When starting any performance improvement initiative the challenge most managers face is where to start. This is a result of constant “fire fighting”. We are constantly handling problems and issues as they come up but we are not tracking them to see if our improvement efforts are effective. Conversely, because we have never tracked issues as they arose, we don’t know where to start.
In any performance improvement initiative such as QAPI the focus must always be on work on the most pressing issues first. That gives us the best return for our efforts.
Deciding on what exactly to work on first can be the most difficult decision in any performance improvement initiative. The focus must always be on the most pressing problem that, when resolved, will give us the best return for our efforts.
If this is the case, the first step you should take is to gather the data. This is a very simple process, using a Pareto Chart. Using the chart will bring what to work on into crystal clear focus.
The use of the Pareto Chart brings this into crystal clear focus.
Start by spending the first month gathering data.
Put a Pareto Cart on your gemba Board or a prominent spot in your department. Enlist the help of your staff to track performance failures in a no blame, no shame environment. It’s not about who made a mistake or that something happened, it’s about tracking those incidents and resolving the root cause so they don’t happen again.
Completing the form is very simple. Write in the department or unit. Indicate the period you are measuring. Keep it simple and track by calendar month, indicating the month. Whenever something happens such as: a fall from a wheelchair, fall from a bed, a resident is left in the bathroom for an excessively long time, a medication error, bedsores, write it in the category column and write the date beside it n the date column. If it happens again, write the date in the next box over. In a month, it will be very evident visually, to you and your staff, exactly what your biggest problems are and the order you need to fix them.
Review the chart every day to see if you can determine any trends that may indicate the performance improvements efforts you are doing are not effective.
Whenever an incident occurs, a 5 Whys analysis (the tool and its use is described in this chapter) should be done immediately to determine the root cause and a countermeasure should be done to eliminate the cause of the incident