Outcome Improvements in Healthcare Look to William Deming

Having a great finished product is what any producer wants to provide.  This is no different in the healthcare industry, except the “finished product” has a lot more to do with services and care than actual purchases.  In the end, quality and improvements to processes play a vital part in the outcome.  To make these happen, it is necessary to find where quality is lacking and where improvements need to be made.  Obviously, this is easier said than done, especially with the fact that in healthcare, lives, and livelihoods are on the line.  That is why outcome improvements turn to proven knowledge and experience exhibited by and through Dr. Deming’s principles for improvement


1. Create constancy of purpose toward improvement

When the going gets tough, the tough seek to improve.  The first principle that Deming put forward was get everyone on board with the improvement agenda. Having a single purpose helps to get everyone into the same boat.  When you have different agendas and different pulls in management, you will never reach any sort of end goal.  If you are talking about healthcare, having dueling programs running that might contradict each other in the way they are carried out.  Or, in some cases, there are individuals that don’t want to get onto any boat because change is involved.  This is where the tough need to get going: selling purpose is essential to getting everyone together.


2. Adopt the new philosophy

Using the same old philisophies and ways of doing things is not enough.  As with selling the fact that a new agenda of improvement is necessary, you are also selling that what once may have worked no longer has the same efficacy that it once did and a move to a more modern philosophy is required.  Outcome improvement seeks out what is efficient and effective now.  Luckily, this doesn’t change overnight, but it does change over time.  Most likely the philosophy that is being adopted isn’t as dramatic as trying to convince everyone that the world isn’t flat, but it may feel like that at some points.  Diligence and follow-through will make sure that everyone within your healthcare organization sees where you are headed.


3. Eliminate the need for inspection on a mass basis by building quality into the product in the first place

Trust your gut.  Obviously looking at this principle, it seems to apply more to the automobile manufacturing where Dr. Deming started creating his beliefs, yet it is still very applicable to healthcare.  Probably the easiest way to see this applied is to think of someone standing over your shoulder watching every move you make and questioning every decision.  You’re more likely to make mistakes by overthinking, more likely to resent the person and/or deed of being watched over all the time, and more likely to want to get out of the situation as a whole.  Physicians and medical professionals know what they are doing, and should be trusted to do it.  There will always be the checks and balances, but outcome improvement should rely on the talents and abilities of those working within the system.


4. Minimize total cost. Move toward a single supplier for any one item

Money talks.  The skyrocketing costs associated with healthcare are related to a number of different aspects and technologies that are now implemented.  There are also more requirements asked of healthcare organizations when it comes to reporting and reimbursements, so more man-hours are tied up to make the system run smoothly.  In all of this, there is also more areas for waste to happen, thus more opportunity to find ways to make streamline costs.  Dr. Deming suggests here to go with a single supplier that you can create a relationship with and understand their costs and routines.  This may not always be possible or necessary within the healthcare industry, but it is concepts along this line of thinking that will make this principle more effectual and doable.


5. Improve constantly to improve quality and productivity, and thus constantly decrease costs

Measure twice, cut once.  Outcome improvement is not a one-and-done or a finish-line kind of notion, especially in healthcare.  Looking for areas to implement improvements requires constant diligence, and the willingness to cut costs where possible, without sacrificing quality.  Persistency has a rippling effect in the respect that when you improve and observe in one area, the desire to feel this same success will emanate to other departments.  Breaking this principle down, when you improve the quality, shore up the productivity, you will be rewarded with decreased costs due to not repeating healthcare steps ensuring everyone is doing what their roles and responsibilities demand. 


6. Institute training on the job

Never too old to teach a dog new tricks.  Due to the amount of technology and knowledge that is being updated each year, there is a necessity to make sure that training is not only readily available but is implemented to assure that outcome improvements are standard practice.  There may not be a right way or wrong way to do this but maybe better established by each organization looking at their needs. 


7. Institute leadership

You can’t lead from behind.  When individuals don’t know who to turn to for judgment calls and are left floundering, it can be frustrating and a knock to the morale.  Structure of a system is mandatory for functionality.  Leadership shouldn’t just be thought of as the top down, but also the bottom up, in that there should be levels of leadership that can handle certain issues, and then move up the scale, rather than bothering the top level decision-makers for answers that they may not have expertise in. 


