QI Buzz

June 2015Flying bear likes to dive for salmon

Questions to ask about the service quality improvement process

For some great ideas on service quality improvement, we like to revisit an article by Harvey Mackay, nationally syndicated columnist and author of the New York Times #1 bestseller “Swim With The Shark Without Being Eaten Alive”, published in the Arizona Republic in 2004. It contained several important customer service questions that can be used to prompt a service quality improvement process. These are helpful to review routinely with your team.

First, ask the questions, and then be sure to listen carefully to the answers.

  1. What caused complaints today?
  2. What was misunderstood?
  3. What process should we shorten?
  4. What is too complicated?
  5. Where can we cut costs?
  6. What upsets our customers?
  7. Where are we wasting staff time with too many people on a project?
  8. Where do we need to add help?
  9. What materials are we wasting?
  10. Is there a better or more efficient way to do your job?
  11. Do we do anything that doesn’t make sense – or is just plain silly?

Mackay also suggests keeping a suggestion box for shyer team members, since quiet people can have great ideas; you just need to encourage that input.

From Harvey Mackay, AZ Republic, Nov. 26, 2004


May 2015

Why Should I Change? – Engaging Your Practice Team in QI.

You’re excited about improving asthma care, but asking your partners or staff to take on a new project can be a challenge.  Change is hard! You’re using Implementation Science tools like the PDSA cycle to manage process changes, but how do you manage people changes?

Change management, managing the people side of change, also has a set of tools and science behind it. One model, called ADKAR©, gives a great framework for thinking through change. People move through linear stages of change, just like stages of grief. If you’re stuck on one step, addressing the next step won’t be effective. Here are some tips for helping the process along.

  • AAwareness of the need for change. Have you communicated WHY you are asking your colleagues to do this work? Paint the big picture, describe the wonderful goal you are trying to achieve. The most influential person to create awareness is the leader of the business or the practice, followed closely by your employee’s direct supervisor. You can’t over-communicate about WHY you are making the change. If your group is not aware of the reason you are asking them to change, no amount of education or training will make a lasting difference.
  • D Desire to support and participate in the change. Even if your colleagues are aware of the need for change, they will drag their feet until they are ready. This is one of the hardest parts of managing change, but here are a few factors to think about: (1) What the change is, and how it will impact your employee, (2) the organizational context for change – how much change is already going on, what happened as a result of past changes; (3) personal situations such as family stress, upcoming events, or other factors that may impact the decision to change; and (4) intrinsic motivation, whether it is the desire to help others or to avoid negative consequences. The practice leaders will play a role in creating the desire for change, and direct supervisors are also trusted messengers.
  • K – Knowledge of how to change. This is usually the place that people start, but without addressing the first two barriers, teaching and coaching won’t change behavior. Key factors include an individual’s knowledge base and ability to learn, and also resources and time available for training and education.
  • A – Ability to implement required skills and behaviors. Even with knowledge of HOW to change, someone must also be able to use that knowledge successfully. It’s important to dedicate time to develop and practice new skills.
  • R – Reinforcement to sustain the change. How will your organization reinforce the new methods and behaviors? Is there positive reinforcement for the hard work accomplished? Are you watching for “work-arounds” that let people go back to old habits? How will you sustain the changes?

Adapted from Jeffrey Hiatt, ADKAR – A Model for Change in Business, Government and our Community. 2006. For more information about the ADKAR© model, read the book!


May 2015

Brainstorming to plan a PDSA – Asthma Planned Care Visits

Do your patient visits slow down during summer months? Are you interested in bringing in your patients with moderate or severe persistent asthma more frequently? The slower summer months may be a good time to test some changes through the use of PDSA cycles. Before you start sending email reminders or making calls, there are some questions you may want to consider. Convene your QI Team for brainstorming about how to bring in those kids and parents.

For a good brainstorming session, use these ground rules:

  • Gather a group of people who have different roles in the practice
  • Have something to write on – a whiteboard, a big piece of paper on the wall, or regular paper you can pass around
  • VERY BRIEFLY, ask your question – example – ‘We’d like to bring in kids with asthma for prevention visits. How could we do this?’
  • Take 5 minutes for each person to write their ideas on a note card
  • Go around the table, each person throws out one idea without elaboration, keep going until all ideas harvested
  • No comments on ideas until after they are gathered
  • After all ideas are listed, group similar ideas together
  • Allow clarifications, but don’t debate
  • Vote for the top group to determine the topic that you’d like to start with
  • THEN – flesh out the hows and whys

This will help identify topics for PDSA cycles, and also help to anticipate possible barriers you may encounter so you can prepare for them.