Eight Steps To Improving Your Practice

Start Page: 54

A Brief History Of Quality Improvement

The current concept of quality management can be attributed to Dr. W. Edward Deming, who was a mechanical engineer for Western Electric. He was interested in improving processes so the outcome could be more predictable. The mode at the time to ensure quality was to inspect each and every part produced by manufacturers, tossing the unacceptable ones and keeping the good ones. He had observed that many American manufacturers were throwing out a lot of bad parts and felt there had to be a better way of managing resources.

Dr. Deming’s primary interest was looking at the process and then looking at the outcome. If there is an undesirable outcome, you need to fix the process. Henry Ford brought the concept of manufacturing assembly lines to reality but Dr. Deming was responsible for making sure that each handoff in the process was done to perfection. He was interested in fixing the process and if that is perfect, the outcome should be perfect.

When Dr. Deming introduced this to American industry in the 1930s and 1940s, they were not interested. So, Dr. Deming took his idea to any receptive audience he could find. The result led him to post-World War II Japan, where the automobile and electronics industry invited him to their country. The result was dominance by the Japanese, starting in the early 1980s.

By Steven D. Chinn, DPM, MS

All medical practices are essentially small enterprises, not very different from any of the Fortune 500 companies. Practices generate revenue by providing services or selling products. They also have expenses for staff, rent, equipment and insurance. There are also elements of marketing, finance, human resources, etc. Like all companies, podiatric practices are challenged by inefficiency and the desire to continue improving on their profit margins.
When the typical private practitioner hears phrases such as “Quality Improvement,” “Total Quality Management (TQM)” or “Process Enhancement,” these terms might create images of an assembly plant making better cars or airlines with excellent on-time departures. But how would you feel if you owned one of those vehicles with exploding tires? What would you do if you found out your plane did not have the scheduled maintenance check?
Healthcare has similar applications and expectations. The quality standards are based on years of experience, standards of care and research. The public has very high expectations as a result of this. They do not have much tolerance for physicians and nurses who make any type of mistake. With healthcare’s focus on patient safety, there are major initiatives to make sure medical errors are significantly reduced or eliminated. Although healthcare is considered a service industry, our product is alleviating people’s illnesses or injuries. We make people feel better.

Where Does Quality Improvement Fit In?
Considering medical practices are small businesses, the concept of quality improvement is really making sure all the systems are running at peak efficiency. This way you can manage things that cost your practice time, material or money and maximize things that can enhance revenue, whether it’s spending more time taking care of more patients, dispensing more orthotics or doing more procedures. Your bottom line can be either maintained or improved, depending on the economics of your environment. If the process is perfect, the outcome should be perfect.
The basic tenet is improving the process to enhance customer satisfaction. The customer is everyone who has contact with your practice. Customers may be your patients, their family and friends, your vendors, your family and friends, your staff and their family and of course, you.
What does it mean to achieve customer satisfaction? In the case of your practice, it might be more money at the end of week. To your staff, it might be less time-consuming, non-productive paperwork. To your patient, it might mean a better clinical outcome. To your family, this might mean seeing you at dinnertime, instead of 9 p.m. every night. The bottom line is different for each customer but the end results are what make the biggest difference.

With the challenges that are occurring for healthcare, the issue is one of efficiency. The field as a whole needs to look at ways of making processes and systems more efficient. Those in healthcare are working as hard as they can. The issue is how to work smarter.
How can you apply the concepts of quality management to your practice? Like Dr. W. Edward Deming (see “A Brief History Of Quality Improvement”), we are going to look at an eight-step process that will help you take your practice to the next level.

1. How To Identify Areas For Improvement
First, focus on areas that are problematic or can have significant effects on the practice if it were to occur. For example, how many times does the front office staff tear up the office trying to rectify one lost charge slip? The amount of wasted time, both theirs and yours, when you have to redo another charge slip can be astounding. Of course, the ultimate outcome of this, if the charge slip were not found, would be lost practice revenue.

image description image description

Post new comment

  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

More information about formatting options

Enter the characters shown in the image.