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QI Process and Responsible Leadership

Quality improvement (QI) consists of systematic and continuous learning and trials that lead to measurable improvement in specific patient groups within the healthcare organization.  It is important to have effective and strong leadership of healthcare professionals for strengthening quality and integration of care.  When stakes are high in an organization, the ability to organize to create change and implement improvement does not come naturally for people.  Leadership behaviors displayed by front-line management and senior leadership within the organization  become critical to those committed to healthcare quality improvement.  (9 Essential Skills of a Healthcare Quality Improvement Leader: Here are nine critical leadership behaviors exhibited by individuals and organizations committed to healthcare quality improvement (n.d.), 2018)).

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Julie Kliger, MPA, BSN, RN founder and principal of the Altos Group, led a nine-hospital collaborative that reduced sepsis mortality by more than 50%, from her experience she believes that “Moving off of the status quo takes leaders who can inspire others to take action”. (9 Essential Skills of a Healthcare Quality Improvement Leader: Here are nine critical leadership behaviors exhibited by individuals and organizations committed to healthcare quality improvement. (n.d.),2018)).  The expectations for healthcare leaders to take accountability for continuous improvement and gains in quality have risen in recent years.  New leadership roles within healthcare organizations have also emerged, roles such as Chief Quality Officer (CQO) who are responsible for overseeing, implementing and aligning quality initiatives across the healthcare organization (McGrath, P., PhD, Shippy, A. A., MD, & Williams, D. M., PhD. (2018)).

Responsibilities of leaders may vary from organization to organization, however, there are five core drivers for effective leaders. 1.  Developing an infrastructure to Support Quality, ensuring that quality is a component in the organizations strategic plan.  Providing a department to support quality across the organization and provides regular opportunity for reporting. Ensuring that there is and engaged and knowledgeable committee, providing clear roles for Senior leadership in the systems quality efforts and aligning their goals and incentives (McGrath, P., PhD, Shippy, A. A., MD, & Williams, D. M., PhD. (2018)).

2. Create a culture to Enable and Engage Employees, this includes supporting and including the front line staff. Removing the barriers of the people who do the work. Assess, and develop the organizations staff’s knowledge and ability for improvement through learning opportunities for employees at various levels throughout the organization.  (McGrath, P., PhD, Shippy, A. A., MD, & Williams, D. M., PhD. (2018)).

Continuous improvement is key in leading quality across an organization, three final and very important drivers are quality planning, quality improvement and quality control. 3. Plan, define the purpose and values that will create action. Understanding the needs of the customer, identifying and prioritizing strategic opportunities to improve the status quo, and clear learning objectives that can be chartered, sponsored and executed (McGrath, P., PhD, Shippy, A. A., MD, & Williams, D. M., PhD. (2018)). 4. Improving, providing caregivers the tools to solve problems, test change and learn from their trials.  A few basic daily changes can help front-line teams to problem-solve and improve. And finally, 5. Sustaining Improvement, after results have been achieved and the improvements need to be able to be sustainable. Sustaining these improvements requires standardizing the work, creating and sharing the responsibilities to continue the process and committing to using the systems. Unlike forcing compliance, the focus should be on managing the improvements to maintain gains (McGrath, P., PhD, Shippy, A. A., MD, & Williams, D. M., PhD. (2018)).

Quality can mean different things to different stakeholders when it comes to healthcare.  Whether it be the clinical outcome of a patient’s treatment, or the patient experience from a service perspective. Regardless, improving healthcare quality is priority. Todays patients are not only expecting the top technology and treatment but want to be assured that their medical visits are both effective and safe. Healthcare leaders have been adopting the Six Sigma methodology and related change techniques.  Evidence shows that when Six Sigma method is used to improve the patient care experience and process, it removes the need to re-do many tasks, including correcting reporting errors, re-schedule appointments and retrace steps. By removing these do-overs and waste can save the organization money as well as improve the patient experience (Using Six Sigma to Improve Clinical Quality and Outcomes. (2019, January 16)).

Six Sigma uses statistical tools to measure and improve quality, however unlike other initiatives Six Sigma includes data collection.  Six Sigma uses a common language and shared techniques, and requires leadership support, yet it is driven by those employees closest to the process all while supporting and aligning with the organizations vision, strategies and mission (Using Six Sigma to Improve Clinical Quality and Outcomes. (2019, January 16)).

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Another method popular for its methodical approach is Lean.  Eliminating waste while delivering value to customers, or patients in healthcare. Combining Lean and Six Sigma (Lean Six Sigma) allows organizations to increase profit, decrease cost, improve efficiency and effectiveness and develop employees (What is Lean Six Sigma? (2019, April 23).

Lean Six Sigma is completed in five phases: 1. Define; Define the problem, 2. Measure; Quantify the problem 3. Analyze; Identify the cause of the problem 4; Improve; Implement and verify the solution and 5. Control; Maintain the solution. (What is Lean Six Sigma? (2019, April 23)).

Lean Six Sigma increase revenue, reduces cost and frees up resources that can be used for other initiatives within your organization and at the same time it positively impacts employees by increasing their engagement by allowing them in the decision making process of  improving their daily work (What is Lean Six Sigma? (2019, April 23)).

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