The Level of Healthcare in The Virginia Mason Medical Center - Essay Example

? Deming’s 14 Point Program: Quality Outcomes in Today’s Health Care Environment Deming’s 14 Point Program: Quality Outcomes in Today’s Health Care Environment Introduction The Institute of Medicine, in the report named Crossing the Quality Chasm by Corrigan has identified six specific aims for improvement in the healthcare field. According to the report, healthcare environment should be safe, effective, patient-centered, timely, and efficient (Crossing the Quality Chasm). Admittedly, the efforts by healthcare organizations to improve quality seem well in accordance with the fourteen point program suggested by Deming. This work intends to look into the present day practices in healthcare environment and how they reflect the suggestions made by Deming. Going Lean in Healthcare- The Virginia Mason Medical Center The Lean Health from the Institute for Healthcare Improvement has its innovation series number 7 of 2005 named Going Lean in Healthcare (2005) in order to present ideas to improve quality. The lean management is based on the concept of determining the value of any given process by separating value added steps from non-value added steps, and eliminating waste so that every step adds value to the process. So, it becomes necessary for the leaders in a healthcare organization to evaluate processes by accurately specifying the value desired by the user; recognizing each step in the process and eliminating non-value added steps; and making value flow from the beginning to the end based on the needs of the patient (Going Lean in HealthCare). An example is the Virginia Mason Medical Center. It is estimated that through the adoption of Lean principles, the Virginia Mason Medical Center has saved nearly $ 10 million by creating more capacity in the existing programs. The Virginia Mason Medical Center, in order to introduce the program, conducts an Introduction to Lean course which is followed by Rapid Process Improvement Weeks. These Rapid Process Improvement Weeks are meant to analyze the existing system, propose changes, test the suggestion, and implement the useful ones. Admittedly, these steps are well in line with the sixth and fourteenth points as suggested by Deming (2000). These steps help in creating a culture that is helpful to accomplish the transformation. Also, it is a way for providing the restructure training. Through the Improvement Week participation, the members get adequate knowledge about the Improvement Plan. Also, such Rapid Process Improvement Weeks are in sync with the 5th point as suggested by Deming. It is pointed out by Deming that organization should try to improve continuously. These steps first ensure proper participation and training of each member of the organization. Secondly, they remove fear as each member gets the chance to become a part of the Improvement Plan and also to know more about the plan. It is found that there is significant improvement in everything ranging from setup time, product distance, lead time, productivity, and inventory when the plan is implemented at the Virginia Mason Medical Center. From the case of Virginia Mason Medical Center, it becomes evident that the changes should come from the leadership. It is pointed out in the whitepaper that introducing quality improvement should be a whole-system strategy. Also, it should be led by those who are at the top of the organization. It is pointed out that a top management team that is aligned in its vision is necessary for going lean. Evidently, this point runs parallel to the first point as suggested by Deming. He points out that the top management should create constancy of purpose. This includes defining the specific standards of service, and adhering to the purpose. Another important factor is the development of a lean culture that promotes quality. It is pointed out that instead of function silos, there should be interdisciplinary teams which include physicians, non-physicians and other staff. Here one has to remember the 9th point of Deming that class distinctions should be removed in order to drive out fear. The multidisciplinary teams help reduce fear, improve communication and enhance the feeling of self worth. Another important point is the role of managers. The Virginia Mason Medical Center makes evident in its Improvement Plan that the managers should, instead of simply directing he subordinates, teach and help subordinates in functioning effectively by removing barriers. And another important aspect of going lean is to continuously strive to reach the ultimate performance which is the total elimination of waste. Yet another important point is the way problems are handled. Instead of blaming people, the Lean culture looks into the reason behind the issue and then tries to remove the reason. In the Virginia Mason Medical Center, the process starts from the Board of Directors that called for a change and adopted the new strategic plan. At first, the medical center developed a strategic plan that was well prepared both in words and in graphic form. The graphic form is a pyramid with the patient at the top. The patient-focused vision, mission and values are supported by the four pillars of people, quality, service, and innovation. The term ‘people’ indicates the recruitment and retention of the best people in the industry. Similarly, ‘quality’ indicates relentlessly ensuring the