Work on What Matters Most

One of the major causes of TQM and Six Sigma failures is selecting the wrong project. This selection is probably one of the most important decisions that management can make to support the improvement process.

There are many approaches that can be used to select projects. They range from management intuition to complex analyses of how the processes affect business opportunities. I will show you a weighted selection approach that is effective, using a health care example.

In this approach each opportunity is evaluated in a number of parameters. For example:

A) Changeability = 2 points

B) Reduce cost = 2 points

C) Decrease mortality = 5 points

D) Improve patient care = 4 points

E) Improve staff morale = 3 points

F) Reduce wait time = 1 point

Each of these parameters is weighted by a point score from one to five. A rating of one indicates that it’s low priority, and a rating of five indicates that it’s very high priority.

In figure 1, there are four typical improvement opportunities listed with the six parameters. Although only four improvement opportunities are listed, in reality the list could contain dozens. Some of the typical opportunities for a health care program include:

• Reducing inpatient wait time

• Reducing billing errors

• Reducing pharmacy errors

• Reducing response time to bed calls

• Reducing record errors

• Improving risk management

• Improving medication administration

• Reducing critical-care recovery time

• Standardizing procedures for different treatments

• Reducing the outpatient processing cycle

The six evaluation parameters are listed A through F in the top row of the table along with the related weighting factor. Each of the improvement opportunities are evaluated on a scale of 1 to 5 for each evaluation parameter. A rating of five indicates that the opportunity will be easy to take advantage of or that it will have a great effect on the health care profession. This rating is then multiplied by the weighted factor for the parameters being evaluated to define a score for the opportunity/evaluation parameter combination. For example, “Reduce billing errors” is evaluated at level 2, which means that it is rather difficult to change. Column A (“Changeability”) has a weighting factor of 2. The total score for the “Reduce billing errors/Changeability” combination is 4 (2 × 2 = 4).

By summing up the individual scores for each parameter for an opportunity, the total weight for that opportunity can be calculated.

Based upon the analysis in the table, “Medication administration records error rates” are the most important improvement opportunity. Prescription errors are estimated to kill several thousand people a year. You might think that physicians care more about their money than the health of their patients. When they write a check, they write out the figure and then double-check it by spelling out the amount. The same physicians scribble out almost illegible instructions on prescription forms. Errors are very common; for example, the interpretation of a prescription as 10 mg when 1.0 mg is correct.

Based on the results of this analysis, the executive team will typically select 10 to 25 critical processes to which the business process improvement approach will be applied. The number will vary based on the size and complexity of the organization.

Consideration should be given to balancing the work load within the organization and ensuring that all functions are participating. This approach concentrates attention on critical issues, sets priorities for resources, and ensures that the effort is manageable. Although it is a relatively simple and useful way to select business opportunities, this approach has a number of drawbacks, including:

• “Pet projects” are commonly identified.

• Management perspectives may not be supported by hard facts.

• Top management may sway the decision.