Making a List, and Checking It Twice

December 22, 2009

There is a popular lyric that is often heard this time of year: "Making a list, and checking it twice." In its original context, the list was made to determine whether someone was "naughty or nice." In our world of patient safety and quality, we don't need a list to determine naughty or nice; we need a list to help us keep our patients safe and ensure the success of the organization. Actually, one list isn't enough—we need three. In addition to all the checklists and tables that we use, consider where your organization stands on the following:

1. Do you have a list of all your processes?
2. Do you have a list of all your performance improvement activities?
3. Do you have a list of all your data?

We all work to manage and improve all of these activities, but often we forget the simplest of tools—the list. Maybe it is time to set a goal for 2010 to work on developing all of these lists.

Your Process List

The process list is the cornerstone of your process management program. It should list all the key processes in your organization and will likely be broken down into sub processes. Then what do you do with this list? Use it to prioritize your process management activities. Rank your processes by risk, complexity, impact on economics, and impact on regulatory compliance. Then start linking your process list with your occurrence reporting system and your data. Remember that the IHI is putting out some good material to help support your process list.

List of Performance Improvement Activities

The next list includes all those process, safety, and quality improvement activities that are being done. Where does this list come from? Start with all the corrective actions from your cause analyses, and then add the improvements from your FMEAs, performance improvement teams, accreditation audits, commitments to Leapfrog, and others. Before you know it, your list will include several hundred performance improvement activities—maybe many more than you realized. Next, group them together and prioritize the list. The top priorities you must get done; the items at the bottom of the list … well, maybe they just don't make the cut this year. Help your staff members know where to put their time.

List of Data

Consider committing to make a data inventory list in 2010. Think of this as your master list of all the data that you collect in your organization. Your supply management department knows all the supplies and equipment in its inventory—do you know what data you have in inventory? Remember, all that data is not free. In one way or another, you are paying with resources for every number and bit of that data. We can't afford to waste it or collect it and not use it. Once you make this list, connect it back to your process list; determine what data is still valuable and what data should be discontinued. Look for imbalances—for example, are you collecting a disproportionate amount of data in any one area?

All three of these lists are key management tools to help make sure that you are being effective in improving your safety, performance, and risk management. Feeling that you have control over these areas really does end up being pretty "nice."

Have a great holiday season, no matter how you spend it, and hopefully it won't all be spent at work!

Ken Rohde 12/22/09