The Quality Improvement Challenge. Richard J. Banchs

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Senior lab tech a.m. shift Efram, N ER ER clerk Gild, R ER ER nurse Goldsmith, H ER ER nurse Goldstein, S ER ER physician Hussain, H ER ER clerk Kundenman, B Laboratory Lab tech Libra, F ER ER physician Manheim, N ER ER nurse Monroe, J ER ER medical director Opostini, C Laboratory Senior lab tech p.m. shift Smith, A Pathology Director of Pathology Vitorini, K ER ER physician Woldenbaum, B Laboratory Shift supervisor

      REVIEW QUIZ

      1 A team leader should be chosen on the basis of all the following characteristics EXCEPTgood process knowledge,respected by the front line professionals,excellent interpersonal and communication skills,leadership position in the organization, orgood facilitator.

      2 All of the following characterize a group of people performing as a team EXCEPTcomplementary skills,common purpose,focus on individual goal achievement,mutual accountability, orcommon approach.

      3 Regarding the composition of a QI teamfront‐line professionals need to have the largest representation.the ideal team size is 4–8 members.it is important to have team members that bring subject‐matter expertise.it is important for the team to have a mix of skills.all of the above.

      4 Team members should be preferentially selected on the basis of all the following characteristics EXCEPTbring process knowledge,have a high‐ranking leadership position in the organization,have technical expertise,have problem‐solving skills, orhave great interpersonal skills.

      5 A team leader’s role is to facilitate the team’s success in achieving the project’s goals.TrueFalse

      6 The formation of high‐performing QI teams in healthcare is made more difficult byclinical silos,prioritization of patient care,resource constraints,conservative culture, orall of the above

      7 What is the role of the QI team during an improvement project?share findings and communicate through all project phases.provide message content for written communication to senior leaders.provide material and audiovisual support for meetings and presentations.provide or facilitate coaching and training of the front line.all of the above

      Key: 1d, 2c, 3e, 4d, 5a, 6e, 7e.

       Exercise key: While the problem affects the ER and the professionals working in the ER, the root of the problem for a long turnover time of routine samples is in the lab. In this example, team members should be chosen preferentially for their subject‐matter expertise: processing samples. ER staff and providers are the customers of the process; lab personnel are the stakeholders. Given these roles, your QI team should include a majority of lab personnel, who are the stakeholders with the best process knowledge. The stakeholders do the work and therefore have the expertise. Chose a majority of front line workers and some supervisors. A customer (ER staff or provider) can also be a member of the QI team helping team members have a better perspective of “what the customer needs.”

      1 1. Bossidy R. (2002). Execution: The Discipline of Getting Things Done. Random House.

      2 2. Heifetz R. (2002). Leadership on the Line: Staying Alive through the Dangers of Leading. Harvard Business Review Press.

      3 3. Katzenbach R. (1993). The Discipline of Teams. Harvard Business Review Press.

PART IV THE THIRD “R”: THE RIGHT PROBLEM

      YOU NEED TO KNOW YOUR PROJECT’S SCOPE AND BOUNDARIES

      What process does the problem relate to? What is the target of the improvement? Where does work begin and end? The process boundaries clearly define the extent of the project scope and serve as an effective way for making decisions about the project activities. The project scope establishes the limits of the project work, defines the inclusions and exclusions, and helps define the expected outcomes of the QI project.

      The easiest way for all key stakeholders to agree with the scope and boundaries of your project is to show the beginning and the end of the process that is going to be targeted for improvement. This can be done well with a high‐level process diagram, such as the SIPOC diagram.

      What Is a SIPOC Diagram?

       The SIPOC diagram shows a process snapshot and captures all the key activities and relevant elements in a process in order to help define the scope and boundaries of a project.

      The SIPOC diagram

       provides an easy way to visualize the process in its entirety;

       presents the process in 4–6 high‐level steps;

       visually documents the relationship between suppliers, inputs, outputs, and customers; and

       clearly identifies the start and end of the process.

      It is critical to understand the start and end of a process because they impact the stakeholders, the criteria used to select who should be involved in the improvement team, and the scope of the project.

      Advantages of the SIPOC Diagram

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