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Sustaining Your Project's Improvements


By William T. Choctaw, MD, JD, CSSBB, Physician Advisor
The Joint Commission Center for Transforming Healthcare
Sustainability of improvements, or the continuous activity of a process/project at or above the achieved improvement level for a minimum of two years, is an invaluable element of all high reliability healthcare organizations. 
Nationally, many health care professionals are working assiduously on ways to develop and implement process excellence improvements to provide quality care and safety for their patients. Nevertheless, sustainability probably occurs in less than half of these endeavors. 
Sustainability is always difficult and almost impossible if you do not have a plan. Based on my experience with more than 200 Robust Process Improvement/ Lean Six Sigma (RPI/LSS ) projects over the last five years, I would like to share some of my “lessons learned”. 
A practical guide to establishing sustainability is as follows:
1. Define the problem – It sounds obvious, but if this first step is not adequately addressed, only chaos and confusion will follow. Albert Einstein noted “If I had 60 minutes to solve a problem, I would spend 55 minutes defining it and 5 minutes solving it.” In other words, scope the problem sufficiently so that it is solvable with your existing:
  • team
  • timeframe 
  • infrastructure

Improvements targeted to a well-defined problem are most effective.

2. Determine current state with quality data – It is important to be able to evaluate the size and impact of the problem. Is it significant enough to warrant time and effort? Quality data is important because a neutral reliable source is needed to make good decisions. The data should be transparent and reliable.  A process is needed to collect data and should include:
  • surveys
  • meetings
  • brainstorming sessions.
 Current state determination is actually an advanced form of defining the problem. It also helps the team clearly distinguish the problem (current state) from the improvement (future state).
3. Monitor the improvement – Here, there are two steps. First, an individual needs to be responsible for managing the improvement once the project is completed. This team member needs to be a process leader absolutely committed to the process and to the improvements implemented. The team member will be designated as “process owner“ for the improvements. Second, a reliable structured monitoring process needs to be implemented, using regular reporting intervals (weekly, monthly, or quarterly), and reliable data in a validated format (such as statistical process control chart, etc.). If an improved process is not monitored, no one knows how (or if) it is helping.
4. Plan for sustainability failure– The first principle of high reliability organizations is preoccupation with failure. A reasonable familiarity with the mechanisms of failure and a well-developed prevention plan is important . Although it is counter-intuitive, we must plan to prevent failure more so we can actually increase sustainability of our improvements. The team should ask itself one question – how can our improvements fail? Then, convert those issues to an action plan.
Finally, sustainability of our project improvements over time creates a positive feedback loop effect that allows us to do more projects for more improvements to help more patients. It strengthens our team confidence and fortifies our internal team relationship. Process excellence requires sustainability and we must stay relentless in our efforts. The success is in the journey!
William Choctaw, MD, JD, CSSBB is Physician Advisor for the Joint Commission Center for Transforming Healthcare, where he contributes on a variety of topics. Previously, he was Chief Transformation Officer at Citrus Valley Health Partners (CVHP) where he practiced surgery and was a member of the hospital executive team for seven years. In 2013, Dr. Choctaw launched a Robust Process Improvement/Lean Six Sigma program at CVHP, in partnership with the Joint Commission Center for Transforming Healthcare.