8. Drive out fear

Nothing to fear but fear itself.  There are many degrees of fear, both internal and external.  Most of the fears that any of us face has to do with a lack of knowledge or understanding of what is going on.  When an organization is willing to hear the fears or concerns of its members and to do something about it.  Action speaks loudly and will drive fear out of daily routines.  Also, it is very important to remember personal feelings when dealing in emotional issues.  You may not understand what someone is going through, so be respectful of information conveyed to you.


9. Break down barriers between departments 

Tear down this wall.  One of the biggest obstacles that many healthcare organizations face when working towards outcome improvements is self-generated.  They compartmentalize everything so dramatically that every department, every group of individuals and so forth is separated by an unwritten wall.  There is no reason for it when working towards improving the system.  Obviously, there is some separation when it comes to leadership and responsibilities, but this shouldn’t translate to ideas, communications, and building tools.  Use successes from other departments to build upon and learn from things that didn’t go so well.


10. Eliminate slogans, exhortations, and targets for the workforce

Just do it, got milk, eat fresh.  When wanting to motivate employees to work better and more efficient, many companies and organizations tend to lean towards slogans or motivational jargons that in theory would inspire everyone.  However, this usually comes off as upper management taking a hands-off approach and being cheerleaders rather than true leaders that would get down in the trenches.  This is also the feeling that is promoted when setting targets.  Many professionals sense that those in upper management have a 30,000-foot view of what is going on and don’t understand the daily grind, thus resent that someone is setting a standard that may not be possible, and if this person knew what was happening day in and day out, that standard would be revised.  Those in highest responsibility places may have to have a little more faith with those performing the hard duties, and maybe get their own hands dirty (so-to-speak) every once in a while.  This will go much further than a poster with inspirational words.


11. Remove barriers that rob the hourly worker of his right to pride of workmanship

Clock in, clock out, that’s it.  This is another principle that doesn’t necessarily translate from the automotive industry to the healthcare industry, however, the underlying feeling absolutely does translate.  Just because you are a worker and doesn’t mean that you don’t provide a huge support in services.  Your work should be valued, your abilities should be recognized and your accomplishments should be seen as a sense of pride.  Everyone matters in the big picture, but no one should be set behind another just because they haven’t worked themselves to the top. EBM emphasizes the importance of the results of large clinical trials in formulating individual treatment strategies," reports an article in the Journal of Managed Care Pharmacy. "EBM uses scientific evidence that is rigorously obtained — and this contrasts with anecdotal experience, which can be biased, since even the most knowledgeable physician can be influenced in the decision-making process by recent experience with patients.


12. Remove barriers that rob people in management and in engineering of their right to pride of workmanship

It’s hard to be king of the hill.  Just as the hourly employee feels minuscule in the big picture, management sometimes interprets the fact that they made it to a certain position as being their only reward and recognition.  This can also be construed by others in the organization and is detrimental to progress in improvement.  Because someone has reached a pinnacle in a job or industry doesn’t mean that there isn’t more to provide, isn’t more to create or more to have pride in.  When communication and bouncing around of ideas is possible, management can offer great workmanship and knowledge.  No one should be discounted no matter what position they hold.


13. Institute a vigorous program of education and self-improvement

Making the most of yourself.  Going along with the principle of training on the job, education and improvements must be a focal point within any organization, whether it be healthcare or not.  But, particularly in the healthcare industry, it is so important to build upon the foundations that have already been established and make more for yourself.  This doesn’t mean that a nurse must only focus on medical instruction, but may work to educate him or herself in business or holistic medicines.  When someone educates themselves, they also empower themselves in abilities to improve themselves and others.


14. Put everybody in the company to work to accomplish the transformation

All aboard!  It doesn’t matter how well transformation and outcome improvements are planned out, if everyone isn’t onboard, these outsiders will act as an anchor in slowing down progress.  Obviously, not everyone agrees with everything, and there will be concerns and challenges.  However, it is important to have your whole team working toward the same end goal.  This may include letting some people go from the organization, but it will strengthen the group as progress is being made. 

Dr. Deming didn’t have all the answers and his principles may be added upon, which is absolutely necessary to build a strong healthcare organization in the long run.  To find and achieve outcome improvements within your healthcare facilities, you need to utilize as much knowledge and function to make a difference in your community and sphere of influence.

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