One of the most common tools used to measure quality improvement wherever
services are offered is the survey. It has many good applications if it is well designed
and can provide a lot of information if it is properly analyzed.

When and why should you use surveys? Of course one of the most frequent uses is
with patients and clients. In fact, Medicare is beginning the H-CAHPS survey of
hospitals to find patients’ views on many different facets of their service. The survey
is voluntary and results will be posted online in 2007. It is becoming a necessity for
physicians and healthcare professionals to find out what their patients think as
more and more information about care from insurance providers and other sources
is being posted online.

The employees of any healthcare facility should be surveyed too. They should, after
all, be considered clients. Since they provide many different services and are the
front line connection to patients, their input about their work environment and
satisfaction with it are to be taken seriously. You should not just be surveying
doctors and nurses, but also maintenance, administrative, and all other groups at
your site.

What are some of the basic ideas you should keep in mind when designing a survey?

1. The best questions are the anchored endpoint type. One end would be “very
satisfied” and the other “very dissatisfied” or something similar, with a 7 or 10 point
scale from one end to the other. The five point scale is too short. It doesn’t provide
enough variance.

2. You may ask a few yes and no or gather demographic data, as age.

3. Limit yourself to one open-ended question. They are too hard to provide
statistically significant data.

4. When writing the questions, work with a team of representatives of the people
who will be surveyed. This helps avoid bias and makes sure you have good
questions.

5. Be sure to choose a random sample to survey. It is better to survey 30 or 40
randomly chosen patients or clients whom you interview or have fill out a survey
while in the office rather than getting more surveys by subjects who return mailed
surveys or volunteer in some other fashion. Voluntary surveys are basically
worthless from a statistical point of view.

Once you have collected your surveys, it is time for analysis. For simple analysis, I
suggest using Microsoft’s Excel. It has some dynamite graphics. Too, you need to
get the mean and standard deviation of each question where appropriate.
Remember, you want your mean to be as good as possible with low standard
deviation. If you want some more insight and powers of prediction of what action
you should take based upon the survey, I suggest you employ someone who is
trained in statistical analysis or a statistician. The return on the investment of a
professional analyst should easily exceed the expense.

Summarily, surveys are a valuable instrument in finding out the opinions of your
patients and employees. Care should be taken in designing the instrument to insure
there is no bias and that there is randomness in conducting the survey. Investment
in professional analysis is well worth it. The result will be healthier patients who are
more loyal, a definite financial plus.

Donald Bryant helps healthcare providers meet their challenges and writes
“Making Good Healthcare Better” a free monthly ezine for healthcare
providers who want to dramatically improve patient health, improve the
bottom line, and make work more rewarding, guaranteed. Go now to
http://www.bryantsstatisticalconsulting.com to get a free article with tips you can
use to start making improvements immediately and to learn more about Lean Healthcare

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Last month I talked about keeping your quality improvement changes in place
using a manual that you develop of SOP’s, standard operating procedures. By the
way, if you missed that issue, you can find it on my website, and several earlier ones
too.

This month I want to address starting a quality improvement project. That is, how
do you decide what project to work on? What issue or process is causing the most
waste, is doing the most harm, is most affecting the bottom line? Maybe you are a
leader at your site and you have an idea of what is generally causing problems. For
instance, you may think that patients with catheters are getting a lot of infections.
Perhaps, checking patients in at your site is taking too long and creating a
bottleneck. Maybe patients are complaining about having to wait too long at check
in at a doctor’s office. It could be that certain departments are running short of
supplies too often. There are many other possibilities. The probability is that
unless you are directly involved in the contentious process, you probably are not
aware of what the exact problems are and are not aware of possible solutions.

This leads us to the conclusion that in order to discover the many problems facing
every organization, especially in terms of wasted effort, time and money, there has
to be in place a mechanism for the problems to surface to the leaders from the front
lines of the organization. There has to be a way for the leaders to hear about the
problems from those who are directly involved. For instance, does anyone in your
organization know what ideas the cleaning staff has for making the organization
better? When I say that there has to be a way for the ideas to surface, I don’t mean
that the only ones with a voice should be nursing staff and other professionals.
Rather, as in the Baldrige Improvement Plans, the entire staff is involved in quality
improvement.

I know of a few hospitals where the leadershippresident, CFO, COO, etc.go out
several mornings every week to talk to staff at all levels and patients to see how
things could be better and to get some positive feedback about what things are
going well. Perhaps at your site you want to start something like this. As time goes
by and as suggestions are implemented, staff will feel safer about making
suggestions.

