The Quality Improvement Challenge. Richard J. Banchs

QI team is most effective when its members help create the conditions that allow key stakeholders to solve the problem that directly affects them.

A QI project is a partnership between four key actors: The Primary Sponsor, the Local Sponsor, the frontline professionals, and the QI team. The Primary Sponsors are the senior leaders who provide resources and legitimize the project; the Local Sponsors are the mid‐level leaders, managers, division heads, and departmental leaders who support the project, engage the front line in project activities, and support the change; the front line professionals are the people responsible for operationalizing the improvement and change; and finally, the QI team. The fundamental role of the QI team is to be the facilitator (see Figure 6‐1):

       Facilitate the role of the Primary Sponsor. The Senior leaders and Primary Sponsor are the project authority. The role of the Primary Sponsor is general oversight and legitimization of the process improvement efforts; allocation of resources; communication and influencing opinion; and opening doors for the QI team. The QI team can help the Primary Sponsor by providing continuous updates on the progress of the project, coordinating the calendar of activities for meetings with the front line, and providing message content for written communication, meetings, and presentations.

       Facilitate the role of the Local Sponsor. The Local Sponsors (managers, division heads, departmental leaders) are responsible for the success of the project at the front line; they are the QI team’s project partners. When the Local Sponsors support the project, they are important ambassadors for the change; they have a key role in project activities and acceptance of the change. Local Sponsors are responsible for making the improvement possible. They keep the front line informed and engaged, provide resources, coach performance, and arrange for training. The QI team can facilitate their role by providing continuous updates on the progress of the project, helping them coordinate calendar of activities for meetings with the front line, providing message content for written communication, meetings and presentations; and sharing tools, processes, and techniques to help sponsors with project activities and change management.

       Help the front line be engaged and succeed. The front line has a crucial role. They are the project owners and should be engaged in understanding the problem, finding possible causes of poor performance, co‐creating solutions, and working through the technical aspects of the change. The QI team can facilitate their engagement by frequent sharing of information, creating the conditions for change (the Change Space), and providing coaching and training on the new process.

FIGURE 6‐1 The role of the QI team.

THE FIRST TOLLGATE REVIEW

      Periodically, the improvement team needs to confirm that they are on the right track to achieve their project objectives. This is best done through a tollgate review with the Primary Sponsor. A tollgate review is a go/no‐go checkpoint where the team leader, team members and the Primary Sponsor meet to discuss ongoing project activities, review results and deliverables, and assure that the project is on track. The first tollgate review should be scheduled with the Primary Sponsor soon after organizing your team, at the end of the first “R”: the “Right People” (see Chapter 25).

EXERCISE: THE QI TEAM AT HEART MEDICAL CENTER

The Leadership at Heart Medical Center would like to reduce the long patient wait times in the emergency room (ER). Preliminary work has identified turnaround times (TAT) on routine blood and urine analysis in the main chemistry lab as the major causes of delay. You have been asked to assemble a team to address the issue. Using the hospital’s list of available personnel (see Table 6‐1), select six team members for your QI project.

TABLE 6‐1 Heart Medical Center Hospital Roster

Hospital Roster: ER & Labs
Name	Department	Position
Alens, F	Laboratory	Shift supervisor
Andrews	Laboratory	Lab tech
Anselmo, L	Administration	Hospital CMO
Bronch, G	Laboratory	Lab tech
Constatnts, D	Laboratory	Lab clerk
Deli, M	ER	ER physician
Dormund, M	Laboratory	Senior lab tech a.m. shift
Efram, N	ER	ER clerk
Gild, R	ER	ER nurse
Goldsmith, H	ER	ER nurse
Goldstein, S	ER	ER physician
Hussain, H	ER	ER clerk
Kundenman, B	Laboratory	Lab tech
Libra, F	ER	ER physician
Manheim, N	ER	ER nurse
Monroe, J	ER	ER medical director
Opostini, C	Laboratory	Senior lab tech p.m. shift
Smith, A	Pathology	Director of Pathology
Vitorini, K	ER	ER physician
Woldenbaum, B	Laboratory	Shift supervisor

      REVIEW QUIZ

      1 A team leader should be chosen on the basis of all the following characteristics EXCEPTgood process knowledge,respected by the front line professionals,excellent interpersonal and communication skills,leadership position in the organization, orgood facilitator.

      2 All