How best can Quality Management and Healthcare professionals use tools to integrate Quality M...

How best can Quality Management and Healthcare professionals use tools to integrate Quality Management Systems into healthcare organizations?

Posted by Grace Duffy on Mar 13, 2019 8:20 am

Pierce Story, co-chair of our Healthcare Quality and Improvement committee (HQIC), made some excellent comments about the focus of our HQIC QMS Monograph 2 that will be released on Friday, March 15. One of the valuable messages in the Assessment Monograph 2 for our Healthcare QMS series is the awareness that implementing a QMS differs in approach depending on the organizational maturity of the organization doing the design and implementation:
 
  • I was struck by the Maturity Model and a recent discussion I’d had with a technology vendor.  This vendor develops and installs “patient tracking” and “capacity management” software.  Yet, they are now having to hire entire teams of “optimization experts” because their clients often do not see the benefits the software is meant to provide.  Why?  Well, it is obvious that the operational models into which the technology is being placed are not suited for its use.  That is, the operational models are at one level of sophistication/maturity and the software is at another.  Thus, because the software cannot support a certain level of optimization that doesn’t exist, its “utility” for the organization is reduced.  I thought of the QMS model and the necessary standards for an organization that are required in order that an organization might benefit from new technologies meant to improve operational performance.  One cannot get the latter without first understanding the organization’s current level of operational and management sophistication (or lack thereof).  Furthermore, without an alignment of the operational models and the software which is meant to support and improve them, the results will almost always be sub-optimized. 
  • Stage 3 of the QMS model requires a detailed understanding of the external operational interdependencies that could impact any pilot outcome.  So, as a simplistic example, implementing the QMS in Emergency Department triage will only work if one understands that the performance of this function is largely dependent upon upstream and downstream operations.  Thus implementing change to one element of a system should be done within the context of the interdependencies of that element and the rest of the system that might impact its results.  Without at least that acknowledgement, any improvement system risks being seen as ineffective as the interdependencies limit improvement opportunities.  Thus, in some cases, one has to disregard outcomes as one focuses on ensuring that the 10 QSEs are in place, since without those the system won’t improve even in ideal circumstances.  Only when the 10 are in place and functional, and are then spread up- and downstream, can the pilot area see the kind of improvements that are hoped for from the QMS implementation.
Susan Peiffer, Deb Hopen and I recognized the wisdom of Pierce's comments and suggested that some version of Pierce's thoughts should be part of the introductory section of our H/C QMD Tools Monograph 3. Since all of us will be part of Monograph 3 development, I am interested in member thoughts around how best to approach to choosing the tools and how to sequence the use of quality tools in the design and deployment of a QMS within the Healthcare organization. 

What do you think? 
Grace L. Duffy

Re: How best can Quality Management and Healthcare professionals use tools to integrate Quality Management Systems into healthcare organizations?

Posted by Jeremiah Genest on Mar 19, 2019 5:19 pm

Grace

How can I find this monograph? While not in healthcare, maturity models are something we are spending a lot of effort on and I’d live the perspective.

Re: How best can Quality Management and Healthcare professionals use tools to integrate Quality Management Systems into healthcare organizations?

Posted by Joe Wojniak on Mar 20, 2019 10:06 am

Hi Grace- Healthcare organizations and how they work to improve is an area that I'm interested in learning more about.  So, I'm also interested in any drafts of the monograph.  Just some thoughts regarding your question- the healthcare organization is a very interdependent system as Pierce notes.  I think that Kaiser Permanente could be looked at, I believe they use Six Sigma or Lean Six Sigma for improvement but I do not know whether they've implemented a QMS.  This leads me to a personal observation, which is that in some business sectors organizational improvement has been largely separated from the QMS, even though the QMS requires organizational improvement.  If the context of the monograph is initiating organizational improvement, some of the most visible and local improvements can be implemented using Lean methods.  Once small improvements have been demonstrated, these small successes can lead to a growing acceptance from the upstream and downstream operational departments.  Organic change in this way can be very slow, but is necessary.  Once management "buys in" then top-down revolutionary organizational change becomes a possibility.  But, everyone in the organization ultimately needs to support the continuous improvement "atmosphere".  I believe this is being called organizational engagement.  Poudre Valley Healthcare was a Baldrige Award winner a few years ago- their story might help illustrate the topic.  Here's a link to an article- https://www.nist.gov/baldrige/poudre-valley-health-system
Great topic! Love to learn more. -Joe W.
Joe Wojniak ASQ CMQ/OE, CQE

Re: How best can Quality Management and Healthcare professionals use tools to integrate Quality Management Systems into healthcare organizations?

Posted by Grace Duffy on May 22, 2019 1:27 pm

The Monographs 1 and 2 are on the QMD My ASQ site under the documents at the bottom of the Healthcare Quality and Improvement Committee.

Grace
Grace L. Duffy

Re: How best can Quality Management and Healthcare professionals use tools to integrate Quality Management Systems into healthcare organizations?

Posted by Grace Duffy on Aug 24, 2019 10:17 am

The Healthcare Quality and Improvement Committee (HQIC) is working now on Monograph 3 of the Healthcare Quality Management series which focuses on tools that support the implementation of the 10 Quality System Elements (QSEs), plus an introduction to data gathering and analysis relative to the integration of the QSEs as a systemic platform for achieving Best Practice level process performance. The projected delivery date for the joint QMD/HCD HQIC Monograph 3 is December 15, 2019.
Grace L. Duffy