One mistake that kills healthcare improvement projects
With mounting pressures to improve healthcare quality and cost outcomes, many improvement projects fail to achieve the desired results – simply because many administrators and clinicians make a mistake of jumping to solution before taking the time to understand the problem. The short-term costs of these failed efforts are significant, both in wasted time and resources. Worse yet, future efforts will likely be met with staff disengagement and resistance to change.
What can you do to be more successful in making improvements that produce measurable and sustainable results?
Use data to examine the problem
Start with answering a few key questions:
Is the problem new, chronic or recurrent?
What is its impact on overall quality and financial performance?
Is the problem isolated to a service line, a hospital unit or specific providers?
Is the problem linked to a specific patient population based on their age, payer, diagnosis, severity of illness or discharge disposition?
Is the problem impacted by admission/discharge month, day of the week or time of the day?
The answers will point you towards more targeted actions. For example, upon analyzing your length of stay (LOS) data, you may discover that:
LOS has been the highest in a month of December for the last 5 years. This is a normal seasonal variation.
Action: Keep monitoring and do nothing, as hard as it might be for us, action-oriented folks.
LOS is the highest for patients discharged on Mondays.
Action: Review weekend staffing and workflow of your case management and hospitalist teams and make changes, if necessary.
LOS is higher than expected for SNF patients.
Action: Review and, if needed, redesign processes for early identification and transfer of SNF discharges.
LOS is higher than expected for heart failure patients.
Action: Review current heart failure management approach with your hospitalists and cardiologists. They are also your source of truth regarding barriers to timely discharges of heart failure patients.
Ask, listen and observe
Data analysis is a powerful tool for understanding a problem. But never underestimate the power of simple conversations and observation. Go to the people impacted by the problem – patients, hospital staff, physicians. Ask them questions, observe them in action. They are the experts. They will validate results of your data analysis, deepen your understanding of the problem and help generate solutions. You will gain their trust and respect, which you will need when the time comes to develop and implement solutions.
Prioritize solutions
As we often find in healthcare, complex problems, like length of stay or readmissions, have more than one underlying cause and will require more than one solution to see measurable impact. You must prioritize solutions based on their potential impact and ease of implementation.
Stay tuned for my next blog post, where I discuss how to develop and implement effective solutions.
In the meantime, share any additional comments or insights on this blog in the comments section or offer your suggestions for future blog topics.
