IHI.org - A resource from the Institute for Healthcare Improvement
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Organization of Health Care:
Assign Accountability for Continued Clinical Improvement at All Levels of the Organization
  1. Encourage the senior leaders to provide time for a day-to-day team leader to manage the initiative.
  2. Assign accountability for day-to-day leadership for continued clinical improvement.
  3. Ask the senior leader to identify an enthusiastic and respected clinician to champion the work and the team. Establish accountability of the clinical leaders for improvement activities. Ensure that clinical leaders develop improvement knowledge and skills.
  4. Have the clinical leader spearhead the engagement of other senior leaders. Ensure that the clinical leader reports to staff and the center about improvement activities.
  5. Gain the partnership and trust of the CEO and the medical director so that they will formally delegate authority to the team to make change.
  6. Select the improvement team and establish a regular meeting time. Make leaders and the team accountable for improvement.
  7. Engage administrative and clinical staff in the improvement activities, so that people at all levels are aware of the beneficial changes.
  8. Regularly evaluate the team process as evidenced by regularity of meetings and reaching set goals.
  9. Make maintaining the progress part of ongoing work and part of all job descriptions.

Tips
  • Ask the medical director to advocate for providing sufficient time for the day-to-day leader’s work.
  • Provide education on leadership.
  • Consider rotating the role of physician champion to avoid burn-out.
  • Choose a physician champion with the following characteristics:
    • Commitment to improve/change the system
    • Ability to articulate needs of the team without alienating others
    • Willingness to be a team member
  • Invest time and resources in improvement training for clinical leaders.
  • Demonstrate the benefits of clinical leader participation.
  • Avoid overloading the physician champion by using the team leader to deal with day-to-day activities.
  • Include support of and participation in the improvement activities in the annual evaluation for all staff.
  • Look at past performance of staff members when choosing the team.
  • Ensure that the improvement team knows how to graph and display measurable progress.
  • Assign meeting tasks, such as facilitating, timekeeping, taking minutes, and preparing overheads.
  • Use process measures, such as percentage of kept appointments or number of adherence interventions, and outcome measures, such as CD4 count or viral load, to inform care.
  • Keep tying improvement efforts to the organization’s mission and goals.
  • Include participation in improvement actvities in job descriptions.