highest quality of care. The term ‘service’ means offering extraordinary patient service. Lastly, adequate attention is paid to creating a culture of innovation. The second important stage is defining the roles and expectations in explicit terms. As a part of this, expectations, responsibilities, and accountabilities are clearly defined. Thus, everyone gets sufficient knowledge about what they are supposed to do for the success of the plan. Also, they come to know in clear terms as to what they can expect from the organization in return. Based on the lean system, the medical center introduced its own production system that has six areas of focus. The first and foremost area of focus is the patient itself. The second area of focus is the creation of an environment that looks safe so that people feel free to participate in improvement. An important strategy in this connection is the no-layoff policy. The third focus is on the implementation of a company-wide defect alert system called ‘The Patient Safety Alert System’. The fourth area of focus is promoting innovation through ‘trystorming’ (quickly trying new ideas) and the fifth one is the creation of an organization without waste. The last point of consideration is the creation of an accountable leadership. Here, the benefit of the no-layoff policy is that the employees do not feel the need to improve themselves out of a job. This will increase commitment and engagement. One has to remember the fact that this seems in accordance with the suggestion by Deming that organizations should try to remove fear from the employees. Also, the Patient Safety Alert System is a strategy in which anyone can, and must, stop a process if they find something wrong in the process. The Patient Safety Department will look into the issue and will conduct a root-cause analysis. Here, one has to remember the suggestion by Deming that all the barriers that prevent the staff from functioning effectively should be removed. ThedaCare Inc. and Improvement Plan Very similar is the story of the improvement plan at ThedaCare Inc., a Wisconsin based organization. Here too, the management adopted its new Lean goals and metrics. Then it presented the same graphically for its staff. It is a triangle that represents quality, employee engagement, and business. Quality target set is to ensure more than 95% world-class clinical and service quality, and employee engagement target is to become one among the Fortune 100 best companies. Business aims to gain $ 10 million in profits. Thereafter, the staff members engage in process improvement efforts called the Event Weeks which are intended to develop the ThedaCare Improvement System. The system is based on three essential tenets; respect for people, teaching through experience, and focus on world-class performance. In the next stage, each of the tenets is made clear to the employees in explicit terms. To illustrate, the term ‘respect for people’ means a lot of things in practice. They are error-free practice, timely service, no waste, no-layoff policy, and working together to improve performance. It also means avoiding things like long wait times, non-value added work, wasted time, wasted materials, and focus on tasks instead of patient outcomes. The ThedaCare Improvement System has set three specific goals. They are improving staff morale, improving quality, and improving productivity. As a result, the organization saved nearly # 3.3 million in the year 2004. Also it is found that the physician triage times are reduced by 35% and phone triage abandonment rates are reduced by 48%. In addition, there is a 50% reduction in admission paperwork times. Here it becomes evident that employee morale and satisfaction have a significant role in improving patient safety at workplace and also that safety at workplace can promote employee satisfaction. Safety and Quality Admittedly, the very first point of improvement as found by IOM is safety. The report named To Err is Human by Kohn, Corrigan & Donaldson (2000) of Institute of Medicine, a few years earlier, revealed that the number of people who lose lives as a result of medical errors in a year is somewhere between 44,000 and 98,000. Recently, healthcare environment has become more aware about the situation and has started various measures ranging from six sigma philosophy and continuous improvement in the effort to increase safety. In the article named Creating a safe and high quality healthcare environment, Stone Hughes and Dailey (n.d.) point out that there are a number of safety climate scales which are developed in the field of occupational health and patient safety. The attributes of such a safe climate include chances for safe work practices, availability of personal protective equipment, minimal conflict, cleanliness of work site, proper communication, and proper feedback on performance (Stone, et al). In fact, the Agency for Healthcare Research and Quality (AHRQ) has emphasized the relation between organizational climate and worker and patient outcomes. When a systematic review of the various studies into the effect or organizational climate on worker and patient outcome, it was found that they all are linked positively. Admittedly, the Agency for Healthcare Research and Quality has identified various enabling factors that can lead to effective microclimates for safety. The enabling factors are leadership, technologies, communication and financial resources. When