Quality Principles and Alzheimer’s

by Robert J. Carrico

I am fortunate to have a wonderful family, as well as great friends, neighbors and clients. I have also, however, witnessed at least one person in each of these groups suffer from Alzheimer’s disease.

Alzheimer’s disease is the most common form of dementia, and it involves memory loss and other cognitive impairments caused by brain dysfunction. Currently, there is no cure.

Many of us who deal directly with quality principles and tools in our professional lives see how we can apply them to areas outside of our jobs. For me, this has been especially true in dealing with dementia among those close to me.

My experiences with them, which have included part-time caregiving, caused me to become an Alzheimer’s Assn. volunteer several years ago. This organization, whose mission also covers related disorders, is staffed with caring people who have a great deal of knowledge about the disease. Many of them have had a loved one suffer from dementia. The staff also seems to have an intuitive grasp of the principles of quality.

In business, we focus on customers when gathering information about their needs. I have noticed we also do this when dealing with someone who has dementia. In the latter case, however, the needs are not often stated explicitly; they are usually unstated and must be inferred and anticipated.

To understand these needs, we try to sense the real meaning of behaviors, and we are told that we must “get into the reality” of the person with dementia. To hear the voice of this customer, we must listen very closely.

Using Quality Tools

An arsenal of problem solving and prevention tools is essential to the assurance of quality in a manufacturing environment. It is also necessary when dealing with a person with dementia. We might not be articulating the formal steps of preparing a process failure mode effects analysis (FMEA), but this is, essentially, what we are doing when we plan a safe and comfortable environment for this person.

For example, we might use contrasting colors to distinguish a door from a wall or a plate from a table because dementia can result in difficulty making perceptual discriminations. Another example is labeling doors to prevent failures that can result from memory impairment.

Control plans are essential for keeping a manufacturing process in control, and I have also found them to be important for managing the often unpredictable behavior of someone with dementia.

Although not formally stated, the control plans are in the mind of the caregiver. For example, the reaction plan for bringing the erratic and sometimes violent behavior of a person with dementia under control usually includes redirection. When redirecting his or her attention by changing the subject, activity or setting, out-of-control thinking is often aborted and calm restored. The reaction plan might also include fast-acting medications for more severe situations.

A clear example of problem prevention and patient safety is Safe Return, a national program administered by the Alzheimer’s Assn. and law enforcement agencies for the safe return of those with dementia who wander off. Many of the families with whom I have worked have enrolled in this program. Six of 10 people with Alzheimer’s will wander off at some point, and about 50% of those who are not found within 24 hours will either die or suffer serious injuries.

Reducing Variation

The principle of quality that is most on my mind when I am in the presence of someone with dementia or his or her caregiver is variation reduction. Variations in behavior are obvious to anyone who has confronted this disease in which the same stimulus can elicit completely different responses at different times. The uncertainty that this unpredictable behavior causes might be one of the greatest sources of stress for a caregiver.

When we think about how often we count on the predictable responses of others as we conduct our everyday affairs, it is not difficult to see why caregiving is so stressful and why elderly caregivers of someone with dementia have a 63% higher mortality rate than their same age peers. The preventive measures discussed earlier can help reduce this variation in behavior.

The quality objective in this situation is quality of life. With these examples, we can see the principles and tools of quality help meet that end. I might have had the advantage of formal training in these principles and tools, but I really think that many of those who confront Alzheimer’s disease and other dementias learn them very quickly on their own.

ROBERT J. CARRICO is president and owner of Carrico & Associates, Franklin, MI. He earned a doctorate in cognitive psychology and a master’s degree in mathematical statistics from Wayne State University in Detroit. He is a member of ASQ and belongs to the organization’s Healthcare Division. He is certified as a quality engineer, reliability engineer and quality auditor. Carrico is also a volunteer advocate with the Alzheimer’s Assn.

I worked in mfg. for 17 years and have made a switch to healthcare. The thought of applying FMEA's and Control Plans to this environment will be extremely beneficial.
--Brenda Georgenson, 05-06-2008

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