Patti Cullen's Blog

Doing it All: Quality Improvement and Operational Excellence

by Patti on Thursday, April 26, 2012 10:00 AM

Some members love to work on quality improvement, but are held back by some operational realities such as “my nurse manager just left for higher wages” or “the survey team just walked in.” Sound vaguely familiar?

As we just completed our first Quality Symposium, and I listened to the vigorous discussion at our Quality Council last week, the dilemma of “raising up” quality as a driving force in the midst of day-to-day operational crises has been front of mind for me.

I think quality is so important, but I know all members haven’t been able to step out of operational overload to envision themselves as leaders in the practice of quality.

One of the profession’s quality “gurus,” Jeri Reinhart from Benedictine Health Systems, referred me to “Emergence: 2011 Future of Quality Report,” which I read after the last Quality Council meeting. I wanted to share a few quotes from that report, then try to reconcile the push-pull between performance excellence and operational overload.

“The quality community must raise its voice and say, 'through quality all of our goals can be realized.”

“Quality is not an accident and comes from more than good intention. Quality can’t be taken for granted. When the importance of quality is reduced in any way, processes fail to work, mistakes are made, and we will all pay for that day of reckoning.”

“Quality is not today what it was in 1996 or even 2008 for that matter. Those who lead the practice of quality are leading change and finding themselves moving up the strategic ladder and making a huge difference in their organizations.”

The Future of Quality report (available at identified the upcoming trends in the practice of quality:

  • A larger role for quality in strategy

  • Enterprise quality

  • Expanding complexity and scope

  • From product/service-centric quality to experience-centric quality

  • Quality culture

  • Waste reduction

  • Quality in every field endeavor

  • New roles for the quality leader

Admittedly it can be difficult for linear thinkers, for task-oriented regulatory compliance followers to adjust their thought process from direct linear to global process thinking. I personally find it more difficult to conceptualize quality processes than to try and solve issues like trying to restore long-term care coverage from undocumented residents. I am learning though. I learn a great deal from members immersed in quality processes — one of the resources distributed at our Quality Symposium was a detailed glossary of quality improvement terms and acronyms, so now I just look up what I didn’t know rather than “fake” the knowledge!

I also have learned over the past few weeks about incremental action — it is OK to take smaller steps as long as you are going in the right direction. Many members don’t recognize that what they are doing is indeed quality improvement — they collect and analyze data; conduct root cause analysis when issues/problems are identified, and take action to correct the situation — all key components of quality improvement. I am excited for our new partnership with the Minnesota Council on Quality, where I intend to “soak up” whatever I can about organizational assessments and the Baldrige criteria for performance excellence. In the near future I will highlight some of their well-tested assessments/resources. When my brain starts hurting from the uncomfortable thought adjustments, I may just convert to a few new practices I learned at our first (but not our last) Quality Symposium.

For example, as Dr. Gifford explained the four goals of the Quality Initiative campaign for all American Health Care Association/National Center for Assisted Living (AHCA/NCAL) members, some simple “how do we get there” things were discussed:

Focus on foundational principles of quality

  • Start with some basic principles

    • Adaptive vs. technical changes

  • Follow Baldrige criteria (e.g., Quality Awards)

  • Measure practice (e.g., LTC Trend Tracker & Dashboard)

  • Rely on staff to identify & make changes

Collaborate with others

  • Advancing Excellence & LANES

  • QIO program

  • Partnership for Patients

  • Our own members

Realign reimbursement to support quality

OK, so I really didn’t give great guidance about balancing operations and quality improvement — they are both very important and you can’t do just one or the other. Many would say if you have your quality improvement systems in place, your operational issues will take care of themselves.

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