these enabling factors are available to employees, there will be better management of workload followed by proper collaboration and occupational safety. When these microclimates are created, the employees will be able to improve their actions. To illustrate, there will be more chances to adhere to safety practices like hand washing and providing evidence based care. Such employee actions have an impact on patient actions. When they observe that the employees are cooperative and careful, the patients offer adherence and collaboration in return. This results in employee outcomes of job satisfaction, reduced stress, and occupational health. In the case of patients, the presence of enabling factors results in patient-centered care and evidence based care. This results in reduced healthcare-acquired infections. The outcome of all these will be reduced cost of care, better employee retention and increased reputation. The book What works: effective tools and case studies to improve clinical office practices by Houck (2004) looks into what the Primary Care Partners do to improve quality. It is reported by the Primary Care Partners that the very first element of sustaining improvement is the regular doctor meetings which are usually conducted every week. In addition, it is revealed that the management is highly supportive financially when it comes to practice improvement efforts. Thus, one immediately recalls the Deming opinion that the change should initiate from the top management. Secondly, when the tracking of results or outcomes is considered, it is reported that the setting presently monitors nearly a dozen factors ranging from patient satisfaction, staff satisfaction, doctor satisfaction, blood pressure, HbA1C, Aspirin, ACE inhibitor for CHF, HDL cholesterol, LDL cholesterol, tobacco use, and all possible financial situations. In addition, there is regular measurement of patient satisfaction along with suggestion boxes for staff along with production based compensation for the physicians. Veteran Affairs and Quality Evidently, VA is concerned about quality, access, satisfaction, function, community health and cost effectiveness as the main value domains. In order to improve quality, it takes such measures as prevention index and palliative care. Also, in order to ensure better access, it has taken steps like introducing technology that helps in reduced wait time and hassle-free scheduling. Also, to ensure patient satisfaction, there is Picker-based satisfaction survey. In addition, there is the Survey of Health Experiences of Patients. Also, in order to make appointments more effective, there is the adoption of Computerized Patient Record System (CPRS) that provides a comprehensive history of the patient immediately on selection. This helps in analyzing the current status before ordering new interventions. There are some other tools that help in effective handling of outpatients. To illustrate, there is the CPRS notification system that alerts clinicians about abnormal test results automatically. Also, it offers computerized provider order entry that leads to lesser possibility of ordering wrong drugs and prescription errors. Admittedly, VA offers an admirable array of services in measuring and improving quality in mental health and substance abuse. Some advantages of VA over and above other competitors in the field are better infrastructure, better integration of care, electronic medical records, and better data about treatment. Yet another important factor that is taken into consideration is the wait time for evidence based services. It becomes evident that 88% of the facilities offer medication evaluation/management within a period of two weeks. Similar is the case of most other services like MHICM, Supported employment and psychosocial interventions. In addition, one can see a new patient food service that allows the patients to select the kind and time of food they want. Conclusion In total, it becomes evident that the healthcare environment is trying to improve quality. Also, the efforts are sensitive to patient satisfaction and safety. The steps are taken well in accordance with the points suggested by Deming. The management adopts the policy first, then the employees are introduced to the policy through proper training, and then the policy is implemented with proper participation of all the stakeholders. References Corrigan, J. M. Crossing the Quality Chasm. Committee on the Quality of Health Care in America. Retrieved from http://www.mhsip.org/mhstatpres/janetcorrigan.pdf Deming, W. E. (2000). Out of the crisis. Massachusetts: MIT Press. Going Lean in Health Care. (2005). IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement. Retrieved from www.IHI.org Houck, S. (2004). What works: effective tools and case studies to improve clinical office practices. Colorado, USA: HealthPress Publishing. Kohn, L. T., Corrigan, J. M & Donaldson, M. S. (2000). To Err is Human: building a safer health system. Institute of Medicine. Retrieved from http://www.csen.com/err.pdf Stone, P. W. Hughes, R & Dailey, M. Creating a safe and high quality healthcare environment. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Retrieved from http://www.ahrq.gov/qual/nurseshdbk/docs/StoneP_CSHQHCE.pdf Stetler, C. B., Mittman, B. S & Francis, J. (2008). Overview of the VA Quality Enhancement Research Initiative and QUERI theme articles. Implementation Science. 3:8. Read More