Updated August 30, 2013.

There are plenty of acronyms and labels for the many methodologies to improve a process. It can be daunting to the untrained. Most, if not all, of the process improvement methods do in fact require varying degrees of intensive training. One of the earliest, and longest-lasting, improvement acronyms can be explained in everyday speech, with language we use as we travel through our days in the hospital, in the clinic, in the lab, in the pharmacy, and even on the manufacturing plant floor.

Process Matters in Healthcare

The pressure is on to deliver better care, more affordably. Everyone in the healthcare production stream needs to pitch in to reach this goal. Devices, drugs, supplies, and equipment all need to be produced for the lowest possible cost. In the administrative and clinical areas of a hospital or clinic, there are many opportunities to reduce waste:

• Optimize staffing levels.
• Avoid medical errors.
• Avoid healthcare acquired infections.
• Optimize inventory so that drugs and supplies do not expire before they can be used.
• Reduce waiting times.
• Reduce transport times.

A Simple Plan

W. Edwards Deming created the acronym FOCUS-PDCA so that organizations could have a simple plan to eliminate waste in their production and service processes. This was a big shift from the old way of thinking. Before Deming started to persuade people to examine the process, companies typically only had a retroactive quality control effort. That is, a process or service would happen, and hopefully someone checked the result of that effort.

Anything that did not meet the benchmark standard would be re-worked. Deming's focus on process showed people that a greater impact on waste occurs when you begin upstream, by understanding the entire process, not just looking for the end result.

FOCUS-PDCA

F ind a process to improve
O rganize a team that knows the process
C larify current knowledge of the process
U nderstand the variability and capability of the process
S elect a plan for continuous improvement
PDCA, the acronym for Plan, Do, Check, Act, gives the team a cycle to test their improvement strategies one by one, in a controlled manner, to measure results.

Sample Improvement

So let's find a process to improve and work through this as an example.

• Process: Discharge process for hospitalized heart failure patients over 65.
• Team: Could include Chief of Cardiology, cardiology nurse, administration
• Clarify the process: The team meets to create a flow chart or process map
• Understand the process: The team measures the process as-is to determine a range of data, which in this example could be: (1.) what percentage of patients with heart failure, over 65, are readmitted within 30 days?; (2.) how long does it take the staff to discharge this type of patient?
• Select what to improve: The team chooses to reduce the 30-day readmission rate.
• Plan: The first plan they select is to set up heart failure patients over 65 with a connected health program upon discharge
• Do: The team implements this one change during a fixed time period
• Check: The team measures and checks the results of their connected health discharge intervention
• Act: The team acts on the results. If the intervention worked, then the team keeps this new program in their discharge process. They may even take some action to try to further improve their 30-day readmission rate reduction. If the test did not improve 30-day readmission rates, they would try another idea, and run it through the PDCA Cycle.

There are other, more complicated statistical tools, and methodoligies such as Six Sigma, that require intensive training. Deming's FOCUS-PDCA (some people refer to the "PDCA" Cycle as the "PDSA" Cycle...Plan, Do, Study, Act) works well when you need to create an early victory to get people on board with making changes for improvement.