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Continuous Quality Improvement initiatives at Queen Mary Hos

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Sam Gerlach

on 14 April 2016

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Transcript of Continuous Quality Improvement initiatives at Queen Mary Hos

Continuous Quality Improvement initiatives at Queen Mary Hospital

Case Background
1995-2000 hospitals in Hong Kong adopted CQI as a strategy for change and for improving quality while containing costs
How did the CQI unit lower the resistance and clear the path for change efforts?
How Important is CQI to the success of QMH? Using CQI, what hospital operations have been improved? What benefits have resulted?
Discuss how FADE, as a CQI model, is applied to the project “Food wastage Minimization.”
What are the specific steps necessary to achieve the desired objective of minimizing food wastage?
CQI advocated certain procedures:
-data collection and analysis to diagnose problems
-formulation of hypotheses for improvement
-conducting of experiments and the collection and analysis of data about their results
-revision of procedures based on such research
Using the QMH experience of implementing CQI, discuss the CQI concept and the processes involved in its implementation
Dr. Seto and Ms. Cheng helped establish the Continuous Quality Improvement Unit in support with the Infection Control Unit to create the CQI Unit.
What other factors or tools should QMH adopt to achieve the full potential of CQI?
Identify three major pitfalls of CQI and discuss their impact on operations.
How could other service-oriented businesses use CQI?
Discuss possible benefits, sources of resistance, and initiatives that may be taken to minimize the resistance to make CQI effective
Queen Mary Hospital established a CQI unit that focused entirely on improving the quality of its services to its patients. (FADE)
Originally used these four steps in its project “pre-operative skin preparation: shaving and Pre-operative baths” then the CQI’s intention was to administer the same CQI model in other areas, which was the “Food Wastage Minimisation"
The question for Queen Mary Hospital
would the same model, methodology, and approach work in implementing the new CQI undertaking?
1996 - healthcare was pioneered in the US
CQI has two definitions as described in the case is:
A managerial philosophy that seeks to create organization-wide participation in examining, planning and implementing improvements in the quality of services as defined by customers
A comprehensive management philosophy that focuses on improvement by applying scientific methods to gain knowledge and control over variation in work processes
Healthcare sector in Hong Kong
Considered to have one of the most advance healthcare sectors in Asia
offered expensive private healthcare, yet wrestled with problems and opportunities created by rising costs, new technology and government policies
Healthcare sector in Hong Kong cont.
Private hospitals accounted for less than 15% of the overall services provided and the rest by hospital authority (HA)
Queen Mary Hospital background
This hospital authority took over from the govt
the management and operation of 46 public hospitals
Start up seminars
Education and training in CQI
Collection of data
Identification of problem areas
Priority projects and implementation of quality improvement initiatives

Queen Mary Hospital established Clinical Audit Unit
Separate from the CQI
Facilitate all of the auditing mandate requirements
Each unit was audited on an annual basis
Any problems were submitted to the CQI unit

What are the causes of resistance?
The hospital staff at QMH was more worried about the health of their patients than to participate in the CQI.
Doctors were indifferent; many worked on their own and sometimes preferred to be treated as PRIMA DONNA.Meaning anyone who acted as if they were a world-famous talent
The concept was treated as CHING PENG (‘making cakes’ in Cantonese) or not a big deal by both physicians and nurses
Each group within the QHM guarded their own autonomy.
Pre-Operative Skip Preparation: Shaving and Preoperative Baths
Shaving was not needed in the pre-operation Standard Operating Procedure (SOP)
Physicians, surgeons, nurses and hospital staff were more susceptive to CQI after understanding firsthand the amount of time and money the process can have
Since the CQI team was able to demonstrate that the process can help not only the hospital, but also the staff, much of the QMH staff was susceptible to CQI and what it had to offer
Very Important
Allows the hospital to repair/replace current procedures to make them more effective (implementing pre-bathing before surgery to avoid infection)
Allows the hospital to remove unnecessary procedures to be for efficient (shaving patients when it was not necessary, disinfecting the surgical area twice before surgery)
Process educates patients and staff and involves them to providing their input and suggestions
Create a team working environment to problem solve
Saving the hospital time and money
74 less dressing packs used in a two week period by implementing pre-surgery bathing
Reduction of nurses work by 18 hours in two weeks by eliminating wound cleaning and shaving
Reduction of the amount of food wasted by hospital
Streamline Work Process Flow
Educate patients and staff
No one works together, many barriers between autonomous groups
CQI relies on employees buying into the process, which not many people at QMH do
Environment is resistant to change
Implement Kaizen
Error Reduction via Lean Thinking
In small businesses, error reduction can cause less defections that can become costly in the long run
Some defections are out of your control
Lean thinking strives to match or exceed the values of their customers and minimize waste as much as possible
Customer service adaptability via Kaizen
Gives employees responsibility in finding gaps in the system
Higher retention in employees is likely to happen due to the increased level of responsibility
Not all employees want that kind of responsibility
Creating a rewards program may create an initiative for employees
Improved morale in employees
By not blaming the employees, they feel more comfortable at the job and more invested in the company
Focusing more on the problems of the process, not the workers performing the process
Employees with higher morale can increase productivity and lower the employee turnover rate
Based on Jim Harvey's speech structures
On what they were doing wrong and what the customers were saying about them.
Complaints received:
Food portions were too big for female patients vs. too small for male patients
For elderly patients, the food was either indigestible or too solid
The rice served was undercooked
Internal Information
There was often excessive amount of rice
The Ward staff had inefficient order and request service
The data provided by the customers and research
(23%) 228kg/day
(28%) 112kg/day
Indicated that almost
Set objectives which were given to reduce the amount of food wastage and rice leftovers, and to streamline the work process flow.
Ask themselves how do we take these procedures and make them better?
Amount of rice cooked was the same regardless?
Develop a way to reduce the amount of rice every day
Inefficient order and request service
Had to be distributed by the main kitchen
How do we make this more efficient?
Portion Size
How do we get to a higher customer approval?
Implement the new systems and strategies into daily operations
Undercooked Rice
Implement Poka- yoke
chart/screen- above/near steam cooker that has the proper time needed to cook each ingredient
If results do not occur:
Steam Cooker
Standardize distribution equipment
Fair portion size
Unequal if different equipment is used
Same amount of rice cooked
Inefficient order and request service
Had to be distributed by the main kitchen
Three options:
Remove the service completely
Move the distribution to another smaller kitchen
Rework the service...
Indigestible and solid food
Meet with patients
Right foods for each individual
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