Richard J. Banchs - The Quality Improvement Challenge

A QI project is a partnership between four key actors: The Primary Sponsor, the Local Sponsor, the frontline professionals, and the QI team. The Primary Sponsors are the senior leaders who provide resources and legitimize the project; the Local Sponsors are the mid‐level leaders, managers, division heads, and departmental leaders who support the project, engage the front line in project activities, and support the change; the front line professionals are the people responsible for operationalizing the improvement and change; and finally, the QI team. The fundamental role of the QI team is to be the facilitator (see Figure 6‐1):

Facilitate the role of the Primary Sponsor. The Senior leaders and Primary Sponsor are the project authority. The role of the Primary Sponsor is general oversight and legitimization of the process improvement efforts; allocation of resources; communication and influencing opinion; and opening doors for the QI team. The QI team can help the Primary Sponsor by providing continuous updates on the progress of the project, coordinating the calendar of activities for meetings with the front line, and providing message content for written communication, meetings, and presentations.

Facilitate the role of the Local Sponsor. The Local Sponsors (managers, division heads, departmental leaders) are responsible for the success of the project at the front line; they are the QI team’s project partners. When the Local Sponsors support the project, they are important ambassadors for the change; they have a key role in project activities and acceptance of the change. Local Sponsors are responsible for making the improvement possible. They keep the front line informed and engaged, provide resources, coach performance, and arrange for training. The QI team can facilitate their role by providing continuous updates on the progress of the project, helping them coordinate calendar of activities for meetings with the front line, providing message content for written communication, meetings and presentations; and sharing tools, processes, and techniques to help sponsors with project activities and change management.

Help the front line be engaged and succeed. The front line has a crucial role. They are the project owners and should be engaged in understanding the problem, finding possible causes of poor performance, co‐creating solutions, and working through the technical aspects of the change. The QI team can facilitate their engagement by frequent sharing of information, creating the conditions for change (the Change Space), and providing coaching and training on the new process.

FIGURE 6‐1The role of the QI team.

Periodically, the improvement team needs to confirm that they are on the right track to achieve their project objectives. This is best done through a tollgate review with the Primary Sponsor. A tollgate review is a go/no‐go checkpoint where the team leader, team members and the Primary Sponsor meet to discuss ongoing project activities, review results and deliverables, and assure that the project is on track. The first tollgate review should be scheduled with the Primary Sponsor soon after organizing your team, at the end of the first “R”: the “Right People” (see Chapter 25).

The Leadership at Heart Medical Center would like to reduce the long patient wait times in the emergency room (ER). Preliminary work has identified turnaround times (TAT) on routine blood and urine analysis in the main chemistry lab as the major causes of delay. You have been asked to assemble a team to address the issue. Using the hospital’s list of available personnel (see Table 6‐1), select six team members for your QI project.

TABLE 6‐1Heart Medical Center Hospital Roster

1 A team leader should be chosen on the basis of all the following characteristics EXCEPTgood process knowledge,respected by the front line professionals,excellent interpersonal and communication skills,leadership position in the organization, orgood facilitator.

2 All of the following characterize a group of people performing as a team EXCEPTcomplementary skills,common purpose,focus on individual goal achievement,mutual accountability, orcommon approach.

3 Regarding the composition of a QI teamfront‐line professionals need to have the largest representation.the ideal team size is 4–8 members.it is important to have team members that bring subject‐matter expertise.it is important for the team to have a mix of skills.all of the above.

4 Team members should be preferentially selected on the basis of all the following characteristics EXCEPTbring process knowledge,have a high‐ranking leadership position in the organization,have technical expertise,have problem‐solving skills, orhave great interpersonal skills.

5 A team leader’s role is to facilitate the team’s success in achieving the project’s goals.TrueFalse

6 The formation of high‐performing QI teams in healthcare is made more difficult byclinical silos,prioritization of patient care,resource constraints,conservative culture, orall of the above

7 What is the role of the QI team during an improvement project?share findings and communicate through all project phases.provide message content for written communication to senior leaders.provide material and audiovisual support for meetings and presentations.provide or facilitate coaching and training of the front line.all of the above

Key: 1d, 2c, 3e, 4d, 5a, 6e, 7e .

Exercise key: While the problem affects the ER and the professionals working in the ER, the root of the problem for a long turnover time of routine samples is in the lab. In this example, team members should be chosen preferentially for their subject‐matter expertise: processing samples. ER staff and providers are the customers of the process; lab personnel are the stakeholders. Given these roles, your QI team should include a majority of lab personnel, who are the stakeholders with the best process knowledge. The stakeholders do the work and therefore have the expertise. Chose a majority of front line workers and some supervisors. A customer (ER staff or provider) can also be a member of the QI team helping team members have a better perspective of “what the customer needs.”