Crusading for efficiency.

Integrating principles from a variety of theories, managers have developed a conceptual framework for reengineering processes in an endoscopy unit to improve the value of services provided to customers. A major goal of this redesign was to enhance or maintain quality of care, increase efficiency, and maintain or reduce costs. This was accomplished by analyzing data and outcome measures related to patient, physician, and staff member satisfaction, as well as resource allocation. The departmental results were tangible, positive, and visible almost immediately. With the right team and the right techniques, tools, methodologies, and decision-making processes, redesign projects can and do lead to dramatic improvements in productivity, service, customer and staff member satisfaction, cost control, and innovation.

Efficiency↗

PubMed1999

Musings on using evidence to guide CQI efforts toward success: the computerized firm system as primary care microunit.

BACKGROUND: The attempt to transfer classic industrial CQI (continuous quality improvement) theory into the clinical arena has proved to be more difficult than originally promised. A new "computerized firm system" approach to incorporating CQI efforts into mainstream practice settings, which has been able to obviate many of these shortcomings, is described. METHODS: To make it easier for CQI efforts to be successful, the scope of activities undertaken in completing the Shewhart cycle popularly referred to as PDSA (plan change, do change, study results, act on results) was delimited. Rather than plan the intervention themselves, staff worked with experts on tailoring a preselected change idea with already established efficacy--a computerized reminder system. Because the clinic was divided into two small group practices known as firms, a controlled time-series trial (CTST) design was used by initially turning the reminders on for one firm but not the other. The clinic was thereby also relieved of the responsibility of conducting a study to determine whether the intended improvement in quality had been achieved. In essence, one clinic was asked to do just DA (that is, do-act). RESULTS: This approach engendered the successful completion of a streamlined Shewhart cycle in a busy clinic setting at remarkably low cost. The compelling nature of controlled evaluation results aided leadership in rapidly disseminating the reminder system to the remaining 11 primary care clinics associated with the university's 2 academic medical centers. CONCLUSION: Computerized firm systems can be developed to conduct CTSTs as part of streamlined CQI cycles guided by both published and local evidence, and they are worth developing.

Efficiency↗