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Oil and water may not mix, but two seemingly disparate quality techniques from outside health care have been merged "to derive a hybrid culture-busting, solution-finding methodology ready to be tried out in your organization," say Duke Rohe, FHIMSS, performance improvement specialist, and Estella Woodard, MS, clinical director of the Diagnostic Center at the M.D. Anderson Cancer Center in Houston.
The two techniques, GE Workout and the Osborn-Parnes Creative Problem-Solving Technique, were used in concert to address inadequate or insufficient use of the pneumatic tube system at Anderson. (See "Two types of thinking are essential for creativity," in this issue.) "We did not have a procedure in place," recalls Woodard, who notes that the safety department had made at least three attempts to put together a procedure that staff from several different areas (lab, safety inspection control, and nursing) could agree on.
This new, unorthodox approach was implemented during a five-hour session in July 2000. As the new system is utilized, these results are anticipated:
At first glance, the two techniques seem like opposites. The GE Workout is an intense strategy session involving as many a 40 high-level people, and the session does not end until a resolution is achieved. "It’s amazing how quickly personal agendas drop when all know they can’t leave the group until they discover a solution best for the group," says Rohe.
Osborne-Parnes is used to drive consensus toward the most effective solutions. Proponents say ideas flow at three times their natural rate. It involves "convergent" thinking, which filters out the unusable, and "divergent" thinking, which generates as many ideas as possible, no matter how wild they may seem.
"The GE Workout process is already beginning to be used in health care, but the workout session, the culture-buster side, had not been used," says Rohe. "Osborn-Parnes had probably not been used in health care because health care is notoriously naïve and tends to look inward for solution finding." Rohe says he was confident the two techniques could be merged, because "in creativity, one of neatest things is to take two disconnected ideas and make them work. I understood the workout process, and I had been a proponent of the brainstorming process."
Woodard says she enthusiastically supported the new approach. Right from the start, things were done differently. "We looked at the group that the safety officers had put together and realized that part of the problem was the people at the table were really not in a position to make the final decision," she recalls. All of the new participants chosen were either managers or they had decision-making authority.
A month of intense pre-work was required. Rohe and Woodard met with each participant and made sure they understood what was required of them. "We almost created the expectation that you were to come to this event and the solution would be found," says Rohe.
"As [participants] prepared, they would involve other people in their area, because many times there are solutions at the bench that managers won’t realize," adds Woodard. "It also made them feel more a part of the process, instead of feeling that something was happening to them."
As Rohe explains, the GE Workout session should include 80% of all the solution-finding decision making that needs to be made. "The team leader was amazed at the level of decision making; she could not believe how even the hard-sell members turned 180 degrees during the session," he says. During the Creative Problem-Solving, a high-energy session, "everyone was looking at the clock, which pressured them to move past their own personal solution to find the best team solution," says Rohe. Twelve members were split into two parallel teams; one team that refused to do Osborn-Parnes’ contributed only half of what the other team contributed. "This five-hour session was so power-packed, it felt like one hour," Rohe observes.
In the months following the session, as recommendations were implemented, "we have had zero spills," says Woodard. "The leak-resistant carriers are better than the ones we had been using. And because we have developed procedures that enable us to track where samples are sent, we have more trust in the system."
Not all findings were initially positive. "Even in the face of what we thought was a success, we found the system had a capacity limit much shorter than believed," says Rohe. "We’re now garnishing $100,000 in funds to get rid of the capacity limitations." Even that points out the strength of the process, however. "Every time we find another roadblock, we can find a solution using the system," Rohe explains.
Both Woodard and Rohe see future applications for the new system implemented at M.D. Anderson and for this hybrid quality technique. "We will use the tube system for a new building set to open in two to three years," says Woodard. "We’ll also use the session for customer service. It’s great — especially when you need to make changes quickly."
"We’re setting [the process] up for a GI clinic, to determine the best way to handle overflow patients," adds Rohe. "In addition, the thoracic research nurses are using it to improve the way they do things." Rohe is convinced that there are a number of opportunities for quality managers to discover new techniques outside the world of health care. "There are probably many more out there we are missing out on," he says. "Each institution needs to do its own internal exploration."
• Duke Rohe, FHIMSS, Performance Improvement Specialist, M.D. Anderson Cancer Center, Houston. Telephone: (713) 745-4433. E-mail: email@example.com.
• Estella Woodard, MS, Clinical Director, Diagnostic Center, M.D. Anderson Cancer Center, Houston. Telephone: (713) 745-4433.