August 31, 2016 (Updated)
I have met with hundreds of Board of Trustee members and C-suite members while assessing quality and safety at institutions. There is a consistent interaction I see whether I am at a small rural hospital or at a major academic medical center. Meetings typically start with discussions of current process improvement initiatives, data collection, adverse event identification, root cause analysis, transparency and engagement of clinicians and staff. Some of the discussion meets with nods of understanding and approval but there are blank stares or quizzical glances from some at the table. The common thread is that there are significant gaps in knowledge in the theory, methodology and tools used in process improvement by many. Most concerning is the knowledge gap seen in some senior leadership and Board members. Fortunately easy steps can be adopted to ameliorate the situation.
The work and theories of Deming are not part of the routine training of physicians, administrators and most healthcare team members. Furthermore the techniques of process improvement are not part of the experience of most Board members. For there to be a culture of safety, the lexicon and tools of process improvement must be understood by all those at the table. Regardless of the descriptor presented, Lean, Six Sigma, Kaizen or the Model for Improvement, the team must speak the same language and understand the methods. The quizzical looks previously described remind one of a Tower of Babel experience.
I always ask what the organizational socialization process is for the thousands of employees of the institution. I also then ask how new senior management and Board members are onboarded and familiarized with process improvement. Further I query on how those already trained keep up on the newest developments in the field. Very few if any organizations have both a robust initiation program or any means to keep the senior team up to date on the most current developments in the field.
The following solution is crucial for developing and maintaining a culture of safety. Make sure a comprehensive tool kit covering the basic elements for process improvement using the chosen methodology of the organization is in place. Also make sure the reading materials, webinars, lectures and references are understandable. Close the loop of training by engaging the board and senior leadership in subsequent discussion to ensure understanding and the ability to apply the methods and tools to practical problems in day to day operations.
Lastly and just as important is to be sure to update the skill set so that the newest, best practices in process improvement are communicated to the key members of the team. Having a dedicated person responsible for updating the Board and C-suite members creates accountability. The essential element of new member training and maintenance of knowledge will ensure that a culture of safety will thrive.
Health/Business Consultant/Educator, Patient Safety, Quality, Risk Management, Public Health Advocate