Family doctors are discovering the value of quality improvement to improve how they care for you. Using strategies borrowed from business and industry, they are learning to identify specific practice goals, design innovative tests of change, measure and evaluate the changes, and incrementally improve their daily practice.
I’ve been teaching this approach to my colleagues and their practice teams in small group learning sessions with the Practice Support Program, an innovative peer-teaching program under the direction of the General Practice Services Committee.
Before considering potential areas for change, we identify problems – the barriers that are preventing you – our patients – from enjoying the best health outcomes. These barriers may include long wait times for medical consultations, procedures and investigations; communication problems; the costs and side effects of medications; and socioeconomic factors.
One process that can direct us where to focus the lens of quality improvement is root-cause analysis. This is the search for the factors that contribute to a problem, such as long emergency department waits or patients not taking their prescribed medications. Ultimately, we’d like to identify the root cause – the primary problem that is at the beginning of a long cause-and-effect chain.
One technique in root-cause analysis is the five whys, used by Toyota as well as countless generations of toddlers. In an attempt to get at the root of a problem, we ask, “Why?” repeatedly (five is just a guideline) to each response.
Why is the doctor running behind? The previous patient took extra time.
Why? He had more complex problems than could be managed in a single visit.
Why? The medical office assistant (MOA) didn’t know the patient had so many problems.
Why? The patient didn’t tell her.
Why? The MOA didn’t ask when she booked the appointment.
You don’t have to be running a factory, a large organization or a medical clinic to apply quality improvement to your life. The principles can help each of us in our quest to achieve our personal potentials.
What are the barriers to you achieving your most important goals, enjoying mutually fulfilling relationships and experiencing personal wellbeing?
Look for the root causes. Start asking, “Why?”
After applying root-cause analysis to every problem I came across, I made a surprising discovery. There is one underlying cause of all the problems in the world.
The root cause of all of our problems – the opioid crisis, alcohol and drug abuse, war, poverty, crime, prejudice and discrimination, abuse in all its forms, hunger, global warming, the extinction of plant and animal species, and the unaffordability of housing in Vancouver – is the false belief in a separate self: the illusion that we are completely separate, disconnected individuals, separate from all others, our and others’ families, our neighbours, our and others’ communities, our nations and other nations, life on this planet and Earth itself.
This myopic delusion obscures the truth that we are all connected; we are community, humankind, nature, life and the planet; and we are each responsible for the health of our neighbour, coworker and classmate, our community, humankind, all life and our planet.
Dr. Davidicus Wong is a family physician. For more on achieving your positive potential in health: davidicuswong.wordpress.com.
