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Getting Improvement Projects Done!

Patient Safety Quality Monthly, July 16, 2009

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"It's been five years since the event happened. I thought for sure we had it all fixed—and now this happens, and I find out we didn't do half the things we were supposed to do!"

"We finish a root cause analysis and have another eight corrective actions that we promised to do. Then we have the improvement teams, the responses to the state and The Joint Commission, as well as all the things the board wants. I bet we have at least 100 performance improvement/patient safety projects that we have started—I have no idea how many we have finished."

If you are like most organizations, a key weak point in your performance improvement/patient safety loop may be getting things done. Perhaps you are becoming confident at doing your problem analysis and designing good improvements based on best practices. But the real test is whether all that effort actually makes changes in the way your processes work, and those changes ultimately change your outcomes, satisfaction, or efficiency. If the project doesn't get done, there is no partial credit, but more importantly, there is no improvement.

So what are the typical things that stand in the way of getting our improvements done? Let's look at a couple of classical failure modes:

1. We didn't really get full buy-in from our leadership, so it has been an ongoing battle to get resources and funding. Perhaps we get the nods and "nice job," but there is always something standing in the way of the capital or the approval to expend the time.
2. Although the proposed improvement looked like a great idea to the team, we failed to get buy-in from the impacted departments or functions that would have to make some changes to make the improvement work.
3. Maybe everyone is on board, and we really got the CFO to approve the funds, but it still slides along because no one person is in charge of the project.
4. We have a strong project leader or manager, but the number of activities that need to be coordinated is getting beyond his or her grasp and things are falling through the cracks. What was at first a "darling" project is now a can of worms and about to be canceled.

If you have been involved in quality projects for any length of time, I am sure you have seen all of these scenarios and probably many more. Typically, we can divide the reasons that our projects don't get done into two major reasons.

First, sometimes we don't clearly sell the benefits to all stakeholders involved. We often think of our jobs in quality/performance improvement and patient safety as analytical or technical jobs—we look at problems and then design solutions. Often, we need to add a sales hat to all the others that we wear. Although we think the benefits are self-evident, don't count on it. If we don't sell the benefits, leadership attention and resources will go elsewhere.

Key point: Your leadership buys in to the benefits, not the description of the features, of your improvement. If you can't clearly explain and sell the benefits, it is less likely you will get the support you need. Think benefits—always!

Second, we often forget that each of these improvements is really a project. We need to take full advantage of our project management skills. We need to assign a project manager, set a schedule and due date, assign resources, and track actions that build up to completion of the project.

Key point: Activities that are not on the master list—all in one place, with an owner, due date, and approved resources—don't get done. Keep a master list of all performance improvement projects, and track their status regularly with your committees, department leadership, and senior leadership team. Out of sight is out of mind, which means the project won't get done. Don't rely on meeting minutes. Make a list!

In future articles, we will look at some simple ways to get your improvements done. If we can be of any assistance in helping you plan for or 'get your improvements done' please give us a call and we would be pleased to chat.

Ken Rohde 7-16-09

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