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Improvement Ideas
Leadership begins with ideas. This
new section of the website is designed to house an ever-growing
list of good, practical ideas for improvement of quality
and safety, as a resource for all those working hard to make
care safer. Although the list is hardly exhaustive, it focuses
on those ideas that might be particularly relevant to people
in leadership positions.
- Idea
One: Eliminate the Denominator (PDF
Version)
Most “Quality Dashboards” contain data on rates
of hospital-acquired infections, adverse drug events, falls,
and other harm events e.g. “central line infections
per 1000 line hours” or “falls per 1000 bed days
.” Typically, these rates are shown alongside some
sort of benchmark rate for that indicator, usually established
by analyzing the rates for comparable hospitals, and then
displayed as the 50th, 75th, or 90th percentile. It’s
not uncommon for the dashboard to display any rate better
than the 50th or 75th percentile as “Green.” Expressing
data as rates, with benchmarks, allows the quality staff
and executive team to answer a question commonly asked by
Boards: “How are we doing compared to other hospitals
like ours?” Knowing how you’re doing compared
to other hospitals isn’t a bad thing. (Read
More...)
- Idea
Two: Give a Pop Quiz (PDF
Version)
Leaders exert much of their influence by how well
they channel attention—first for themselves, and
then for the organization. As a general rule, what the
most
senior leaders are paying attention to gets the attention
of everyone else. So if most of the air time at senior
leadership meetings is going to reviews of budget performance,
you can be pretty sure that managers throughout the system
will be watching their budgets closely.
So, when the senior leadership team returns from a planning
retreat having adopted a new set of strategic goals, with
a major emphasis on quality and safety, everyone will be
watching to see whether the executives really start paying
attention to this new priority, or whether they are just
paying lip service to quality. One way to dramatize the
need for a new level of attention to quality is to give
your senior leadership team a “pop quiz” in
which you find out what in fact is top of mind for each
of them. Without warning, give each executive a single
piece of paper with each of the categories of strategic
goals listed in the first column. The next column should
be headed “Most Recent Month’s Result” and
the third column “Goal for this Year.” Ask
them to fill in as many actual numbers, by memory, as they
can, without talking to each other, or consulting their
Blackberries. (Read
More...)
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Idea
Three: Put a Face on the Problem, Starting at the Board (PDF
Version)
Patient stories, especially stories about harm,
are a powerful way to engage the hearts of Trustees
in
quality and safety
issues. An emerging “best practice” for
Boards is to hear the stories of patients and families
on a regular
basis, perhaps at every meeting. This primer is intended
as a practical guide to Boards on how to bring patient
stories into their regular agendas. Four methods of
bringing patient stories forward are summarized, beginning
with
the easiest and least controversial, and progressing
to more difficult, but perhaps more powerful methods.
(Read
More...)
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