“Quality is Job 1” is a well-known slogan from back in the day of Ford. Aristotle said, “Quality is not an act, it is a habit.” And John Ruskin was quotes as saying, “Quality is never an accident. It is always the result of intelligent effort.” Obviously, quality is a deeply ingrained idea that transcends a single industry. When considering how much time, effort and resources go into quality improvement in the healthcare industry, you might begin to see and feel the dilemma that face many who are not just promoting but working to make a culture structure within their organizations.
Industry standards are established as a means of understanding the minimum that is expected. Some standards are regulated by the government or other authority figure in order to maintain that minimum threshold and have something from which to measure against. The minimum isn’t about quality, it is about getting by, and this isn’t sufficient for more and more within the healthcare system. In fact, exceeding standards, becoming highest in quality within a community or even across the nation is closer to what organizations are striving for.
But, one does not simply achieve a high quality of standards. Quality improvements are attained after much analysis of the system as a whole and a discerning of problematic areas by way of the data that the organization is collecting. Information that is contained in events like:
- Length of stay
- Emergency department visits
- Follow-up visits with personal physician
When tackling the quality improvements, one of the unfortunate first steps that many organizations and decision-makers take is to blame the people working within the system instead of at the system the professionals are working within. People are usually at fault, is the general rule of thumb, however when analyzing much deeper than surface issues, this is not usually the case. This rush to judgment causes a lot of internal strife that could easily be avoided. Obviously, there are going to be mistakes that are made, but are the mistakes due to the established rules and protocols rather than just unfortunate mishaps?
Along those same lines, many processes are extremely complex or get in the way of fundamental procedures. Extra steps that have to be taken because the organization demands it, but they aren’t necessary, helpful or promote quality improvement; they just happen to have been around forever, or were marketed at some previous point. In many cases, these problematic situations have been brought to the attention of management and others, but were never really addressed. There are many reasons and excuses why problems aren’t confronted and dealt with, but these cultures and ways of doing things must change in order to bring in better quality and better outcomes of patients and procedures.
There are times when management uses the same justification that many parents do: just because I said so. Weeding out old habits and practices is much easier said than done. Firstly, identifying when management is creating its own stumbling blocks requires the ability to accept that management isn’t always right. This comes much easier and across better when the problems are identified through analytics. Data-driven decisions and discoveries back up where issues are happening instead of departments or managers feeling like they are being singled out without reason. No one wants to be the root of a challenge, especially in the healthcare industry where people’s lives are on the line. But, when logic and understanding are presented and no fingers are pointed, solutions and remedies are easier to see and implement.
In any service-based environment, the need for routine is foundational for repeated success. However, the same is true with faults in routines: are steps more important than safety? If undo harm is happening to patients under the guise of procedural bureaucracy, no benefit or improvement will ever come about. People are the highest priority and their safety and well-being are of the upmost concern. When the system is failing to guard health and heart, breaking down the barriers of routine to root out the problem should be made a priority.
Implementing changes, no matter how minute, can always cause its own set of problems. None of it should be taken lightly because every critical step can either be an answer or furthering the predicament, and for illumination to which way the scale is tipping, it is necessary to keep in mind a few concepts. Change isn’t usually reflected immediately within a system. A patience game helps to let the dust settle and manifest if quality improvements are being reflected. Yet, patience is the last thing that some decision-makers have. By measuring successes and comparing data to previously recorded numbers, whatever minor tweaks that need to be executed can be done so in a more controlled environment.
Additionally, enthusiastic leaders want to jump in with both feet to confront as many problems as possible in the soonest amount of time possible. An overabundance of change can lead to a large turnover of staff and can also mask where successful ventures are happening and where failure is occurring. Too much of a good thing truly can be bad for an organization. This is why many facilities won’t implement changes across the board, even if it is a single alteration, but will choose a department or area that struggles the most and work to transform on a smaller scale. Furthermore, it is possible to work out obscure issues to better apply these changes later on down the road. This can act as a motivational tool to bring others on board rather than forcing adjustments upon people.
Change and improvement isn’t a one and done sort of ideal. Things evolve over time, whether it be demands, regulations or technology, which then influence the established norm. The necessity to measure and account for slipping quality should always be on the mind. This shouldn’t be seen as the constant burden, but ongoing opportunity to serve better and be a stronger influence within the community.
Quality improvement shouldn’t be a slogan without true action behind it. The healthcare industry is under great scrutiny every day and with great personal expense on the line. There is a balance in providing the best care possible, implementing changes and moderating those changes. None of this is easy, it isn’t without its complexities and there isn’t a playbook that every organization can follow due to the fact that every community has its different needs and nuances. But it is all possible to bring about improvements and positive outcomes in healthcare.