The Practice Success Prescription: Team-Based Veterinary Healthcare Delivery by Drs. Leak. Morris Humphries
Thomas E. Catanzaro, DVM, MHA, FACHE, DACHE
Organizations have different approaches for applying the Baldrige criteria in their self-assessment and action exercises. In the BNQP, repetition of application is very common, using the feedback mechanisms of the BNQP process to fine tune measurements and analysis of the organization self-assessment and action plans. As healthcare organizations strive for excellence, they alter their process to become either more formal or more informal, to achieve the self-assessments goals in the subsequent BNQP application. The basic ten steps are:
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Step 1 |
Identify the boundaries of the practice to be assessed. This step should ensure that all appropriate areas are included and that data and information are consistently collected from those areas throughout the self-assessment and action activities. In addition, it should ensure that self-assessment and action champions and team members are selected who are representative of these areas. |
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Step 2 |
Select seven champions, one for each Criteria for Performance Excellence category. In the healthcare criteria, the categories are:
 Leadership
Strategic planning
Focus on patients/clients, other customers, and markets
Measurements, analysis, and knowledge management
Staff focus
Process management
Organizational performance results
The champions must have both leadership and facilitation skills, as well as widespread knowledge of the practice entity. Enthusiasm and criteria knowledge are important assets in the self-assessment, planning, and action processes. |
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Step 3 |
Decide on the format for and scope of your self-assessment and action plan. This step should clarify expectations for what is to be accomplished and the resources needed to compete the task(s).Selecting a format to easily communicate the self-assessment results sets the stage for future steps. Communicating results of the self-assessment and implementing an action plan enables the organization to enhance alignment and better achieve common purposes. |
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Step 4 |
Practice owners and champions prepare the organization profile. Depending on the extent of the gaps uncovered, it may be valuable to move to Step 9, "Develop and implement an action plan for improvement". Developing an action plan and implementing improvements to close identified gaps will prepare you to complete a full self-assessment in the future. |
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Step 5 |
Practice self-assessment techniques with your seven category champions, using the Criteria for Performance Excellence as a guide. Practicing these techniques will help you learn how to use the criteria for self-assessment and action. Although you might start with an oral discussion or bulleted report in your first self-assessment and action planning process, in future self-assessments you can progress to a full written response of meaningful measurements, linkages, and analysis of the scope of the perceived results. |
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Step 6 |
Champions select category teams. Champions and teams prepare a response for their assigned items. Each Champion will guide a team of three to five enthusiastic and knowledgeable individuals through the next steps of the self-assessment and action planning process. Using the member's expertise, each team provides or obtains data and information to respond to the questions in each category item of the Criteria for Performance Excellence (ASQ publication T1116). |
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Step 7 |
Share responses among the teams and finalize the findings. Identify key strengths and gaps in category responses. Sharing responses should help you arrive at a common understanding of what the practice is doing, reach consensus on the strengths and gaps in the practice approaches, and share, learn, and improve the practice processes, as well as identify overall systemic Themes that cut across categories. |
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Step 8 |
Prioritize your practice's key strengths and opportunities for improvement. Prioritization will help you develop an action plan that most effectively uses available resources. Using the organizational profile at this point, to maintain a focus on what is relevant and important, helps the teams focus on what is really important for the most effective results. Decision factors are now addressing any resource constraints, strategic assessment linkages, organizational impacts, costs, time to implement, and people available. |
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Step 9 |
Develop and implement an action plan for improvement. The outcome of self-assessment is a road map for improving your practice entity An improvement action plan will include steps for achieving improved results. The action plan will include both short-term actions to keep the momentum alive, and the top priorities needed to make the results a "mountain top" achievement. |
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Step 10 |
Evaluate and improve your self-assessment and action process. Regularly scheduled self-assessment and action are key to ongoing improvement. By improving the self-assessment and action process, teams can reduce cycle time, gather more useful information, improve action plans, and achieve better results. |
What is an example of this process? In the self-assessment, a human hospital found that only sixty-seven percent of their M.I. patients had received beta-blockers, while cardiology doctrine was stating it should be one hundred percent. The hospital changed its nursing protocols and achieved one hundred percent beta-blocker dispensing, just by taking the prescription out of the doctor's decision process.
In another case, the hospital's nosocomial infection control policy was that all surgery patients should receive preventive antibiotics within four hours post-surgery, yet it was not happening. Again, the hospital changed its nursing post-surgery protocols and achieved one hundred percent preventive antibiotic administration within four hours (see www.creative-healthcare.com for applications of Six Sigma in human healthcare delivery).
Success in a companion animal veterinary practice is mostly defined by client perceptions. Some practices use twenty-twenty hindsight, while others actually ask their clients with the Council of Clients, as outlined in Building the Successful Veterinary Practice: Innovation & Creativity. A diagram of the expectation would look like:
By now, your head is probably spinning, mainly because the Baldrige criteria are based on measuring, quantifying, and assessing improvements in excellence of performance. They are a yardstick to measure excellence, but not the process of improvement needed. It is for this reason that the improvement process needs to be based on an enhanced system of change analysis, and that is why we are introducing your practice to the Six Sigma process.
| Figure 16: Three Main Six Sigma Targets | 
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