question answer

OVERVIEW: PROCESS IMPROVEMENT AND PROBLEM-SOLVING – HOW THEY RELATE TO YOUR DAILY WORK IN THE HSA INTERNSHIP AND BEYOND

      

Documents:

Quality Improvement: Appropriateness, Process Improvement and Problem Solving

Process Improvement: Addressing Failures in Coordination, Failures in Care Delivery, and

Key Ideas: Problem Solving

A key aspect of operational activity in organizations is to solve and identify problems: This activity aims to identify problems, to prioritize which ones are most important to solve, and to solve the most significant problems by means of collaborative team activity among members of the organization. Problem solving is done by teams, and is based on the use of hard evidence, quantitative analysis, and team collaboration and consulting.

Quality Improvement as it is practiced in the health care services industry has developed in a number of forms over the past 30 years, and is based on the work of W. Edwards Deming and Joseph Juran. It focuses on two (2) key sets of activities:

Ensuring Appropriateness of Care: Ensuring Appropriateness means making sure that health care services are provided on the basis of accurate clinical diagnosis, that the most appropriate and effective health care intervention/treatment is chosen, and that care is delivered in the most appropriate location and at the most appropriate level. Quality Improvement is a collaborative/team effort involving administrators and both clinical and non-clinical providers. With respect to ensuring Appropriateness of Care, clinical providers will play a relatively larger role in the team effort.

Improving Processes of Care: Process Improvement, the second major aspect of Quality Improvement, assumes that a patient’s medical condition and needs have been accurately diagnosed, and that the right (appropriate) treatment is being delivered at the right (appropriate) level of care. Process Improvement works to reduce failures in the Coordination of Care and failures in the Delivery of Care as they arise in daily operations.

Quality Improvement is a collaborative/team effort involving administrators and both clinical and non-clinical providers. With respect to Process Improvement, administrators and managers will play a relatively larger role in the team effort.

Most of your involvement with problem-solving will be focused on Process Improvement.

Problem Solving: Involves identifying a gap between a current state of affairs (for example: it takes an average of 4 hours of turnaround time to process a critical lab test for Emergency Room patients) and a target or desired future state of affairs (that turnaround time should be 2 hours).

A key tool for problem solving is the A-1: The A-1 is a set of guidelines for solving identified problems, a physical tool for structuring the actual problem resolution process, and a record of how a particular problem has been resolved. So – it helps guide problem solution, and to help others fully implement the solution.

Key parts of the problem resolution process guided by the A-1 include:

Mapping current work processes related to the problem and doing so by means of Flow Chart Analysis;

Conducting Root Cause Analysis to identify the real sources of the problem to be solved; and

Using standards of good process and practice developed by successful organizations via Benchmarking.

Key Ideas: Process Improvement and the Reduction of Waste:

Process Improvement works to reduce failures in the Coordination of Care and failures in the Delivery of Care as they arise in daily operations:

Failures of Care Coordination: This is waste that occurs when patients are subjected to care which is fragmented and marked by poor or non-communication among providers. The results are complications, hospital readmissions, decline in functional status, and increased dependency, especially for the chronically ill, for whom care coordination is essential for health and function.

Failures of Care Delivery: This is waste that occurs when there is poor execution of care or lack of widespread adoption of known best care processes, including, for example, patient safety systems and preventive care practices that have been shown to be effective. The results are patient injuries and worse clinical outcomes. The issue here is using the best knowledge-based and experience-based processes of care.

Process Improvement is most effective when it is based on a clear understanding of the 8 different kinds of Waste. (For details and 3 sets of examples, see the reading on Process Improvement and Waste in Item 5.1 in Blackboard Assignments for this course.)

Waiting
Transportation
Motion
Inventory
Over processing
Overproduction
Defects
Misuse of Human Potential