Healthcare Customer Satisfaction: More Talk AND More Action Customer satisfaction (Voice of the customer) is a recurrent th...
Friday, December 2, 2011
WARNING: THIS ENTRY IS A LITTLE LONG.
I used to worry about creating neologisms (new words) because in psychiatry it is said to be a symptom of psychotic behaviour. But I decided what-the-heck. English has always been a language in transition. Besides this is not so much a new word as maybe a new acronym, and we know that English is inundated with new acronyms every hour. So with that let me introduce my new phrase: cycle gipe.
Walter Shewhart got it right in 1920 when he created the notion of a series of events that follow a regular pattern. First you Plan, then you Do, then the Check the Results and then do fix through Acting and then you do it again and again. W. Edwards Deming understood it and modified it slightly; but the concept remained the same. We can call these good examples of a continuum of activity, but since the point was made that the process should be one of continual repetition, these are good examples of what we can appropriately call cycles.
But sometimes things don’t work out just that way. Not only does the process sometimes not go through the repetition process (hence not a cycle) all too often they barely make it through the first stage of continuum. So do we have a word for that?
Well we do. Impolitely one might think about another acronym (fubar) but wanting to be a little more positive, I thought about NCC for non-continued continuum. But I decide to be even more positive with "cycle gipe" (a cycle with Good Intention but Poor Execution).
I will use it in a sentence. Our laboratory’s continual improvement program was cycle giped when we stopped doing our internal audits.
Here are a few additional examples of cycle gipes.
The intra-laboratory continuum failure
A laboratory needs to create and provide and update job descriptions because the job description tells workers what you want them to do and describes their reporting process. This document can become the employee’s training manifest and their training compliance record, and then form the basis for their competency assessment manifest. Rather than being a one-size fits all document, it is a record personalized for each employee. Rather than being written as a one-time document, it is a living document that undergoes continual revision and is repeats through a cycle process.
I know it sounds like a lot of work, but compare to all the time lost with work confusion, it actually should save time. And rather than having one part in HR and another with the supervisor, and another in the quality records file, It becomes the one fit-for-purpose document which again saves time and confusion.
So why does this fall into cycle gipe? I suspect the main reasons are tradition and distraction. Historically job-descriptions have always resided in the Human Resources Department, and training records live somewhere else. And even if we do update one part, we usually don’t get around to updating the others. Or worse one person updates one part, and someone else updates another. So even if we start off with a unified document, given a few months all the parts get changed. A good example of “Good Idea but Poor Execution”.
The answer here is simple. The document is created in one place and is maintained centrally. All the departments have access to it, but only one person controls it. It becomes a single document under document control.
The control is greater, the utilization is uniform and the outcome is better, but the net work involved is less.
The Cross-System Continuum Failure.
This is a more insidious failure but with much broader implications, and is much harder to control because the responsibility for monitoring success or failure does not lie in the hands of people with the responsibility for creating the process in the first place.
For the best of intention, a standards development organization (SDO) creates a document that describes from first principles a policy statement. Let us take for sake of argument and example, a policy about patient identification. The policy makes sense and takes into consideration certain basic principles. If undertaken as written and intended, it should prevent or reduce many laboratory errors. This would be a good thing. An accreditation body reads the policy statement and it sounds good, and adopts this as a requirement in their accreditation standard.
So it comes down to the laboratory with an expectation that certain activities will occur. The laboratory reads the requirement and implements it as policy and instructs that it should be put into action. So far all is good and the continuum has worked as intended.
The problem occurs at the next level when put in the hands of the front-line worker the good idea doesn’t work as intended. Maybe it is a language issue or a cultural issue or a work pattern issue. Whatever the reason, the process is not implemented. That should be picked up as a non-conformity through internal audits or competency assessment , but that only works if there is an audit process in place. And all too often there is not. So there is no record that implementation has not succeeded. But that should be OK because the accreditation team should pick up the absence of a record, but that doesn’t happen either. And monitoring live activity is not something that is done effectively during accreditation assessments. So the SDO never finds out that the policy is not working, and so with each new version of their document it keeps on getting repeated.
Ergo, we have another good idea and good intention but poor execution.
So how often does that happen? Must be pretty rare, right?
So here is the message. Over and over we see that Shewhart and Deming were right. Continuums and cycles work when we go through a step-by-step process. But they all have opportunity to fail when we forget or neglect to go through all the steps.
Plan - Do - Study - Act.