On Improving Health care from the Inside Out

• The first step to improvement in health care is getting inside the problem. Don't talk about what you think happens, watch what actually happens. Don't assume what patients/clients think is important, ask them. Follow the process from the start to finish. Study the system in which the problem exists. 

On Quality Improvement Exercises

• We don't see quality improvement as a sprint, a fit of enthusiasm, or a set of projects. It is a sustained leadership directed, in part, at perfecting your core processes- the ones that most of your staff are involved in, and that are supposed to deliver value to your clients.

On Automation

• Don't automate wasteful processes - obliterate them. Help staff do what they do best - provide care! Align clinical priorities and technology priorities to enable better care.

On the Importance of People

• Drive out fear! The first quality improvement effort that leads to staff termination is the last quality improvement effort, in that organization, for a very long time. Most improvement can not be accomplished without staff involvement. They know their work and are best suited for identifying and driving out waste. An employee who is afraid of losing his/her job will simply not be able to contribute.
• Reducing staff due to labour costs savings from better processes should be done through attrition. The reality is, most health care organizations have a laundry list of what they would like to do, if they only had the time. Keep this list ready, and be prepared to invest in retraining.

On Value

• How do you find out what "value" is? Ask the client. All improvement activities must be centred around the concept of generating value for the customer.

On Process Visualization Tools

• What's the best process mapping method? Don't get caught up in this debate! The best type of map is the one that serves your objectives. Doleweerd Consulting uses up to eight different methods to visualize a process, depending on the problem to be solved, and the audience involved. For example, to improve workflow or to automate, we prefer to use Ben Graham Process Maps, or occasionally swimlane diagrams. To undertake lean quality improvement, value stream maps are very powerful. To show processes that contain many variables that can change over time, we might choose State Dependent Process Mapping. Finally, for a managerial audience that likes to think conceptually, an overview of a process created using simpler tools like MS Viso or flow charts, will do the trick.

On Quality Improvement Tools

• We don't apply every quality improvement tool just because we can - we do what is relevant for getting results in the scenario in question. Whether that is Ishikawa Diagrams, making the workplace visual (5s), waste walks, Kaizen events - the right tool at the right time is everything.