Leadership needs to make sure that staff feel safe about making suggestions, no
matter what the method of suggesting changes is used. Perhaps you might want to
use an anonymous survey for collecting initial suggestions. After some of the
suggestions are acted upon, the staff will feel like the leaders really want good ideas
and will feel safer making them known. Perhaps you might want to use a consultant
in Lean Healthcare (many of these ideas I suggest come directly from Lean
Healthcare) to teach the staff the principles and processes of Lean Healthcare and
other tools as may seem fit. This approach will help a large organization start
making many positive changes quickly, rather than using the idea of slowly
spreading the means of change throughout an organization, as some prefer.

Whatever your initial process of getting the ideas percolating up in the organization,
after some ideas for quality improvement recommended by the rank and file are
successfully implemented and after the improvements and savings are made known
in the organization, it is time to create ways to get more ideas. Perhaps you want to
have regular meetings with a designated leader and representatives from several
staffing areas that will bring up ideas. That means that the rest of the staff must
feel comfortable about making suggestions to these team members. If your site has
few employees, then perhaps it would be best to have regular staff meetings with all
employees where the agenda always includes time for quality improvement ideas
and for updates on ongoing projects. Whatever method you decide works best for
your site, be sure that an atmosphere safety and security exists for all the staff.
This may mean going so far as to guarantee that no staff will lose there position as
improvements create more time to get things done.

So, once you have a steady flow of quality improvement ideas being generated by all
in the organization, which ones should you act upon? Next month, I’ll address that
issue. This issue I decided to concentrate on the Define step of Six Sigma’s DMAIC
(define, measure, act, improve, control). Next, I will discuss the measure segment.
Sometime in the future I’ll cover team dynamics too.

Donald Bryant helps healthcare providers meet their challenges. If you liked
this article and want more free tips, visit
http://www.bryantsstatisticalconsulting.com for a free article to help you start
making improvements at your site immediately.

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I know that many of you want to make things better at your sitemake things safer,
have your chronically ill patients become much healthier, get home on time from the
office consistently, and much more. So, where do you begin?!! I like the answer
given by Stephen Covey in “The 7 Habits of Highly Effective People (if you haven’t
read it yet, I highly recommend it). He says to Begin with the End in Mind. What can
this mean? He states that all things are created twicefirst mentally and then
physically. So, the first step is to have a vision of what you want at your healthcare
site. Do you want to reduce infections 60%-70% if your site is an ICU? Studies at
the Institute for Healthcare Improvement show this is possible. If you are a primary
care physician, do you want to increase the income of your practice 10%-20%, leave
the office on time, and also dramatically improve the health of your patients? A
recent issue of Family Practice Management demonstrates how. If you have primary
contact with patients, do you want to consistently know all the prescriptions that
they take so as to avoid conflict in medication or other undesirable outcomes?
JHACO is requiring hospitals to reconcile medications for all their patients. A May
23, 2006 article in the Wall Street Journal discussed how hospitals are improving in
this area.

The point that I am making is to first have a clear vision of what you want to
achieve. You cannot make any long lasting improvements if you don’t have a clear
and detailed plan. As a builder needs a clear and precise blueprint in order to build
a property, so you too must have a clear vision.

You cannot have an achievable vision, though, without knowing what is possible.
Knowing what is possible will require that you become familiar with some quality
improvement tools. This will take some education on your part or the hiring of
someone with expertise. Don’t fall into the trap of the Management Flavor of the
Month, though; such a pitfall was recently discussed in a column by Carol Hymowitz
in a May 15 article in the Wall Street Journal. She stated that leaders often try
solutions that are popular at the momentLean, Six Sigma, etc. Rather, you should
find the tools from these and other management styles that you and others on the
staff can work with easily or that an expert can easily deploy at your site. The tools
you use should fit your site and the employees there. There are many good tools
available. Be sure to include ones that improve communication among all staff
members and patients. You might want to use a kaizen event, for instance. You
will want to find out how things exist in their present state so you can benchmark
your improvements. This will require some sort of mapping process and basic
statistical measures. Be sure to write a manual of the processes you adopt so that
new staff members have a ready reference on the practices you want to maintain.
These and many other tools can be found on the American for Quality’s web site as
well as the Institute for Healthcare Improvement’s website.

If you hire a consultant to help, be sure that they are have a variety of tools
available. American Society of Quality certified quality engineers possess such
tools. Be sure this consultant is willing to guarantee the results the two of you
agree upon if you follow his/her recommendations.

What then, is your first step in creating dramatic improvements at your healthcare
site? Begin with the End in Mind and become familiar with a variety of comfortable
tools.

Donald Bryant helps healthcare providers meet their challenges and writes
“Making Good Healthcare Better” a free monthly ezine for healthcare
providers who want to dramatically improve patient health, improve the
bottom line, and make work more rewarding, guaranteed. Go now to
http://www.bryantsstatisticalconsulting.com to get a free article with tips you can
use to start making improvements immediately and to learn more about Lean Healthcare

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