Quality Improvement Strategies I- Overview

            The Funnel Experiment, developed by W. Edwards Deming, demonstrates interesting aspects of quality care in healthcare settings (Mayo Clinic, 2012). A basic overview of the experiment consists of dropping a marble down a funnel in hopes of it landing on a marked “x.” Even when one drops the marble multiple different times, it may or may not hit the target. Sometimes this can be frustrating and so the person dropping the marble will try to change things in the system by moving the funnel’s position, changing the size of the marble, dropping the marble differently, and even changing the temperature of the environment. As time goes by with the marble dropping, even greater variation ends up taking place than what would have originally taken place had they stuck with the original method. In this example, Deming is trying to show that when well-meaning persons tamper with any type of system or process, outcomes only became worse over time and complexity greatly increases.  

            In quality improvement, it is best not to react to variations in a stable system. No matter what, all processes will vary and this needs to be remembered. Focusing on outcomes will generate better results than focusing on the processes leading to outcomes. The Funnel Experiment is a great analogy for healthcare quality improvement showing that strong leadership who remain focused on outcomes will generate better results and decreased costs.

            From the PowerPoint on chapter two (Sollecito & Johnson, 2013), I learned about the Checklist Continuous Quality Improvement methodology. It originated in aviation and has spread to healthcare. Implementing checklists has significantly decreased central-line infections and allowed for better outcomes in the surgical centers. To be most effective, the checklists depend upon effective leadership, interdisciplinary teamwork, use of a Plan-Do-Study-Act cycle, and engagement of experts on a global scale to improve safety.

            Research shows check-lists (and other QI processes) have been effective in improving care overall, but the question remains as to why healthcare continues to have errors and adverse events occur. Why has not much improvement occurred especially when so many QI processes are in place and available? Two key issues have been shown to not only impede the implementation and adherence of check-lists, but virtually all QI processes in healthcare. These are complexity and cost.  Experts have tried to simplify the matter showing that incentives for improvements, maximizing value and minimizing costs, with effective leadership is what will be most effective in improving quality in healthcare. Because healthcare is so complex, it requires diligence to spread the improvement process (Sollecito & Johnson, 2013).  
           I plan to be a strong leader by adhering to quality improvement processes and standards in my nursing practice. I plan to focus on outcomes and not tamper with systems even if I am well-meaning. My goal is to rally others together in the workplace to work as a team in improving processes. My efforts and their efforts can start improving healthcare at a small scale, but hopefully this diligence can spread.  

Reference

Mayo Clinic. (2012 May). The funnel experiment. Retrieved online from Youtube https://www.youtube.com/watch?v=2VogtYRc9dA&list=PLMB9evqeBMEjBxqB8dNS9CFhcsI0uHJIh&index=7

Sollecito, W. A., & Johnson, J. K. (2013). Mclaughlin and Kaluzny's continuous quality improvement in health care. Burlington, MA: Jones & Bartlett Learning