The Jigsaw Puzzle

 Omar Hasan, MD, MPH  Chief Quality Officer, MaineHealth

Choosing a suitable approach to accomplish a desired change can be challenging in the complex and dynamic hospital environment. Not infrequently, the person leading the change effort has a number of options that can be pursued to achieve the desired objective. Under these circumstances, it is helpful to choose the option that matches the complexity of the problem and the time available to address it. The schematic below illustrates this approach in a simplified way.

For troubleshooting minor issues, such as failure to consistently follow a few simple steps in a known protocol, applying Lean daily management (a part of MaineHealth’s Operational Excellence program, also referred to as ‘OpEx’) can help resolve the issue in a few short weeks. This same approach can also be used to address gaps from a known standard, such as failure to adhere to published clinical practice guidelines. In these cases, using OpEx methods and tools can highlight areas for improvement that can be prioritized for testing and implementing process changes using Plan-Do-Study-Act cycles.

Over time, technological advances or significant changes in clinical practice guidelines may require substantial redesign of clinical care delivery systems. This much change requires a more organized approach with appropriate attention to planning and project management. In some cases, rapid innovation or changing organizational needs necessitate a visionary and open-ended approach that leverages the full complement of systems engineering skills and practices to predict and manage the reconfiguration of teams and services.

As one engages in progressively more complex quality improvement projects over time, the morass of approaches used to accomplish change in a large teaching hospital begins to come into focus just like the picture formed by a jigsaw puzzle becomes clear as the pieces fit together.


Schematic adapted from Art Smalley

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