Performance improvement with a hybrid FOCUS-PDCA methodology.

Abstract

BACKGROUND: In 1995 a team of three members of the quality improvement (QI) department at Hardin Memorial Hospital, Elizabethtown, Kentucky, constructed a unified, simple system of tools and activities drawing on the foundation of FOCUS-PDCA and integrating it with the Joint Commission Improving Organizational Performance (IOP) function and language. METHOD: The team developed documentation tools and educational activities to support each part of the cycle for improving performance: plan--a planning workshop; design--a hybrid FOCUS-PDCA model; measure and assess--a three-part indicator workshop; and measure, assess, and improve--a redesigned QI report form. To document the entire cycle, the team developed an IOP Notebook and a workshop introducing it. Requirements for process design were established based on the standards. Next, the C phase, traditionally interpreted to clarify the current process by flowcharting, was broadened to include internal and external clarification of the process. APPENDIX-USING THE FOCUS--PDCA HYBRID TO REDESIGN AN ANTIBIOGRAM: The hybrid model's hallmark is its flexibility in supporting projects where the need for redesign over improvement is not clear at the outset. In a year-long study in 1995, a "Critter Ridder" Team at Hardin Memorial Hospital used the model to design an innovative antibiogram. In the C phase, customer input was gathered from physicians and a literature search was conducted to identify other antibiogram formats. The team constructed the antibiogram to meet key quality characteristics-accessibility, information, accuracy, timelines, and layout. Documentation on the IOP Notebook templates demonstrates the team's implementation of the performance improvement standards in its design.