Realizing Improvement through Team Empowerment (RITE): A Team-based, Project-based Multidisciplinary Improvement Program

Abstract

Performance improvement in a complex health care environment depends on the cooperation of diverse individuals and groups, allocation of time and resources, and use of effective improvement methods. To address this challenge, we developed an 18-week multidisciplinary training program that would also provide a vehicle for effecting needed improvements, by using a team- and project-based model. The program began in the radiology department and subsequently expanded to include projects from throughout the medical center. Participants were taught a specific method for team-based problem solving, which included (a) articulating the problem, (b) observing the process, (c) analyzing possible causes of problems, (d) identifying key drivers, (e) testing and refining interventions, and (f) providing for sustainment of results. Progress was formally reviewed on a weekly basis. A total of 14 teams consisting of 78 participants completed the course in two cohorts; one project was discontinued. All completed projects resulted in at least modest improvement. Mean skill scores increased from 2.5/6 to 4.5/6 (P < .01), and the mean satisfaction score was 4.7/5. Identified keys to success include (a) engagement of frontline staff, (b) teams given authority to make process changes, (c) capable improvement coaches, (d) a physician-director with improvement expertise and organizational authority, (e) capable administrative direction, (f) supportive organizational leaders, (g) weekly progress reviews, (h) timely educational material, (i) structured problem-solving methods, and ( j ) multiple projects working simultaneously. The purpose of this article is to review the program, including the methods and results, and discuss perceived keys to program success. RSNA, 2016.

Creating a Radiology Quality and Safety Program: Principles and Pitfalls

“…When quality assurance activities reveal opportunities for improvement in operations, it is helpful to follow a standardized approach in performing the improvement activity; this could include using specific project management tools such as an "A3" structured problem-solving approach (Fig 2). Use of a team-based project-based model like the A3 approach that engages frontline staff-from reception staff to physicians-has been shown to successfully complete improvement proj-ects (29). Defining a specific broader improvement methodology for the department to use consistently (eg, "lean" management tools) will also help facilitate and standardize improvement efforts (30,31).…”

Decreasing Stroke Code to CT Time in Patients Presenting with Stroke Symptoms

“…project interventions that were in-flight and to demonstrate how they related to the overall project goals (Fig 6). The term A3 is derived from a standard size of paper (approximately 11 × 17 in [28 × 43 cm]) (14). Our A3 document incorporated a control chart, which established and displayed quantitative measures used to track improvements in the process.…”

Education Research: A novel resident-driven neurology quality improvement curriculum

“…In establishing these programs, Stanford committed to using Lean process improvement, including A3based problem-solving methods. 7 This approach outlines a systematic approach to process improvement that includes developing a problem statement, describing current state, and using fishbone and Pareto analyses to identify key drivers and subsequently link key drivers to interventions. 7…”

“…The content of the workshops was adapted from resources available at the Institute for Healthcare Improvement Open School and the Stanford Realizing Improvement through Team Empowerment program. 7,8 Each 2-hour workshop incorporated small group time to immediately apply concepts to real case examples.…”