Why It Matters
When teams engage in quality planning, they spend less time dealing with problems as they arise and more time planning strategically to avoid them.
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Tired of Firefighting? Adopt a Quality Strategy

By Jennifer Lenoci-Edwards | Wednesday, December 4, 2019

You’re a health care system leader reviewing your emails. You see data that tells you your system’s patients with multiple chronic conditions aren’t reliably getting the care they need. Your finance team has new concerns about your system’s value contracts and their slim margins. You’ve just gotten word that your system is going to face penalties if your safety and quality scores don’t improve. Two team members on a unit struggling with low morale have called in sick. Again.

And it’s not even 9:30 AM.

Sound familiar?

The Oxford Dictionary defines firefighting in a business context as “the practice of dealing with problems as they arise rather than planning strategically to avoid them.”

Health system executives understand this all too well. They tell me they often feel like they spend most of their time putting out fires. Responding to these internal and external demands leave little time or energy for planning strategic aims.

As one executive recently put it, “How can I add one more thing to my health systems goals?” 

The answer is to take a different approach. Instead of constantly firefighting and using a piecemeal method to meet health system goals, build a proactive quality strategy that is built on your organization’s assets, opportunities, and organizational structure. This is what IHI is working on with Tampa General Hospital.

The Benefits of a Quality Strategy

Tampa General Hospital (TGH) is a large academic medical center. Laura Haubner, MD, TGH’s Chief Quality Officer, notes with pride that those who work at this safety net hospital caring for some of the most vulnerable patients along Florida’s Gulf Coast “feel they impact lives and outcomes.”

The organization’s leadership realized, however, that they needed more than their staff’s passion to fulfill their “zero harm to patients, team members, and physicians” pledge. Chief Executive Officer John Couris and the TGH leadership team developed a five-year quality strategy, to support their bold ambitions. Couris has stated that their vision is to be “the most innovative and safest hospital in America.”

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According to Haubner, using a quality strategy to guide their efforts, with guidance from IHI, has had multiple benefits:

  • Elevates quality as an organizational priority — Any health system has multiple priorities to manage. Haubner believes a quality strategy helps ensure “quality has an equal seat at the table.”
  • Defines benefits to patient care — According to Haubner, using a quality strategy to guide their work is “helping to create a clear line of sight from our strategic goals to the bedside.” Haubner reports that TGH is developing and implementing a daily management system to meet their organization’s bold quality, safety, and improvement goals. “We’ve realized that commonly used ‘big dot’ rankings are only meaningful when paired with everyday process improvements,” she says.
  • Makes clear that quality is a shared responsibility — Couris has shared the quality strategy at dozens of team member communication forums. This helps staff understand they all have a role to play in improving care. As Haubner asserts, “Quality isn’t just one person’s job.”

The Value of Listening

The ambition of their zero-harm goal has inspired and reinvigorated many staff members. “Aspirations are key,” Haubner says. “If you don’t think you can do it, you’re not going to.” She is also mindful, however, that the lofty goals of a quality strategy are meaningless if she doesn’t engage with those who aren’t yet convinced they are attainable.

For example, Haubner has learned the value of keeping the work manageable even as TGH strives for big aims. Using her QI experience and training, she understands the power of small, early wins. “We don’t spend a lot of energy convincing people whether zero harm is achievable or not,” Haubner says. Instead, “we decide what is achievable. Once we get there, we get together anmasd decide what’s achievable next.”

Haubner also overcomes potential resistance by avoiding the temptation to push improvement on skeptics. Instead, she engages multiple stakeholders from the start. “We make sure we learn from them,” she notes. “We don’t just tell them what to do.”

Juran’s Quality Planning

Quality Planning is part of Joseph Juran’s Trilogy. Juran defined Quality Planning as a means of “developing the products and processes required to meet customer’s needs.” For me, quality planning means optimizing the assets and structures of your organization. It means using data to build a strategic plan on a firm understanding of where you are and where you want to go.

There are many benefits of quality planning. Most of these benefits involve reducing the waste of misaligned and poorly coordinated quality efforts across an organization. Our customers (including our workforce) expect this kind of leadership. They rely on health care executives to initiate, guide, and monitor system design and improvement at the organizational level.

Quality planning requires executive team leaders to be curious and courageous enough to look closely at the inner workings of their organization. This is the expectation we set for Tampa General Hospital when IHI began working with them.

It’s been powerful to see how TGH is using their quality strategy to foster engagement across the organization. When teams build a quality, safety, and improvement structure that accelerates progress toward their health system’s goals, they spend a lot less time firefighting.

Jennifer Lenoci-Edwards, RN, MPH, is head of IHI’s North America Region. She also leads IHI’s customized support services.

You may also be interested in:

IHI’s Sustaining Improvement white paper

A Framework for Safe, Reliable, and Effective Care white paper

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