By Ashley Christman, RN, LSS MBB, SSBBP, CSM
Healthcare quality and patient safety are not dependent upon a singular factor. Rather than addressing the system and its processes in a methodical, incremental fashion, the current healthcare model focuses improvement in a single area, rather than addressing the system
This is where the industry is failing. Organizations are seeing functions—patient safety, provider safety, patient experience and satisfaction, and more—separately, rather than an intricate web with the patient and direct care providers at the center.
In healthcare, quality improvement is seen as the domain of clinical staff. If you look at the profiles of people in quality improvement roles, you will see most are registered nurses or doctors, which send the message that the onus of quality improvement is on the clinical staff alone. This prevailing attitude is sabotaging the ongoing efforts to improve quality and ultimately impacting patient safety and experience.
What the typical healthcare approach to quality improvement (QI) fails to consider is that healthcare is a system made of disparate processes. These processes feed into multiple areas and functions, far beyond direct patient care. The system is an intricate web and confining quality to the domain of clinical staff and their leaders is a huge failing that many organizations are still perpetuating.
The rigidity of roles in healthcare have created siloed efforts of improvement. Yes, there are state and regulatory compliance issues around licensure and scope of practice, but some of the restriction in improvement work is self-imposed by outdated attitudes and practices that no longer reflect the quickly changing field of healthcare. This impacts communication and can result in harm to our patients.
As healthcare continues to adapt Lean and Six Sigma into its QI practices, the industry is falling into the trap of only using Lean tools, but not following the spirit of a Lean culture.
A Lean culture empowers everyone to work across departments and functions, make changes to improve quality, and add value to our patients.
Risk is inherent with change, but with Lean, blame is never assigned—mistakes are seen as learning opportunities. Whether or not an organization uses this methodology, the mind shifts that must occur are imperative to improving care and having a true culture around continuous improvement.
Thirty years ago, the New England Journal of Medicine ran a piece called, “Sounding Board.” In it, the author described two cultures: one that is punitive toward mistakes (“bad apples”), and the other is collaborative, with management acting as coaches who encourage honest dialogue about errors, with staff feeling supported to learn from them.
While it’s no surprise, the second was far more effective than the first, I wonder: Why after 30 years is healthcare is still struggling to adapt continuous improvement?
Interested in learning more about quality improvement through the Lean Six Sigma Green Belt program? Check out more here: http://academy.kaipartners.com/course/lean-six-sigma-green-belt-certification/
About the Author: Ashley Christman is a former nurse and Certified Lean Six Sigma Master Black Belt with a background in organizational change management and Lean. Her extensive experience in healthcare quality and performance improvement has transformed a number of organizations and led to better outcomes in patient care, reductions in wait times, and more. Her experience includes consulting for the CA Department of Public Health as well as multiple large hospital systems, including Santa Rosa Memorial and Petaluma Valley Hospital. Her passion for improvement and educating others led her to begin teaching in order to help entrepreneurs, professionals, and leaders create a sustainable culture change by empowering them to be change agents and champions of innovation. You can find her online at @learnlivelean on Twitter and on LinkedIn.