Process Improvement is a systematic approach to problem solving related to the assessment, analysis, and improvement of organizational processes. This is especially important at UCI Radiation Oncology, where technology-driven evolution of care occurs at breathtaking paces, changes to standards are constantly being introduced, and treatment becomes increasingly complex with each passing month. As most in the healthcare industry know, processes are always in a state of flux. Operations are incessantly changing, and new challenges invariably present themselves.
That is why it is so vital to continually monitor every facet of patient care for opportunities in process involvement. Process Improvement is a conclusive way to assess areas of weakness and take the appropriate steps to ensure that excellence is always achieved. At UCI Radiation Oncology, various tools such as Lean Six Sigma, Kaizen, Failure Mode and Effect Analysis, and Total Quality Management are used to provide a framework to assess performance improvement and maintain performance. By focusing on a continuous evaluation of processes, the Department can ensure that top-notch care is provided. At UCI, this process of quality improvement typically involves 3 steps:
1. Routinely evaluate processes to identify what might require tinkering
The initial step in the assessment phase is to regularly review the policies and procedures related to workflow and operations. This will determine the established governance, as well as potentially identify areas in need of improvement. In many cases, Department “deep dives” are conducted which provide insight into how procedures can be refined to reflect more currently desired outcomes. Frequently, suggestions by patients instigate quality improvement processes. Only by measuring and comparing our existing performance based on metrics or key performance indicators (KPIs) with benchmarks of practice measures available within the industry can target goals be reliably developed. For instance, at UCI Radiation Oncology, KPIs that are constantly tracked include measures related to patient wait times, online communication lags, treatment delays, compliance with documentation, emergency hospitalizations, and unnecessary imaging. Additionally, a rigorous program for equipment calibration, treatment monitoring, and independent auditing exists to ensure performance is optimal and that the correct dosage of radiation is delivered. Discussions centered on KPIs typically occur at the weekly quality conference led by our Chief Quality Officers, Dr. Healy and Dr. Reilly.
2. Establish goal targets and propose adjustments
The next phase of quality improvement at UCI Radiation Oncology involves establishing measurable goals for performance optimization with the input of all stakeholders including faculty, staff, and management. In this step, it is critical to identify and implement available technology or work tools to roll out initiatives that have the potential to improve automation and/or workflow efficiency. The impact on staffing, processes, and operations is then vetted. Typically, a quality “champion” is designated who has the responsibility of leading effort to assess the effect of any proposed intervention. Projects which have been conducted in the past include those focusing on patient transportation, room utilization, ancillary support, and wait times.
3. Continuous monitoring of progress
Once the changes are implemented, the last step is to continually monitor the progress of improvement based on the metrics or KPIs established in the previous stages. This step is important because it will hold faculty and staff accountable for the productivity and quality standards developed. A regular cadence should be established for identifying, analyzing, and improving metrics and processes. Daily monitoring of the metric reporting will help determine if implemented changes are improving performance. This way, the Department can identify issues and work to fix the problem by fine-tuning processes and workflow based on performance comparison to departmental goals. Creating opportunities for faculty and staff involvement and idea engagement are keys to success in this important area.
Ultimately, sustainable, organizational improvement cannot be produced by a single memo or executive edict, but rather must be supported by an overall culture that embraces it. Above all, UCI Radiation Oncology recognizes that change is a natural part of healthcare, and only through a “all hands-on deck,” data-driven commitment to continuous quality improvement can the Department continue to maintain its lofty standards in the future.