Is it time to re-examine structure of your quality department? It may be an appropriate reaction to shifting market realities

HealthCare Benchmarks and Quality Improvement, Sept, 2004

"We've been using the interdisciplinary model since 1991," Bielanski explains.

"At this time, the enterprise is so heavy with so many people trying to represent things that we need to free up resources to have more time to devote to solving and monitoring and evaluating the solutions we come up with. We want to make [the structure] leaner and meaner to free people to do systems process improvement," she adds.

The current quality function is "a cast of hundreds," Adams observes. "We have unit-based geographic functions, hospitalwide functions, leadership functions. There is also a group or body outside the quality council that oversees the hospitalwide and the unit-based functions."

There is another issue driving the redesign, she continues. "We were trained to hold people accountable who were technically filling volunteer positions, so we are really trying to engage our senior leaders and look at accountability kinds of issues," Adams notes.

"We think that maybe some improvements weren't happening because we were asking the wrong people to be held accountable, rather than connecting the dots with leadership," she says.

To come up with a new plan, Adams created a strategic team of six individuals--the medical director, Chief Operating Officer, patient care services administrator/Chief Nursing Officer, patient safety manager, process improvement director, and herself.

"Our corporate strategic planning folks conducted some focus groups with all the participants, all the nursing medical directors, senior leadership, and then people on the existing committees and processes and functions," she reports.

In addition, the quality department did an intense analysis of accountability of committees, resources, strengths, weaknesses, regulatory requirements, and other key areas.

"We just completed a two-day retreat, and I think we were blown away with the complexity of the process," Adams says. "Some people thought we could spend a day coming up with a model, but we really want to streamline the structure; and I think we've come up with some innovative ideas we need to flesh out."

While a true model has not yet been finalized, one of the key recognitions of the group is that "you can't get a committee of gigantic proportions to do real work productively," Adams points out. "So we're adopting a model of three--it's a SWAT team approach to real process improvement, and I think we've done the right process."

A change in the structure will require a change in board bylaws, Bielanski says, "But we haven't had a problem yet. We have gone to most of the medical executive committee meetings and will go to the quality council tomorrow and the board next week. I don't think we will have an issue, because all the docs realize there's a problem they need to fix."

Bielanski says she is hopeful the bylaws can be changed within 30 days or so.

Know when change is needed

To make such improvements in the quality structure, you need to be able to recognize when change is needed, Adams notes.