Читать книгу The Quality Improvement Challenge - Richard J. Banchs - Страница 30

The VOC is the expression of the needs and expectations of the customers. In healthcare, patients are our “customers,” and their needs and expectations should drive our QI efforts. However, as in healthcare, most organizations have two types of customers:

1 External customers. These are our patients. We launch improvement projects to address their needs, concerns, and expectations. When we listen to our patients at the point‐of‐care, review patient surveys, or speak to their families we may find patients’ expectations are not met. We may then ask ourselves, how can we improve the care we provide and make their experience a better one?

2 Internal customers. The internal customers are the staff and providers at the front line. Sometimes the customer is not the patient. Frontline staff and providers depend on others for the work they do. They are the end users. Clinical practice involves caring for patients. But to care for patients, providers and staff need consultations, diagnostic imaging, lab work, demographic and insurance information, nutritional services, and so on. Providers and staff provide services to patients, but in turn depend on other providers and staff for their work. When these providers and staff receive the work product of other providers and staff, we call them customers. The providers and staff that perform services for other providers and staff are called stakeholders. Stakeholders are the professionals “doing the work.” Improvement initiatives sometimes are needed to improve the work products our internal customers receive. Example: When you, as a provider, order a chest X‐ray, you are the “customer,” not the patient. The patient will benefit from the treatment approach you prescribe and is the ultimate and last customer. But for the chest X‐ray, you are the customer. What will happen if the radiology technician routinely takes an hour to show up? What if the official reading of a STAT chest X‐ray takes a day? What if a large number of chest X‐rays are overpenetrated, underpenetrated, or miss the costo‐phrenic angle? You, the customer, will not be happy (and rightfully so!). Based on the VOC (internal customer), the radiology department may decide to initiate a QI project.