The Quality Improvement Challenge. Richard J. Banchs

satisfy to provide the high‐quality care or level of service the customer expects. You may need to go back to the patients or customer groups and clarify the exact meaning and specifics for each driver.

      6 Validate the CTQ tree. Validate the CTQs (attributes and requirements) with the customer. Ask the customers if this is what they mean and ask them if they agree with your characterization of their needs and expectations.

Once you and your team create the CTQ requirements, you will have a better chance to define metrics and focus the QI project on specifics. Project metrics are key to evaluating the success of the project in meeting the patient or customer’s expectations.

      Example: Patient Satisfaction with UI Health Outpatient Care Center

If our QI project aimed to improve patient satisfaction with UI Health Outpatient Care Center, we would first need to define what are the attributes and requirements of a visit to the Center that deliver the experience the patient expects. The first step would be to get the Voice of the Customer. Remember, these statements are usually too broad and lack specificity to be used as guidance in our improvement efforts. Once we got the VOC, we would develop the CTQs, or specifications that are going to make our patients’ statements meaningful, specific, and more importantly, measurable. To do this, we would group the VOC statements with similar meaning into families and then ask ourselves, “What do these statements have in common?” We would then summarize each group or family of statements into single‐word descriptors or “drivers” of patient satisfaction. We may need to dig deeper within the VOC statements to find specifics, or go back to patients to ask questions about the drivers. This would allow us to create one or more CTQ for each driver. The CTQs are the specifications for the attributes and requirements of the outcome the patient expects. In the UIH clinic example, CTQs would be: “greeted with a smile”; “registered within 5 minutes”; “accurate information”; “seen by provider within 30 minutes of my arrival”; and “availability of guest features.” The great thing about a CTQ is that it can be measured to establish our current performance, and audited to assess the degree to which we are continuing to achieve patient satisfaction (see Figure 8‐4).

FIGURE 8‐4 The attributes and requirements for patient satisfaction (CTQs) at UI Health Outpatient Care Center.

      Example: Improving the Organization of Medical Supplies in the EDRR

Assume you wanted to improve the organization of medical supplies in the emergency department’s resuscitation room (EDRR). First, you would need to define what attributes and requirements characterize a well‐organized EDRR. What does “well‐organized” really mean for providers and staff (the customer!)? How do they define it? What are the specific characteristics of the layout, organization of cabinets, and shelving that make it so? Following the steps outlined before, we would collect the Voice of the Customer, find the “drivers,” and, with a bit more work, develop one or more CTQs for each driver. It is always a good idea to validate the CTQs with front line providers and staff (see Figure 8‐5).

FIGURE 8‐5 The attributes and requirements for staff and provider satisfaction (CTQs) with the organization of clinical supplies in the ED’s resuscitation room.

EXERCISE: CTQS FOR THE NEW WOMEN’S CENTER

      The new Women’s Center at Lake Hospital had been up and running for the last three months. Dr. Sonia Watson decided it was time to launch a couple of improvement projects to improve patient care. She was eager to provide the community with the kind of service they had long waited for and deserved. For her first QI project, she decided to focus her efforts on mammographies, specifically to improve the appointment, registration, and follow‐up processes. Dr. Watson and her staff held several focus groups within the community to better understand their patients’ needs and expectations, get feedback from previous experiences, and identify critical requirements of patient satisfaction. The team recorded the following statements from their interviews:

       “When I go to a clinic, it’s really important for me to have staff that is kind and understanding.”

       “Mammograms are no fun! A smile at the other end is always welcomed.”

       “I really appreciate it when I receive a timely phone call from the doctor with my test results; ideally I should get it within a day or two after my scheduled appointment.”

       “My technician took good care of me during the procedure; she let me know what she was doing so I knew what to expect.”

       “It’s frustrating when I call to make an appointment and I cannot be seen for a month; I should be able to be seen in a week.”

       “The technologist that did my mammogram listen to my concerns and explained the procedure well.”

       “A text message is helpful to keep my appointments on track.”

       “I find it stressful to wait for test results for days on end and not hear back from my doctor; I think we should be called with results within a day or two.”

       “The staff at the clinic were really helpful; they gave me clear instructions as to when I would be getting my results back.”

       “I want to be able to get the results of a mammogram within a day or two in case it’s cancer! I don’t want to wait.”

       “I prefer to be seen sooner than later; the procedure is not pleasant and it makes me nervous having to wait to come in.”

       “I like when follow‐up appointments are scheduled during my appointment so I don’t have to call back once I leave.”

       “The clinic should provide us with some kind of written material so we can understand what is going to happen, as well next steps in case there is something wrong with my mammogram.”

       “Written instructions at the time of discharge are really helpful for me.”

       “Having a lump in your breast and not knowing if it is cancer is horrible, and the wait is agonizing.”

       “A text or an email reminder is a great thing to remind me when I am due for my next appointment; it really helps me not to forget my annual visits.”

       “My technologist was really helpful during the procedure; she smiled and made me feel comfortable.”

      From the VOC, develop the CTQs. Follow these steps:

       Group customer feedback (VOC) into families of statements with similar meaning. If needed, use an affinity diagram.

       For each family of statements, create the drivers, single words or short sentences, that summarize the idea, need, or expectation expressed by the VOC statements.

       For each driver, develop one or more CTQs; drill down to the specifics. Ask yourself: What does the driver or key word really mean to the patient? How can we measure it? Can you assign a specific descriptor? Make sure your CTQs are specific and measurable.