By Cynthia Jones, BSHA, CPHQ
After nearly seven years as a quality leader in the outpatient oncology setting, I still remember my first days as a newcomer to ambulatory cancer care. I had many years of experience in large acute care hospitals, where quality roles are fairly well defined and quality priorities are well known: Risk, mortality, readmissions, cost, regulatory needs, and data-driven metrics are the norm.
However, one measurement is important in all care settings—patient perception.
Coming from an inpatient background, I was the new kid on the block. I needed to not only explain what I was doing there in the outpatient setting, but also engage cancer program staff so that they would lead the process of identifying quality priorities in their unique areas of cancer care.
One of the first requests in my new role came from the radiation oncology manager and team. They were struggling with patient perception survey results, which were below the organization’s goal. Nothing they did seemed to make a difference.
As a quality officer, I could see numerous areas of improvement; however, it was not my job to fix things, but rather let them discover the issues and gaps that were right in front of them every day.
It was time to go to gemba.
Walking the Walk
A Japanese word meaning “go to the place” or “place where work is done,” gemba is a Lean process that asks unbiased observers to see what is happening around them. Put simply, during a gemba walk, participants “go see, ask why, and show respect.” They walk through the processes of care, ask why things are being done that way, and respectfully take notes without confrontation.
I scheduled a one-hour gemba walk with the radiation oncology team.
My instructions were simple. I asked the team to split up and work in pairs, and then divided the pairs into two groups. Each pair was given a pen and a pad of paper. One group was asked to tour the cancer care facility as the health system VP, and the other as a patient newly diagnosed with cancer or their family member. This way your perspective shifts and you’re seeing facilities and workflow from a business, competition, and especially a patient perspective. Patients and their loved ones are not only absorbing life-changing information, they are also looking for the best place for treatment.
From their assigned perspectives, the radiation oncology staff observed their care environment. They sat in the waiting room, rode in a wheelchair, laid on a radiation table, waited in an exam room, and scanned the facility from ceiling to floor. They took notes, and then came back together an hour later to discuss their findings.
When the notes were compiled, they had around 100 observations. As they sat in chairs, they noticed the need for cleaning and maintenance. When they laid on the treatment tables, they noticed cords and cobwebs. They saw outdated magazines, overfilled trash cans, broken tiles in the bathroom, walls in need of repair, crooked pictures; as busy providers they walked by all of these things every day, but when asked to look as patients and leaders, the need for change became apparent.
We took these observations and turned them into data points that showed our highest areas of need, and we triaged action plans to address the identified issues. Staff learned how to request facility repairs and act on their observations instead of walking by. Their perspective changed. And so did their patient perception scores, improving over time to meet—and even exceed—their organization-wide goal.
The role of quality leader is not necessarily to fix things. Often, it is to help others see existing problems for themselves. Through gemba walks, management and staff can learn to by stepping outside of their daily routine and seeing their facility and their workflow with new perspective.
ACCC member Cynthia Jones, BSHA, CPHQ, is a Certified Professional in Healthcare Quality, Cancer Quality Program, REX Cancer Center, UNC REX Healthcare.