what is happening, where, when, how and by whom, in order to determine what the overall system currently looks like. Only by determining the contemporary state of healthcare quality improvement can its workers and proponents advance it.
Measure to Improve
Once a process’s users have a handle on it, it is crucial to measure it to see where it’s failing or at least faltering. Establishing measures in healthcare is a difficult and delicate process that won’t happen overnight, but there are many ways in which healthcare professionals can make it work. Examples include outcome measures, which sample how the system affects patient health overall; process measures, which track whether the standards of the proposed system are being met; or balancing measures, which help ensure that improving one process doesn’t bring another down.
Manage the Process, Not the People
It is crucial to manage the process itself, not the physicians and nurses who work within it. It is impossible to improve a system when the focus is on each individual worker in that system; not only is that too much to oversee, it undermines the very people who could be instrumental in changing the process.
Instead of managing doctors and nurses by "telling them what to do," healthcare leaders should focus on making sure healthcare workers understand the intent of the system, are engaged with it and use its processes reliably, and have appropriate channels through which to suggest and make improvements. By finding problems and statistical variance, and by bolstering weak points in the system, healthcare leaders can ensure its overall improvement.
Like anything worth having or creating, healthcare quality improvement will be an ongoing effort long into the future. However, as Haughom points out, most physicians are willing to change if it means a better overall system with healthier participants. Change will be easier to effect, however, if healthcare workers see the value in each system adjustment made, each new process adopted and each outdated practice left behind. In other words, systems-level involvement will result in systems-level improvement.