Perhaps you are just starting a quality improvement program or project. You may have several improvement projects successfully completed on your healthcare site. Regardless of your level of experience, you are confronted with or come across an individual or small group of people who do not want to participate in your quality improvement efforts. In fact, they are obstacles to your efforts. What do you do? Ignoring them or doing nothing will ultimately jeopardize your quality. Let me share some ideas on what to do based on my own experience and expert advice.
Before sharing some strategies, I will give an example based on my own experience. A primary care team with six doctors specializing in family practice and internal medicine focuses on improving the process and caring for patients for six months. They have maintained a Lean healthcare consultant to help them consult and learn from time to time. The consultant keeps them focused on standard procedures, the processes of adding additives and eliminating waste and on continuous improvement, all of which focus on the results of patient treatment. They decide to investigate whether they should have their patients, who come to work with exercise, have done their blood work a week before their scheduled appointment. An office manager asks some doctors, nurses, and office staff to gather for a few one-hour meetings before the practice opens for patients in the morning. The goal of this volunteer team is to evaluate the pros and cons of doing the blood work to physical and, if so, to develop a standard operating procedure (SOP) for its implementation. Some of the pros and cons:
· Doctors will be able to discuss with patient indicators, such as triglyceride levels outside the normal range, therefore changes in lifestyle can be suggested.
· Patients who are focused on improving their health can discuss the results with their doctor.
· Some patients may find inconvenience in the laboratory before visiting, especially if the laboratory is located in the same building or near a group practice site.
In general, the team decides that they will pilot this approach with two doctors. SOP is developed with the participation of staff who schedule meetings, nursing assistants and doctors. Indicators of outcomes are developed and monitored in terms of the patients' health, as well as the attitudes of doctors and staff.
The results of this pilot are positive, and the office manager decides to implement changes for the entire office. She discusses the procedures with the rest of the staff and doctors and creates a chart for her use and her staff. compliance with the norm of compliance with the new procedure. After a couple of months, she discovers that there is no progress in improving compliance with the procedure. In further investigations, she discovers that one of the planners and the nurse's assistant do not consistently perform their procedures. She tells them about it, and after a couple of months they still do not carry out their procedures. What should she do?
According to the recent Lifewings newsletter, quality improvement groups for healthcare, Steve Harden said that about 8% of the employees of groups that start quality improvement projects on their website will not participate or will actively block projects. In the newsletter, he advises management to have a plan to address these 8%. Life coaches receive a verbal commitment from management that they will actively engage those who are blocking projects, talking to them and trying to get them to join in the effort to improve. Some will agree, but still will not change. Some will not even agree. Mr. Harden suggests that managers ask these employees to find another place to work. In addition, he says that he celebrates the achievements of those who have helped improve patient outcomes through process improvement projects.
Another Health Care Improvement Assistant, Jim Champi, author Health care reengineering, a manifesto for a radical rethinking of medical care who works for Dell Services, suggests that managers can engage employees in quality improvement projects, first involving those who are enthusiastic and sharing their project successes with their colleagues. He says that often young doctors want to participate, and then can share the results with their colleagues. Sometimes senior doctors do not listen to young doctors; he suggests that an experienced senior physician lead the way.
Jim Zawacki, coauthor This is not magic, the revival of a small manufacturing company , suggests a different approach. In his book, which describes the efforts to improve the quality of Lean in his company, GR Spring and Stamping, he describes how a team of managers and front-line employees encountered those who did not join others as they began the cultural transformation necessary success of the lean process improvement program. After the Lean program was well established, the team decided that management would have to ask those who did not want to change in order to leave the company. Mr. Zawacki, as CEO, made sure that this happened.
If you are just starting an effort to improve quality on your site, you should be faced with dealing with those who do not join it. Sometimes they sabotage most of your efforts and have a negative impact on those employees involved. Management must have a plan on how to consistently deal with recalcitrant personnel, including asking for other work. Do not let the rotten apple spoil the barrel!
