What’s the Plan?

Automakers’ method helps healthcare group create hybrid strategy

by Cecelia McCain

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Launching into a project without a plan is a blueprint for disaster. So, when ER-One of Livonia, MI, needed to transition the management of newly acquired hospital emergency departments (ED) to its organization, it turned to advanced implementation quality planning (AIQP).

AIQP rose out of the organization’s efforts to combine traditional quality planning with the concepts used in advanced product quality planning, a method employed by the Big Three automakers to define and manage projects.

The AIQP model consists of five planning phases that provide a common path for and synchronization of the transition team’s planning activities, while maintaining a rigorous focus on the client through each successive phase of implementation. This approach ensures all critical-to-quality areas are identified, analyzed and—if needed—improved prior to going live.

Here is how ER-One used AIQP (for a sample model, see Online Figure 1):

  1. Analysis: This phase included a site visit to the hospital to conduct a gap analysis, which used in-person interviews of key hospital personnel to examine the existing ED management processes, as well as those of the interdependent areas.
    The transition team compared the responses to the established requirements for managing an ED to identify gaps that needed to be closed prior to implementation. The team drafted a project plan, and provider recruiting (physicians, physician assistants and nurse practitioners) for the new site began.
  2. Pre-start: In this phase, quality improvement methods and tools were used to close the gaps identified in phase one. This included identifying provider orientation and training needs, such as training on the use of hospital-specific technology. The transition team initiated the provider credentialing and scheduling processes, and began developing internal and external communication plans.
  3. Implementation: This is the stage at which the project is most likely to lose momentum, falter and sacrifice any benefits gained in the previous phases. For ER-One, this phase included the development of ED management processes, results reporting, dashboards and quality assurance programs.

    The process required constant interaction between ER-One and the hospital administration to ensure processes, measures, goals and strategic plans directly linked to the hospital strategies and objectives. Sticking to the quality planning model is most essential in this phase.
  4. Going live: ED management was ready to go live, including the operational handoff from the existing management group to ER-One. The team conducted training and created an ED operations manual to ensure successful orientation of the providers to the site. The team implemented the processes developed in phase three and initiated ongoing process management, which included assigning responsibility (ownership) for each operational process.
  5. Ongoing operations: At this point, ER-One was responsible for ED management on an ongoing basis. This included managing the quality assurance programs, monitoring clinical and process results, and implementing quality improvement as needed to ensure the gains are sustained.

In addition to the five phases of the model, many quality tools were used, including implementation gap analysis, project plan, communication plans, process flow diagrams, job aids, failure mode and effects analysis, metrics, strategic plans, on-site orientation manuals, a quality assurance plan and dashboard reporting.

In the past three years, ER-One used AIQP to transition the management of ED clinical and administrative operations in four hospitals, three of which represented the company’s first opportunities to venture outside Michigan. All of the new acquisitions experienced improved patient satisfaction, increased patient volume and positive core-indicator compliance.

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Online Figure 1

Cecelia McCain is director of corporate quality at ER-One in Livonia, MI. She attended Davenport University in Warren, MI. McCain is a senior member of ASQ and is an ASQ-certified quality auditor and Six Sigma Black Belt.

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