Quality improvement programs often fail simply because they are poorly focused. Many QI programs try to do too much; they try to work on too many small, low-impact, department-level QI projects.
Avoid The 1,001 Quality Improvement Project Trap
The 1,001 QI project trap happens when your organization charters improvement QI projects using a bottom-up approach—essentially allowing departments to charter any QI project they feel is important.
This approach results in hundreds of small, low-impact projects. They bring little improvement value to the organization, take up a lot of energy, and stretch quality department resources past their limits.
Quality leaders feel like they’re doing everything they can to improve quality, but are overwhelmed by so many QI projects, and see little improvement for all of their effort.
You might think it would be just the opposite, but time and time again, we’ve run the numbers—and when there are too many QI projects to support, they fail to achieve results.
So, your first step is to keep the number of QI projects manageable, while at the same time you need to achieve your goal to improve care for as many patients as possible. I know this sounds like a no-win situation, but there is a way to manage a reasonable number of projects while improving care for the majority of your patients.
Here are two ways to focus your improvement efforts that get HUGE RESULTS.
Target High-Impact QI Projects
First, target your improvement priorities, and your resources, on high-impact projects. Make sure these projects will deliver huge improvements in multiple areas. For example, a single heart failure project can simultaneously impact a population that composes 7 percent of your admissions, create multimillion-dollar savings, and reduce large numbers of complications and medical errors.
Target High Volume Medical Conditions and Surgical Procedures for Clinical Improvement
In most hospitals, the 10 most common medical conditions and surgical procedures equal approximately 30 percent of the hospital’s patient population. So you only need ten QI teams to improve care for around 30 percent of your patients. This is what I mean by strategically focused improvement! Improve care for huge numbers of patients with just a handful of improvement teams; this is a powerful strategy and one that I’ve used for years.
Targets Large Scale Projects for Process Improvement
You want to take the same approach with your process improvement program. The key is to deploy your PI resources toward processes that are broad based or large scale—processes that run across many departments in your organization. You don’t want to be working up and down in a silo, but working across many silos, or departments, on a singular process that affects a large segment of your organization. Just as with the clinical improvement example above, you want to prioritize projects that affect large numbers of patients.
The medication administration process is an example of such a process. The process begins when the physician writes an order for a medication and ends when the patient receives the medication. It often contains over one hundred steps, may involve tens, if not hundreds, of workers and crosses many department lines.
In one organization the Medication Administration Process had over 125 steps, involved hundreds of millions of dollars in supplies and worker time, and touched every patient hospitalized in the organization, as well as every nurse and physician caring for those patients. This is a perfect example of a broad-scale process that is perfect for redesign using Lean, Six Sigma, or Toyota methods.
Here are my other favorite areas to put at the top of the list for process improvement. They all meet the criteria of being strategically-focused, broad-based processes that affect multiple departments, and a large patient population. They include:
- Operating Room operations—scheduling, throughput, and preference cards
- Emergency Department—throughput and fast-track processes for critical conditions
- Catheterization lab (cath lab) operations—scheduling, throughput, cost management, etc.
- Bed management—turnover and patient placement
What You Should Do Next
Take inventory of all of your quality and safety projects. Does each project improve care for large numbers of patients? Are you prioritizing your high volume medical conditions and surgical procedures for improvement? Are your process improvement priorities focused on large scale processes? If you answered no to any of these questions, you likely need to redesign that part of your quality program.
Remember, too many projects, that are narrowly focused, and have small impact frustrate you and they won’t improve care for the majority of your patients.