Patience, flexibility are keys to quality program’s success

The safety improvement process at the Veterans Affairs Ann Arbor (MI) Healthcare System (VAAAHS) depended on a great deal of flexibility and input from the staff who would implement the solutions. These are some lessons learned in the experience:

  • You can get off to a fast start, but be very patient from then on.

The quality improvement team wanted to address the safety concerns quickly, but actually implementing the safety checklists took some time, explains Daniel B. Hinshaw, MD, professor of surgery at the University of Michigan Medical School in Ann Arbor and a staff surgeon at VAAAHS. Trying to bulldoze a new system into a unit can backfire. You can lose all of your buy-in from staff if they think you are trying to impose a new system from outside.

  • Empower everyone to suggest changes and take action.

Overcoming the hierarchy of a health care system can be difficult, Hinshaw says, but it is vitally important if you are to improve safety. Anyone in the unit must be comfortable with speaking out about a condition that could threaten a patient.

  • Provide feedback and results.

Once people are on board with the project, they will want to know how well they are doing. Marcia Piotrowski, RN, MS, clinical risk manager in the office of the chief of staff, says she quickly heard from irate intensive care unit (ICU) staff when she was slow in posting compliance data for the safety checklist.

  • Don’t rush the project into another unit too soon.

Hinshaw and Piotrowski are eager to implement the safety project in other areas of the VAAAHS, but they found out the hard way that you can’t rush the process. Soon after starting the project in the ICU and seeing some initial results, they tried to introduce it to another clinical unit.

"We thought we had laid the groundwork with the leadership in that department, but some unofficial leaders in the department complained to their superiors that it would take too much work," Piotrowski says. "Because of that, the administration had us back off and we haven’t gotten back to that unit since."

  • Don’t wait for every staff member to sign on.

Once you have the support of the leaders in the department, go ahead and approach the rest of the unit. Don’t wait for every single person to agree it’s a great idea, Hinshaw says. You’ll never get 100% support from the beginning, and waiting too long will just give naysayers time to complain.

"You need to listen well and promote the idea that this will be their project," he says. "That’s what will determine whether you’ll succeed, and that’s why it will never be the same project from one unit to another."