Concepts and Models of Quality Improvement
To understand how to apply quality improvement in healthcare settings, we must become familiar with some of the key models and concepts used in the field. The Plan-Do-Study-Act (PDSA) Cycle, Six Sigma, and Lean are among the most widely adopted models for achieving quality improvement.
The Plan-Do-Study-Act (PDSA) Cycle, also known as the Deming Cycle, is a framework that healthcare organizations often utilize for continuous improvement. It is a dynamic four-step model that includes planning the change (Plan), carrying out the change (Do), studying the results (Study), and determining whether the change should be adapted, adopted, or abandoned (Act). For instance, a hospital might use the PDSA cycle to reduce patient wait times by planning a new scheduling system, implementing it on a small scale, studying its impact, and then making necessary adjustments based on the findings.
Six Sigma, originally developed by Motorola, is another model used to enhance quality improvement. Six Sigma aims for near-perfect results, helping reduce process variability and errors. It uses statistical methods to identify and eliminate defects, aiming to improve patient satisfaction and outcomes. For example, in a clinical laboratory setting, Six Sigma could be used to reduce errors in the testing process, ensuring more accurate and reliable test results.
Lean, derived from the Toyota Production System, is a methodology focused on reducing waste and optimizing value to the customer, in this case, the patient. Lean emphasizes understanding what matters most to patients and reshaping processes to provide the maximum value. An ambulatory care clinic might use Lean principles to improve the patient check-in process by identifying and eliminating unnecessary steps, thereby reducing patient wait times and improving the overall patient experience.
Put it into Practice
Application of Lean in a Diagnostic Imaging Setting
Imagine a bustling outpatient diagnostic imaging clinic located in a dense urban area. The clinic has been experiencing increased patient complaints regarding long wait times and a complex check-in process. Despite their best efforts, the staff is often overwhelmed and struggles to keep up with the daily patient flow. Recognizing these challenges, the clinic’s staff decide to implement the Lean methodology to improve the patient experience and streamline operations.
The first step in the Lean journey is to identify what value means from the patient’s perspective. After conducting patient surveys and interviews, the team realizes that patients value quick, smooth check-in processes and minimal waiting times. They also uncover that patients prefer clear communication about any delays or changes.
Next, the clinic team maps the current patient journey, from appointment scheduling to discharge. They notice several non-value-adding processes and redundancies. For instance, patients fill out paper forms with the same information they’ve already provided during the appointment scheduling over the phone. Additionally, there is considerable downtime between different stages of patient care, leading to longer overall visit times.
The team then works on eliminating these wastes and streamlining the process. They introduce an online pre-appointment system where patients can fill out their forms electronically before the visit, reducing the time spent at the front desk. They also improve the coordination between different staff members to reduce downtime between stages. For example, a MRT is now immediately notified when a patient finishes their paperwork, and an examination room is prepped in advance based on the appointment schedule.
Furthermore, the clinic introduces a transparent communication system to keep patients informed about delays and changes in their appointment schedule, thereby effectively managing patient expectations.
Over time, the clinic begins to notice improvements. Patient complaints about wait times decrease, staff stress levels are lower, and patient throughput has increased without compromising the quality of care. The Lean methodology has empowered the clinic to improve its processes, enhancing both patient satisfaction and operational efficiency.
Each of these models — PDSA Cycle, Six Sigma, and Lean — provides a distinct but complementary approach to quality improvement in healthcare. Though the methods may differ, they all share a common aim: to improve the efficiency and effectiveness of healthcare services, leading to better patient outcomes and increased satisfaction. By understanding and applying these models, healthcare organizations can continually enhance their performance and quality of care.
