Give QI A Chance

In my last column I mentioned that managed care organizations seem to have lost interest in trying out some real, honest-to-gosh QI tools and techniques.  I thought I would use this column to suggest that you try out some QI tools and techniques generate ideas and establish priorities. 

I suggest picking an performance measure that is important but that seems to be stuck.  Don’t pick something big, like the equivalent of trying to solve world hunger.  Pick something focused, like trying to improve a specific HEIDS rate.  And keep it focused, don’t include a series of related HEDIS rates.  Just pick one.

Next, figure out which stakeholders are INVOLVED INTIMATELY in the process.  They may be your staff (in fact, no doubt some of them will be) but could also include practitioners, hospitals, health plan members, and maybe vendor staff.  Give this some thought.  The ideas generated will be a function of the participants.  You want a truly representative group of knowledgeable people.  Avoid having a lot of managerial staff involved.  And avoid stacking the deck with lots of folks from the same narrow slice of the organization. 

Bring the group together.  Ten to 15 people is probably a reasonable number.  Silence cell phones (seriously!).  Set the stage by telling the group what you want them to do.  It might be something like: “We’re here to generate ideas about how to improve our rate of optimal practitioner contacts for members with depression.”  Assure them that all ideas are welcome and that they shouldn’t hesitate to suggest anything that they think has a chance of working.

Next, give everyone five minutes to write IN SILENCE (yes, I really mean in silence) ALL their ideas about how to improve the optimal practitioner contact rate.  (Of course, if that’s not the task you’ve chosen, then give them five minutes to write down their ideas about the correct task). 

When everyone is done—there’s no need to hurry them along since this isn’t a time-limited exam.  Identify a scribe to write down all the ideas of the group.  The room should remain SILENT (yes, really) except for each person taking a turn reading one, just one, idea from his/her list.  If he/she starts to justify the idea or do anything except read it in a way that can be TRANSCRIBED (yes, I really mean JUST transcribed.  NOT edited.  NOT paraphrased.  NOT commented-on) stop him/her and ask him/her to just speak the idea using the words that the scribe should write down.

Similarly, if the scribe does anything other than transcribe, stop him/her and ask him to write down what the speaker is saying. 

Continue going around the room having each person read one idea at a time.  Continue round, and round, and round the room till everyone has read every idea.  Don’t allow folks to shy away from this responsibility unless you’re really sure that they’ve read every one of the ideas the wrote down.

Throughout all of this KEEP EVERYONE FROM TALKING—and most especially keep them from engaging the speaker in any discussion of his/her idea.  One of the factors that frequently inhibits creativity is the fear that one will have to justify one’s suggestions.  There is absolutely no need to explain one’s rationale for suggesting something.  All ideas are good ideas and, when you’re trying to come up with a lot of them, you don’t really need to know why they were suggested.

If you chose a representative group of stakeholders and followed the instructions above, you should have 3 dozen or more ideas.  At least some of them should be things you haven’t heard before. 

Now, if I were there with you, the next step would be to learn how to do nominal group technique to establish priorities among all the ideas—again without any real discussion.  But that lesson will need to wait for another column.

If you haven’t done this before, and you do it well, it can be a revelation.  In an hour you can go from no idea of what to do to improve something, to having a short list of really creative ideas with minimal discussion. 

You might have noticed a certain emphasis on form and technique in my instructions.  That’s because the success of this process depends on technique.  Without the discipline, silence, and lack of commentary you’d have little more than a regular meeting—and you already know what ideas that will generate.