Quality Improvement Process Steps: Four Types of Team Members to Help With at Your Sites

In contrast to the leisurely pace of my canoe trips the world of healthcare is fast-paced and sometimes quite changeable. Currently, there is a demand for significant change in the delivery of healthcare in the United States. There are numerous articles in medical journals, a plenitude of surveys and even political campaigns that tell the medical profession that change is urgently needed to ensure delivery of quality healthcare to all citizens.

The Institute of Medicine in its "Crossing the Quality Chasm" lists ten important principles that a healthcare provider should follow to fully meet the patient's needs; the principles are based upon patient-centered care. A recently completed survey by the Commonwealth Fund indicated that 9 out of 10 surveyed indicated they thought it important that a primary care physician should be responsible for the coordination and delivery of all medical care to a patient. As we know, this seldom happens in healthcare in the U.S.

Fortunately, many healthcare sites are responding to these pressures, even though funders are not very supportive in general. Hospitals are adopting the techniques of Lean Quality and Six Sigma to improve at their sites. The capacity to deliver coordinated care at the primary site is being established as the Patient-Centered Medical Home. If funders and purchasers of healthcare adequately support this movement it seems that there may be a significant improvement in the delivery of healthcare in the U.S.

I believe that the best healthcare providers will respond to these pressures as the best businesses respond to the needs of their customers. In responding to these demands these healthcare sites will have healthier patients, a better bottom line, and more time to get things done. Numerous studies of hospitals that responded to the call of improved quality through continuous improvement programs have reaped the benefits. For instance, St. Luke's Hospital in Kansas City dramatically improved their bottom line by 15% as it sought after and won the Baldrige Award for Quality in Healthcare. The transformed project of the American Academy of Family Medicine reports improved income for physicians who adopt the medical home concept.

Sites that want to respond to the challenges of improved patient focus must have the capacity or build the capacity to be innovative. Phil Crosby, a quality improvement guru, stated that "Innovation is the process of converting new knowledge into new products, services, and processes. Innovation in an organization can take place at a system, process or product level." For healthcare providers, the focus of innovation should be at the system and process level. Innovation, as I mean it here, is not just the "aha" moment of a new invention, but also the capacity to develop the new idea into a system or process that better meet the needs of patients.

There are many tools that are necessary to carry out the work of implementing new systems and processes. Some of the tools are team building, quality leadership, process mapping and process improvement, and kaizen events. Another is knowing the various strengths of your people so they can focus on the areas where they can make their best contribution. I would like to dwell a bit on this. A recent article in the American Society of Quality's "Quality Progress" magazine by Peter Merrill, "In the Lead," listed four types of contributors who are necessary to the innovation process if it is to be successful. They are Connectors, Doers, Creators, and Developers. He went on to list the characteristics of each. Let me briefly list them here.

A Connector

A Connector connects the dots, needs to understand, doesn't like being told what to do, likes to think things through, likes to see the big picture, and likes to define problems. A Connector won't necessarily be strong in all of these characteristics but will possess most.

A Doer 

A Doer likes to get things done, make things work, prefers facts over theory, has high energy and takes risks and pushes for acceptance. A Doer possesses most of these traits.

A Creator

A Creator likes to think in terms of possibilities, see situations as having good and bad sides, doesn't fuss with details, likes to hear about problems and own them, and likes to find out the facts. A Creator possesses many of these traits.

A Developer

Finally, a Developer likes to bring things down to earth, likes right answers, likes to analyze data, likes precision and plans and tends to be very focused and thorough. Scientists and mathematicians frequently fall in this category.

I suggest that as you build teams at your site, assuming that you want to rise to the challenge of finding innovative ways to be more patient-centered at your site, that you try to populate your teams with these types. In order to identify the chief characteristic of any particular employee, you might want to have him or her examine the characteristics, without the labels of Connector, Doer, Creator, and Developer but still grouped into the four types, and circle the traits that they think most closely resemble the way he or she works and thinks.

The one with the most circles is probably that person's type in the innovation process. I scored high in Creator closely followed by Connector and Doer. If you don't have a team member whose highest scores represent one of each of the four types, it is perfectly fine to choose someone whose second highest strength is in one of the missing categories.

If you desire to know more about the Innovation process which is necessary to create systems and processes which are patient-centered, you should get a copy of the September 2008 issue of Quality Progress. You can find out information on how to do so at the American Society of Quality's website,  or you type in the author's name and purchase the article if you are not a member of ASQ.

If you are committed to responding to the call for improvement with a patient focus, I suggest that you focus on the capacity of your site in terms of the capacity of your employees, the understanding of various quality tools which you deem could be useful at your site and the development of leadership which is committed to the innovation process. Be sure to include quality improvement team members which meet the criteria described above.