Practice Area

Lean Six Sigma and Business Process

Quality Improvement Is Fun

I recently read an article with advice on how healthcare organizations can avoid burnout associated with improvement. Huh? If you have a burnout problem because employees are tired of things getting better, you need to get some perspective. Most organizations are dealing with the burnout associated with having to deal with the same old repeatable problems that never seem to get fixed. They would love to deal with “too much” improvement.

quality improvement
Quality improvement, or finding and fixing the things that frustrate workers and patients, is one of the best things you can do with your day.

I do understand that change is not easy, but that’s not what I’m talking about. I’m referring to the sense of accomplishment that comes with figuring something out and solving the problem. Who doesn’t like that? I would find it hard to believe that there is anyone walking the planet hoping that their work day is filled with defects or rework. It truly goes against our human instinct. I think I’m actually allergic to rework. It makes my blood pressure skyrocket, and sometimes my skin gets itchy when I have to re-do something that I already checked off my to-do list.

Quality improvement, or finding and fixing the things that frustrate workers and patients, is one of the best things you can do with your day. I have been using the tools and techniques that fall under the umbrella of Lean Six Sigma for 20+ years, and I consider it the most valuable toolset I have. I think quality improvement is fun. When I read the article talking about improvement burnout, I quickly realized that it wasn’t the improvement that burned employees out. It was the approach to improvement.

Healthcare organizations are implementing various types of quality initiativesAs more and more healthcare organizations are implementing various types of quality initiatives, I think it’s the approach to data, statistics, and advanced analysis that scares people and burns them out. While data and statistics are important parts of providing insight, they should not be the primary focus of continuous improvement. A simple shift in how improvement is presented can change everything. Train employees to view repeatable problems as a mystery to solve. Finding out what is causing the problem over and over again is like collecting evidence for a mystery. Millions of mystery novels are sold every year, and the “who-done-it” shows get some of the highest ratings on television. If you want your workers to enjoy improvement, help them know how to solve a mystery.

According to the Institute of Medicine (IOM), the majority of medical errors do not result from individual recklessness or the actions of a particular group. More commonly, the errors are caused by faulty systems, processes, and conditions that allow mistakes to be made or fail to prevent mistakes. If the goal is to reduce medical errors, the best place to start is by asking questions rather than looking at the numbers. There is no question that staring at a spreadsheet filled with data can instantly result in the deer-in-the-headlight look. Trying to figure out what a bunch of numbers should tell us is not the natural order of solving mysteries. Assembling a list of what we want to know and then collecting the data (evidence) is a lot more fun and effective.

Look at the below types of errors and think about what questions you would have in determining the root cause(s) of the problem. What evidence do you need to solve any of these mysteries?

Types of Errors
Error or delay in diagnosis
Failure to employ indicated tests
Failure to act on results of monitoring or testing
Error in the performance of an operation, procedure, or test
Error in administering the treatment
Error in the dose or method of using a drug
Avoidable delay in treatment or in responding to an abnormal test
Ventilator-acquired pneumonia
Failure to provide prophylactic treatment
Inadequate monitoring or follow-up of treatment
Inappropriate use of antibiotics
Source: Barry, Robert, et al. The Six Sigma Book for Healthcare: Improving Outcomes by Reducing Errors. Health Administration Press, 2002.

Usually, the questions are related to something called “stratification factors.” These are factors in the process or system that provide insight. The best way to start is with the “who, what, where, when, why, how, and how many” types of questions.

  • What are the patient demographics?
  • What time of day, day of the week, or week of the month do these issues occur?
  • Where was the defect?
  • How long was each delay?
  • What were the differences between errors and accurate circumstances?

Start with the most important questions first, and then attempt to answer those questions with data. Data is the evidence, and once you examine the results of that evidence, it will lead to additional questions. Eventually, you will piece it all together and solve the mystery.

There has never been more access to information as there is at this very point in time. You just need to train employees how to ask the right questions and secure the data. This does not usually occur as a one-person show. You need a cross-functional group of employees to work together to solve the mystery. The feeling of accomplishment when you finally figure out why something is repeatedly causing an error, delay, or issue that costs the organization money and everyone else frustration is fun and rewarding.

Having an organization filled with problem solvers is a much better investment than one that is filled with finders of fault.

About the Author

Anne Foley, PMP, MBB, CSSBB, author, speaker and training consultantAnne Foley, PMP, MBB, CSSBB is an author, speaker and training consultant with Corporate Education Group (CEG). Anne has spent 25 years of her career using data to identify root causes of defects and non-value added activities in processes. She incorporates data collection and analysis to decisions ranging from routine to complex. An energetic and interactive trainer, Anne has been leading virtual and traditional training classes, workshops and conferences for 18 years.

For more information on this topic, as well as how Corporate Education Group can help power your organization’s performance, contact us via email or call 1.800.288.7246 (US only) or +1.978.649.8200. You can also use our Information Request Form!


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