Strategies For Process Improvement

It happens to all of us. We get complacent. We get comfortable. We lose motivation. All of this leads to missed opportunities for improvement. If we do not take a moment to step back and re-evaluate our workflows and processes, we run the risk of failing to improve, failing to innovate, and failing to provide our patients with the best care possible.

“Every year I try to grow as a player and not get stuck in a rut. I try to improve my game in every way possible. But that trait is not something I’ve worked on, it’s part of me.” - Lionel Messi

“There are those who would misteach us that to stick in a rut is consistency - and a virtue, and that to climb out of the rut is inconsistency - and a vice.” – Mark Twain

“As an actor, I think you can get really bad habits, if you do the same thing, every day. You can get stuck in a rut. So, I like jumping between genres, and then taking a break and learning something new. I like feeling like I’m still learning.” Brie Larson

Clearly complacency is not exclusive to the medical community. However, one constant that permeates through those who excel, is they are continually looking for ways to hone and enhance their craft. Those of us who perform repetitive tasks, day after day, often fall victim to being lulled into the false sense of security. Everything seems to be working, so it is good enough. Is it really, and how do we get out of these ruts and enact positive change?

First, and possible the most challenging is that we need to acknowledge things may not be as perfect as we think they are. Possibly we are not as infallible as we would like to think, and that is okay, but not making changes because of pride or our egos is not. Just because a process is working, do not assume that’s as good as it gets. Examine processes that have not changed for years and speak to the staff who complete those tasks; ask their opinions and listen to their concerns. Do they feel things are working as efficiently as possible? Do they have ideas on how to make the process work better for them?

We have all heard the cliché to “think outside of the box,” but what does that really mean and how can we practically apply it to these situations? I understand it may not always be easy to ask someone to change how they look at a situation, but it is easy to bring in someone from the outside to observe. An individual who has little to no knowledge of your processes can observe workflow, ask questions and provide feedback. Often they can identify areas for improvement and simplification. By default, they are thinking outside of the box because they do not live and work in that box on a daily basis.

Once a potential process enhancement has been identified, it is critical to obtain as much data and information as possible regarding the process. The ability to support process change with data is one of the most crucial aspects to ensure buy-in and acceptance from your staff. As I mentioned earlier, for many of us to adjust our viewpoint to identify a potentially “better” way is understandably challenging. However, when backed up by real world data (not just gut feelings or hunches), differing viewpoints can be more easily processed by those being asked to change. Data should not only be collected before an adjustment is made, but also as a follow-up to ensure the positive impact we thought we were making is in actually being seen. In addition to data, it is crucial to get feedback from the parties involved after they have worked within process changes.

The following is a process enhancement that I was personally involved with at our facility. We almost exclusively utilize automated dispensing machines (ADMs), for medication delivery to clinical staff. 

The concept is quite simple, when the clinical staff needs medications, they go to the ADM and it is able to dispense it to them. Once enough of a particular medication has been removed, the pharmacy staff is notified that it should be restocked. Seems very straight forward, right? We thought so. However, the ADMs can only grant access to one user at a time. The potential for a problem went unnoticed until receiving the results of a survey (sent out to nursing regarding impression of pharmacy services); many responses contained inquiries as to why the pharmacy was restocking the ADMs at certain times. After consulting with pharmacy staff, they reported often having to compete for time at the machines; I decided to look into things further.

I was able obtain data from the various machines across the facility quantifying dispenses and restocks over the course of several months. That data was then converted to a graphical representation so that peak times for both activities could be identified; it was obvious there was an overlap. This data clearly validated the observations from both the nursing staff and pharmacy staff. Certainly, there were differences among each nursing unit, but there were consistently times when nursing and pharmacy staff were competing for access to a machine.

The data was clear and it was an easy fix, change the restocking times. We went a step further and reduced the frequency of restocks, with each restock optimized to deliver the greatest number of medications. The benefit was twofold, we were able to reduce the number of times per day pharmacy staff was away delivering medications, and at the same time reduce the likelihood that there would be competition for the ADMs.

The solution to the problem really couldn’t have been simpler, but the unknown and overlooked issue was holding back the optimization of the process. Not only was the nursing staff responsible in part for identification of an issue, but they were also the out of the box thinkers when asking “why do these two processes need to overlap?”

We implemented a change that at the outset did not have the full support of the pharmacy staff; it was different than what had been done for years and required a reworking of their daily routine. By presenting them with the hard data showing the competing times for the machines, we were able to get the initial buy-in required to trial the change.

Within the first couple of weeks post-implementation, I was able to get anecdotal feedback from the nursing staff and the pharmacy staff; both parties reported there appeared to be fewer instances when they were competing for the ADMs. This was later verified by repeating the data analytics described previously.

Many people become so comfortable with their routine they become blind to when there may be room for improvement. Do not be afraid look at processes from a different perspective. Work with other departments to help each other analyze workflows. Take the time to communicate with your employees to get their impressions on processes. Don’t be afraid to reach out to the different departments you interact with to get their feedback on the services you provide. Use the feedback to make positive changes, to achieve positive patient outcomes, and to help create a positive team-first culture.