The pipes had been safely stored in their case for the past 5 years. When I was getting ready to sell them it was the first time I’d had a chance to take them out and reminisce a little bit. My pipes were made locally by a world-renowned pipe-maker, Murray Huggins. (There’s a fascinating story about Murray on Oregon Public Broadcasting. If you want to learn more about him, just click here.) My pipes were a relatively early model, before Murray’s reputation had spread. He had experimented with different woods and designs prior to making my pipes, and was unsatisfied with his prior products.
***Best Practices***
He then took a pilgrimage to Scotland to meet one of the more famed pipe-makers of that time in order to learn better manufacturing techniques. That led to him using African blackwood, which is extremely hard, relatively rare and very expensive. This wood needs to dry for years before being shaped. Blackwood is still his primary media today. He copied some of the measurements of the Scottish pipes, and hand crafted my pipes from what he learned in Scotland. After making mine, he continued to experiment with different measurements on future models: tiny changes in the caliber of the pipe bores, or tapers, or distance between finger holes: it all made a difference to his ear. He’d often ask me to bring back my pipes so he could measure some detail in an effort to reproduce it. Through trial and error, the instrument he had made for me had turned out to be a very good approximation of the ideal instrument he aspired to make. After more trial and error for a few years, he eventually came up with designs that were so good that he now has several months’ of order backlogs from around the world.
***Elimination of Variation***
Finding the right calibration for the internal dimensions of the pipes was just part of his journey towards excellence. He also needed to change his work process to eliminate random manufacturing variations. What started as a manual manufacturing process—subject to random errors in measurement or drilling or whatever—is now more hard-wired. He has manufactured his own machining tools that make each bore, each taper, and each instrument, the same. There is still the randomness or creativity of working with individual pieces of wood, or the design craftsmanship of the exterior of the instrument, or even with the reeds that generate the sound into the pipes, but the music-making pipes are as reproducible and standardized as they can be. Customers can rely on consistent sound quality without random variation.
***Strategy***
The other standard that he has maintained is that—despite the huge backlog of orders—he still does all the manufacturing himself. He has a strategic vision for his little business, and he stays with that vision.
***Culture of Always***
In healthcare, efforts to systematically eliminate or reduce randomness are underway. Replacing random is the “culture of always.” Evidence-based practice and best practices are not just buzzwords, they are actually the basis of our hospital reimbursement from CMS (Centers for Medicare and Medicaid Services) starting in two years. Those best practices are known as the Medicare “Core Measures.” Simply put, they are well-established procedures that decrease morbidity and/or mortality, or that improve outcomes. Processes like giving prophylactic antibiotics before surgery, providing aspirin in certain situations, and starting antibiotics for pneumonias within a certain time-frame. If we fail to do those things each and every time that they are indicated, we will not only have inferior outcomes, but we will be penalized in our reimbursement. Some hospitals will not be able to survive with those sorts of payment reductions.
Those who have been through our DNV accreditation surveys will also see some parallels with how DNV views the survey process. Their surveys focus on two aspects of hospital quality.
***Standards***
First is adherence to CMS standards (which DNV summarizes in their NIAHO—National Integrated Accreditation of Healthcare Organizations—standards).
Second, DNV looks for adherence to our own policies and procedures. In other words, they check to see if we have hard-wired and standardized what we do, or do we simply write policies and follow them “sometimes?” This part of an accreditation survey relies heavily on the methods of ISO 9001 (International Standardization Organization), which is a proponent of documenting intent through policies, procedures, and such, and then following through on that intent. Standardization in a healthcare organization—as in bagpipe production—eliminates undesirable variations in the outcome.
In addition to Core Measures, CMS pays based on customer satisfaction. High customer satisfaction also requires that we perform at the same high level each and every time we interact with patients. We, as individuals, will continue to have personally “bad days,” but we can no longer accept patterns of bad behavior. CMS is already measurings our patient satisfaction. You (and all of our potential customers) can see the result on the government’s website.
The satisfaction “score” is based only on what are known as “top box” answers. Top box are the answers that are at the top tier of the scaled responses. For example, one of the standard questions asks patients to rate the responsiveness of the hospital staff. In scoring the hospital, CMS only counts the number of responses that indicate that staff was “always” responsive to their needs. “Sometimes” answers count the same as “never.” This is different from the past, where our Press Ganey scores were weighted according to the number of each of the scaled answers. “Always” is is now our only goal.
***Always***
Of course, it’s not just one type of employee that needs to be in the “always” mode. Each person working in the hospital, from registrars to doctors to therapists to phlebs to administrators walking the hallways need to be always aware of how they shape the patient experience, how they contribute to safety, and how they can contribute to assure that other staff do the same.
***Never-ending Quest for Excellence***
If you check that link above, you’ll see that in nearly every question, we score higher at RVMC than at competing hospitals. To put this in perspective, I recently assisted in an interview of a candidate for an executive position at Asante. When I asked what attracted him to this system, he said, “Asante has so much going for it, most hospital systems around the country are envious of what has been accomplished here. You really do have a strong reputation around the country. But what really impresses me is that the leadership at Asante is not satisfied with what has been accomplished: They strive to achieve the next level of excellence. This is the type of place that I want to work.”
-bp
No comments:
Post a Comment