Build an army of problem solvers: How hospitals can tap process improvement for better patient experience

Sustaining long-term process improvements can be a challenge for many hospitals.

Here, Dr. Charles Hagood, president of transformational advisory services at Press Ganey, discusses how hospitals can implement a sustainable, organizationwide process improvement approach that can positively influence patient experience.

Editor's note: Responses have been lightly edited for style and clarity.

Question: What are some of the biggest challenges for hospitals when it comes to process improvement?

Dr. Charles Hagood: The biggest challenge I've observed from working with hundreds of hospitals — and even from other industries, for that matter — is the ongoing commitment required to sustain improvements long-term. If organizations view process improvement as simply the use of improvement tools and/or standalone episodic improvement efforts, they will be unable to maintain those improvements over time. Hospitals may gain an initial short-term improvement bump via the use of basic tools and improvement tactics, but sustaining and spreading improvement requires a comprehensive, dedicated operating system that includes more than just independent tools. It requires the development of people and leaders; the deployment of strategy from the top of the organization to the bottom in alignment with a true north; standard work and habits for leaders; human behaviors and reliability skills; and a robust daily management system. Organizations lacking such a system are unlikely to maintain long-term, robust process improvement. 

Additionally, organizations viewing process improvement as a quick fix or something that can be delegated to an improvement department and not embraced by leaders are other common challenges for organizations. 

Q: How can hospitals ensure quality improvement efforts also positively affect the patient experience?

CH: First, organizations should broaden their definition of patient experience to include safe, high-quality, efficient, patient-centered care that engages all levels and positions within the organization. An interdependent relationship exists between safety, quality, staff engagement and the patient experience. Similarly, process improvement efforts focused on providing safer and higher quality outcomes can enhance patients' overall experience of care. Both physicians and nurses also value and embrace improvement efforts focused on quality.

Q: What are some concrete actions hospitals can do within one calendar year to improve patient experience?

CH: Before organizations can embark on any improvement journey, they must have an enterprisewide strategy and support from leadership. The entire organization, from greeters and the nursing floors, to the case managers and beyond, should understand the role they play in the patient experience. They are part of the "why" that exists for healthcare, and each of them have a measurable impact on the care experience. 

In considering specific process improvement efforts that can improve the patient experience in year one, I would recommend that organizations select patient value streams that are aligned with what's important strategically to the organization and begin implementation of their improvement system. During that first year, they should also establish a process to learn from the work and set a course to lay the groundwork for spreading that approach throughout the organization. Setting and sticking to strategic priorities is key. Every organization has things that they could do and would like to do, but initially, it's important to stay focused on what you must do strategically. 

I would also encourage the entire organization to undergo training in basic problem-solving skills. Nothing can transform an organization like building an army of problem solvers. Problem-solving not only engages staff in improving their work, but it also makes the right work easier for them to do, which is something most can rally behind. 

Q: Any other thoughts on the relationship between process improvement and patient experience?

CH: While it's important to understand and improve how work is done, we must view all of our processes and systems through patients' eyes. The deeper and wider an organization implements a system of improvement, the better the experience of care outcomes. For example, an organization that has aligned the process improvement activities with the strategy, has trained all levels and departments, and can problem solve within a daily management system, will have better outcomes than those that only use a few tools in isolated areas. Unfortunately, many organizations want a quick fix to solve all problems, and that's just not possible. There are no silver bullets in a journey toward high reliability. 

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