At the Heart of Health Care – Part II

July 30, 2012

By Cathy O’Neill, Director of Quality and Patient Safety, Quinte Health Care

Last week in Part I, I outlined the importance of creating a Pull system for patients to recieve the right care at the right time in the right location as well as the importance of embracing failure as a key component of learning.  This week I want to outline the learnings for developing solutions to the problems and how to sustain efforts beyond a project status.

  • Building systems that work for health care providers and not against requires a fundamental shift in how we develop solutions. Historically when an adverse event has occurred we have developed solutions that tend to focus on education and policy changes, implemented these changes and hoped that a similar event would not occur again. This approach is flawed from the very start as it does not include the vital step of peeling away the layers to uncover the root causes that led to the event. The very fact that we have harmed a patient creates a warranted sense of urgency to fix the systems and processes that failed us. What is not reasonable though is to implement solutions that are not based on the true causes of failure, thereby increasing the likelihood that they will fail again and lead to further patient harm. The Tatham Method incorporates the unique and valuable concept of experimentation which forces you to uncover the authentic causes for failure and apply that knowledge to the re-creation of your system/process. My experience has been that by applying this method we are starting to see fewer solutions focused on education and policy and more that result in the creation of robust and failure proof systems.
  • Quality and performance improvement in healthcare is a continuous journey. The shear complexity of health care contributes to the never ending list of issues to be addressed. It is a daunting task to look at that list and decide where to start, where to direct your limited resources and make a difference. Organizations that are successful in quality and performance improvement have embraced being on an ever evolving journey, set goals and objectives that are focused and attainable, have actively engaged staff in achieving the desired results and allowed for a more organic versus prescribed approach to improvement that yields far more satisfying and sustainable change. The Tatham Method compliments this approach as it incorporates the need to take advantage of quick wins that already exist, such as what frustrates staff on a daily basis, develops confidence in staff by bringing their voice to the table and forces outside the box thinking versus a cookie cutter approach to improvement. It also fosters your ability to be patient with the process and to let it take the necessary course to reach the optimum and desired state. This has been immensely useful to my organization as we embark on the creation of a quality improvement methodology specific to our hospital which we are dedicated to ensuring is built from the ground up and evolves with us as we mature. The Boot Camp experience provides the ability to see and feel the impact of these concepts and undoubtedly have you starting a different conversation about organizational improvement when you return to your hospital.

At the end of our meeting about mislabelled blood specimens I was more confident than I had been at the start that we were heading down the right path for improvement. We were now focused on the right questions and approach to uncover the authentic causes for failure, frontline staff who work with the process were going to be engaged and we were no longer talking about solutions. I was once again reminded that quality improvement takes patience, perseverance and time. My experience at Boot Camp instilled in me this foundational grounding that I now impart everywhere I sit.

It is certain that healthcare will continue to become more complex and challenging for those who work within it and those who access the services it provides. Therefore we need to ensure that the most resilient systems are in place and built on a) the fundamental understanding of previous failures b) the notion of pulling versus pushing c) active engagement of staff and d) the organic development of solutions and process. In response to these known challenges I would encourage anyone in healthcare who is frustrated with fixing the same issues over and over again and/or responsible for systems of care from either a provisional or operational perspective to experience Boot Camp and thus the Tatham Method.  You will find this to be a refreshing experience that challenges the status quo yet provides an intuitive and practical approach to improving your systems of care and achieving positive and lasting results.

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