240 Applying Quality Management in Healthcare: A Systems Approach Summary Quality management is most successful when it is a bottom-up, team activity. The people personally involved in the process to be improved are best suited to identify the causes of performance problems and to propose and imple- ment solutions. Involving frontline staff in improvement projects also reduces resistance to change. This chapter describes the role of managers throughout the life of an improvement projectfrom chartering the team to selecting the improvement strategies to monitoring the results. Improvement tools and techniques are used during various steps of an improvement project. Many different tools and techniques can be used to document the process, uncover improvement opportunities, select improvement actions, monitor progress, and hold the gains. This chapter covers several of these tools and techniques, and students are encouraged to use the companion readings and web resources provided to learn more. Exercise 12.1 Objective: To practice creating a project charter. Instructions: Read the case study. Assume you are one of the two directors in the case study, and you are writing a team charter jointly with the other director to address the problems identified in the case study. Use the template in exhibit 12.1 or a similar format to document the project charter. Case Study: The directors of imaging services and surgical services in a hos- pital are discussing an improvement opportunity involving care provided to patients with breast cancer. The hospital is encountering delays for procedures actions, monitor progress, and hold the gains. This chapter covers several of these tools and techniques, and students are encouraged to use the companion readings and web resources provided to learn more. Exercise 12.1 Objective: To practice creating a project charter. Instructions: Read the case study. Assume you are one of the two directors in the case study, and you are writing a team charter jointly with the other director to address the problems identified in the case study. Use the template in exhibit 12.1 or a similar format to document the project charter. Case Study: The directors of imaging services and surgical services in a hos- pital are discussing an improvement opportunity involving care provided to patients with breast cancer. The hospital is encountering delays for procedures involving surgical removal of breast tissue (lumpectomy) in the area where an image-guided core needle biopsy has been performed. During the surgery, the removed tissue is imaged to ensure that the biopsy clip and microcalcifications are present in the specimen. The imaging must be done with a mammographic unit to provide visualization of the microcalcifications. Because the mammog- raphy machines are in the Breast Center, which is only open regular business hours, scheduling for the lumpectomy procedures is restricted to when a mam- mography technologist is available. This limitation causes delays as late as 8:00 p.m., and technologists must be paid overtime for these evening procedures. In addition, even during Breast Center operating hours, the breast tissue has to be packaged and delivered by hand from the operating suite to the imaging department and after the specimen is imaged, it must be returned to surgery, all while the surgeon waits with the patient still under general anesthesia. The hospital is not able to meet the needs of the surgeon for late cases, and even the requirements for cases during the day are not being fully met. more likely to be successful. This chapter describes how managers can increase the likelihood improvement projects will succeed. The first step is to charter the project, which involves clearly defining the project goals and scope. Next, the members of the improvement project team need to be carefully chosen. This chapter also discusses the improvement tools that the team will use to under- stand the current process and select the best interventions for achieving the performance improvement goals. Charter Improvement Projects Before embarking on an improvement project, the manager or managers in the departments or units the project will affect should establish clarity about the project scope (areas affected) and purpose (desired outcome). The more issues clarified up front, the less likely the team will be to experience false starts. A written project charter is essentially a contract between the organization's management and the improvement team. The project leader and the sponsoring manager(s) may jointly create the charter, or it may be created at the first team meeting. Issues that should be addressed in creating the project charter include these: Purpose: In one or two sentences, describe the purpose of the project. The brief explanations should define, in specific terms, what the project is expected to achieve. Objectives: List some of the measurable outcomes of the project. The objectives should answer the questions "How will we achieve our purpose?" and "What are the signs of success?" Deliverables: What are the tangible milestones anticipated along the way? What progress points can be expected? When defining deliverables, include dates--they add commitment and urgency to the project completion. Chapter 12: Using Improvement Teams and Tools 225 Team and team resources: Identify the people and resources needed to analyze, create, and carry out the purpose. Success factors: These are the essential elements outside the team needed to make the project successful, such as buy-in from the staff or financial resources. A typical charter consists of a one-page summary of critical details of the project, allowing all stakeholders to agree on the goals to be achieved, the scope, the time line, and the resources needed for the project to succeed. Exhibit 12.1 illustrates a project charter template. Project Title Purpose What are we trying to achieve? Objectives What are we trying to achieve? How will we know we got there? The new/redesigned process will (be specific): Deliverables The team is expected to complete the following: What must be done to By : achieve the objectives? By : By : EXHIBIT 12.1 Improvement Project Charter Template Project Title Purpose What are we trying to achieve? Objectives What are we trying to achieve? How will we know we got there? The new/redesigned process will (be specific): Deliverables The team is expected to complete the following: What must be done to By : achieve the objectives? By : By : Team and Resources By : Core project team members: Leader: Other members: Success Factors What leadership and resources are needed to make this improvement a success? People who have knowledge or skills that will be helpful for completing the project: EXHIBIT 12.1 Improvement Project Charter Template 226 Applying Quality Management in Healthcare: A Systems Approach Once the initial project charter is drafted, its completeness can be evalu- ated using the following criteria: It specifies, in detail, the performance problem to be addressed. It contains measurable objectives that include target goals to be achieved. It sets realistic deadlines and expectations. It contains defined time lines for completion of the project. It is relevant to the organization's strategic quality goals. If revisions are needed in the charter, the team should make them before the start of the project. Otherwise, the lack of clarity can eventually derail the improvement effort.