I have received many questions lately about how to staff a quality and safety department. The most common questions are:
- How many staff do I need? Are there any benchmarks for effective staffing levels?
- What type of skills do they need?
- Do they need a clinical background? If not, what other type of education is ideal?
- My organization never approves my FTE requests and we can barely keep up. What can I do?
So, here comes a series on “Building The Ideal Quality & Safety Department.” I’ll post information every Monday until we’ve designed an entire department. When the series is complete, we’ll have a monograph, a step-by-step model for designing your dream department – one that gets results AND one where every FTE can be justified by solid business cases. I’ll publish it as an eBook so you’ll have all of this information in one publication. So let’s get started with an org chart and the specs for a Quality Specialist.
Resourcing Today’s Contemporary Quality Department
Here’s a staffing chart that I recommend for the average hospital’s quality department. After working with many variations over the years, this has become my favorite model.
The Experts You’ll Want in Your Department
For each of the positions shown in the figure above, I have recommendations for their specific role, desired experience and expertise, unique skill sets, and requisite degrees or training. Let’s start with the lead role for your clinical improvement program, the quality specialist (QS).
Ideal QS Experience and Expertise
A seasoned QS will have expertise in the six areas listed below. This is a very specific list and, frankly, these folks are rare. More than likely you’ll find someone with expertise in some of these areas but will have to provide training for the rest. That is okay, but at a minimum, I recommend that you identify people with a rich portfolio of success in at least two, or better yet, three of these areas:
Rapid-Cycle Improvement Methods
This one is a must-have and I insist on a significant track record of successful rapid-cycle QI projects for this hire. They need to be well-versed in the rapid-cycle skills since we no longer have the luxury of slow, incremental improvement.
Clinical Outcome Improvement
People with this expertise used to be very rare unless you were fortunate to raid one of the top hospitals in the country. The good news is that this is no longer the case. With the arrival of EMRs and all of the work in evidence-based medicine, these folks are becoming more common. This person needs experience and expertise in how to reduce complications, readmissions, and mortality rates, not just the know-how to develop order sets. They also need to be familiar with the evidence-based libraries, such as Zynx or Cochrane.
Lean, Six Sigma, or Toyota Process Improvement (PI) Methods
The ability to facilitate teams to redesign processes is part and parcel of the QS’s role. If you can find a candidate with this knowledge, and a track record of success in PI, plus the two areas above, then you’ve found a great candidate for your department. You can easily teach the remaining three skill sets.
Few clinical staff have formal training in project management. I know I didn’t, but shortly after starting my quality career, I met USAF Col. John Myers. His mastery of project management was extraordinary. I learned everything I could by watching him and his department in action. It left such an impression on me that everyone in my former departments now receives project management training and runs every project using project plans. Honestly, it’s one of the keys to getting things done.
The quality specialist (QS) functions as a team facilitator and project manager. This individual ensures that teams make constant progress and meet their year-end goals. They serve a traditional facilitator role at team meetings. Behind the scenes they manage the project plan and are the “go-to” person whenever the team needs help, has questions, or runs into barriers.
In between team meetings, they make sure the work gets done. In fact, they are the critical ingredient to making your year-end goals—one of your most important resources. to take action.
I cross-train all staff in safety so high-reliability design can be incorporated into all improvement projects.
That takes care of the technical knowledge. We can always teach these skills. In the next post I’ll review the critical skills we can’t teach. These are the skills that that make your Quality Specialist a star!