I know that many of you want to make things better at your sitemake things safer, have your chronically ill patients become much healthier, get home on time from the office consistently, and much more. So, where do you begin?!! I like the answer given by Stephen Covey in The 7 Habits of Highly Effective People (if you havent read it yet, I highly recommend it). He says to Begin with the End in Mind. What can this mean? He states that all things are created twicefirst mentally and then physically. So, the first step is to have a vision of what you want at your healthcare site. Do you want to reduce infections 60%-70% if your site is an ICU? Studies at the Institute for Healthcare Improvement show this is possible. If you are a primary care physician, do you want to increase the income of your practice 10%-20%, leave the office on time, and also dramatically improve the health of your patients? A recent issue of Family Practice Management demonstrates how. If you have primary contact with patients, do you want to consistently know all the prescriptions that they take so as to avoid conflict in medication or other undesirable outcomes? JHACO is requiring hospitals to reconcile medications for all their patients. A May 23, 2006 article in the Wall Street Journal discussed how hospitals are improving in this area.

The point that I am making is to first have a clear vision of what you want to achieve. You cannot make any long lasting improvements if you dont have a clear and detailed plan. As a builder needs a clear and precise blueprint in order to build a property, so you too must have a clear vision.

You cannot have an achievable vision, though, without knowing what is possible. Knowing what is possible will require that you become familiar with some quality improvement tools. This will take some education on your part or the hiring of someone with expertise. Dont fall into the trap of the Management Flavor of the Month, though; such a pitfall was recently discussed in a column by Carol Hymowitz in a May 15 article in the Wall Street Journal. She stated that leaders often try solutions that are popular at the momentLean, Six Sigma, etc. Rather, you should find the tools from these and other management styles that you and others on the staff can work with easily or that an expert can easily deploy at your site. The tools you use should fit your site and the employees there. There are many good tools available. Be sure to include ones that improve communication among all staff members and patients. You might want to use a kaizen event, for instance. You will want to find out how things exist in their present state so you can benchmark your improvements. This will require some sort of mapping process and basic statistical measures. Be sure to write a manual of the processes you adopt so that new staff members have a ready reference on the practices you want to maintain. These and many other tools can be found on the American for Qualitys web site as well as the Institute for Healthcare Improvements website.

If you hire a consultant to help, be sure that they are have a variety of tools available. American Society of Quality certified quality engineers possess such tools. Be sure this consultant is willing to guarantee the results the two of you agree upon if you follow his/her recommendations.

What then, is your first step in creating dramatic improvements at your healthcare site? Begin with the End in Mind and become familiar with a variety of comfortable tools.