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...)

  • 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...)