Prevent QI from stretching your resources too thin

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Prevent QI from stretching your resources too thin

Organizational alignment goes a long way

Do you or your leadership team know how many quality improvement (QI) and performance improvement (PI) teams your organization currently has? Does your frontline staff know the organization’s strategic plan and vision? Do your middle managers have leadership training? Do all your PI teams report to an oversight committee?

These are the questions Istikram Qaderi, MD, MPS, associate vice president of quality resources at Champlain Valley Physicians Hospital Medical Center in Plattsburgh, NY, asked his audience at the National Association for Healthcare Quality’s annual educational conference in October. Qaderi discussed the challenges healthcare organizations face as they struggle to meet quality, safety, and service demands—and, more importantly, how organizations can meet these demands without stretching resources too thin. 

“A lack of alignment results in lack of resources due to competing interests, and lack of alignment is the result of lack of structure,” says Qaderi in a subsequent interview. “Building the right infrastructure is the key to avoiding redundancy and building accountability.”

QI departments are overburdened. Between CMS core measures, public reporting of patient satisfaction, Joint Commission survey readiness, and adverse event reporting, QI departments are also working to improve the hospital’s overall performance.

Qaderi says there are three key components to organizational excellence: will, skill, and accountable care structure. Most in healthcare have the will, but many organizations suffer from a lack of structure, alignment, resources, training, and manager and frontline engagement.

Assess your current state

Every year, QI initiatives should be evaluated on how they align with your hospital’s priorities and whether they accomplish organizational goals. In addition, you should assess “what you can take off your plate,” says Qaderi. 

To assess whether QI initiatives are currently aligned, Qaderi asks hospitals the following:

  • Does the organization have an oversight committee that uses a standardized process to select PI initiatives?
  • Do you know how many teams or task forces you currently have?
  • Do the teams understand how their work ties in with the strategic plan?
  • Do all team leaders have knowledge of and experience with PI?
  • Do the teams have the right members?
  • Do all the teams report to an oversight committee?

The answers to all of these questions should be yes; if they aren’t, these are the areas to implement and work on. The oversight committee must have representatives from leadership to frontline staff and should work to keep your initiatives on track and moving toward a common goal, says Qaderi.

Share the plan

Before creating a strategic plan for organizational excellence, ensure that frontline staff is involved, Qaderi says. Invite feedback as well. Every employee of the healthcare organization should understand the hospital’s plan and vision. This is the beginning of destroying silos, in which every department runs QI projects separately from each other, resulting in interdepartmental communication breakdowns. Departments should not be competing for QI resources, which, of course, is counterintuitive, he says. 

Qaderi suggests a good method to test whether an organization has an aligned vision throughout the entire staff. “If you were in an elevator, and you are riding in the elevator with the housekeeping staff, if your housekeeping staff can explain what the hospital’s vision is and his or her role in that vision in the next couple of minutes, then yes, you have a clear vision and an engaged workforce,” he says.

Engaging staff should be accomplished by including them in the development of the organization’s strategic plan, says Qaderi.

“Show frontline staff why this is important. Show frontline staff how their work is tied to their goal and explain how the initiative will improve care and improve their work,” he says. “If you have them involved in the early discussions, you will have an engaged workforce.” Then, keep them engaged by understanding their schedules and the best way for them to take in information. A quick huddle that reiterates the initiative is a good way of getting the message across, says Qaderi. 

“As we know, everybody is stretched for time, and time is money. And we in healthcare also have a short attention span,” he says. 

Long department meetings don’t always effectively catch the attention of staff; a daily or weekly huddle to review important issues can help inform staff without overloading them, says Qaderi.

Understand your best resources

Many PI teams are run by middle managers who were excellent clinicians and promoted within. But Qaderi says hospitals that fail to provide leadership training to those managers risk wasting one of their best resources: their employees. 

“They may lack skills on how to use process improvement tools and knowledge of when to use them,” says Qaderi. If team leaders fail to keep the team focused and motivated during meetings and they are not accountable for follow-ups, chances are the team will not achieve its objective and will also leave members frustrated.

Qaderi says this is the area to invest in to see organizational improvement, either through in-house training or leadership retreats. “We have to put our resources into it. We need to put our money into it if we are going to improve,” he says. Middle managers need to be able to communicate the vision of the hospital to frontline staff and serve as a crucial bridge. 

If you have inefficient managers, you are wasting their time and their team’s time, says Qaderi.

Additionally, keep in check how many task forces, teams, and committees you have working on QI initiatives. Qaderi says most hospitals have too many. “Because it’s so hard to let go. That’s our problem. We don’t want to let go. And that’s causing us to stretch our resources,” he says. 

Don’t stretch your best clinicians too thin because champions often wind up on multiple committees, putting them at higher risk for burnout. Also, quality leaders should understand that new frontline staff may not have enough knowledge or training to fully depend on them to implement QI methods.

Prioritize initiatives

Prioritizing which initiatives are going to be implemented is a necessary component of organizational alignment. Qaderi suggests using a standardized method for prioritization.

“Ask whether the initiative is mandatory. Ask if it can be implemented by adjusting a current task force’s objectives. If it can be accomplished without creating a new task force, it should gain higher priority,” says Qaderi. 

It’s also important to look at the data and identify common, overarching opportunities for improvement throughout the hospital.

“Quality directors need to start with having reliable data and slicing and dicing the data to identify key opportunities to improve,” says Qaderi. “When you do mock tracers and rounds, look for common themes. When you do assessments, such as patient and employee satisfaction or culture of safety assessment, the data will produce common threads to focus on.” 

“There are some initiatives that we know work on quality, safety, and service, such as hourly rounds or improving patient flow. An organization should have those proven initiatives in place”—and not just on paper, says Qaderi. 

In the end, Qaderi stresses the importance of starting change at the frontline and management levels. 

“What happens if we wait around for change to happen? Nothing,” says Qaderi. “Every department and every employee must understand their role. Change doesn’t start at the top, it starts with middle managers and frontline staff, but we need leadership to keep the momentum going.”

Editor’s note: Qaderi can be reached at