Change Is Not a Dirty Word

"We no longer have the luxury of sitting back and waiting for things to happen." -- John Pieno, Florida Sterling Council President

It's true -- today's economy seems to be moving faster than the average business can keep up. Entrepreneurs and managers no longer have the luxury of being able to attract lifetime customers simply by offering a good product or service. There are too many other companies looking to do the same thing, searching for the same customers.

To compete, therefore, a company must continually improve its products and services. That means change.

At the 8th Annual Quality Team Showcase, held Aug. 27 at the Barbara B. Mann Performing Arts Hall, the buzz was all about change: how to make positive changes in methods, equipment and -- perhaps the most difficult -- attitudes.

The Team Showcase was a joint effort by The Chamber of Southwest Florida, the Quality Improvement Network of Southwest Florida and the Florida Sterling Council. All three organizations consist of everyday entrepreneurs, managers and employees who want to improve their companies using the Sterling Criteria for Organizational Performance Excellence, a methodical approach to improvement derived from the internationally-recognized Malcolm Baldridge Criteria.

The Florida branch of the Sterling Council is the brainchild of John Pieno, a former cabinet officer under Gov. Lawton Chiles. His initial goal was to implement a top-down quality improvement program for state bureaucracies. After a massive grassroots approach, the Sterling Criteria spread into other organizations, both public and private. Today, the Florida Sterling Council holds it annual competition, featuring winning teams from each of the council's regional groups -- locally, it's the Quality Network of Southwest Florida, which is affiliated with both the Sterling Council and The Chamber of Southwest Florida.

Competition and Quality

At the Aug. 27 showcase, six employee teams representing local organizations showed how they went bravely into the uncomfortable territory of self-evaluation, measurement and process improvement. The result for all involved: a better product or service.

The competing teams came from several different areas of business. The Ritz-Carlton Naples generated two competing teams, one for improving room maintenance and one for speeding up the employee hiring process. Another team, Lee Memorial Hospital in Fort Myers, came from the healthcare industry. And from the public sector, the Florida Department of Children and Families generated one team, while affiliate G. Wood Pierce Hospital of Arcadia hosted another.

All teams gave 12-minute group presentations on how they successfully improved a product or service using the methods that make up the Sterling approach to quality improvement. Additionally, a team from Florida Power & Light presented a quality team strategy for reducing the number of meter reading errors, although the team came only for exhibition purposes and did not compete for the Region Five title.

Diagnosis: Improvement Needed

The winner of the local Sterling award, G. Pierce Wood Memorial Hospital Team, used a methodical approach, comprehensive planning and improved communication to reduce the number of restraints placed on psychiatric patients over the course of a year. The team sought to reduce invasive intervention as much as possible in dealing with such patients, making for an overall better experience for both patient and staff members.

It wasn't an easy task for the 12-member improvement team, named CURE for "Cut the Use of Restraints Effectively." The use of restraints, after all, was to prevent patients from hurting themselves and hospital staff members. Therefore, the team had to examine not only why the restraints were being placed on patients, but why patients were requiring them so often.

The group identified several root problems from both patients and staff members. Patients felt their needs weren't being met, they were refusing medications or they were copying the behavior of other patients. Staff members had ingrained beliefs about the use of restraints, they weren't recognizing patient warning signs, they weren't all skilled at the same level, they were short staffed, they were inconsistent with rules, and they felt unsafe.

From a treatment standpoint, the CURE Team found that there were several planning factors that were also to blame, including a lack of follow-through on behavioral therapy and not enough communication between treatment teams and direct care staff members.

After determining all these root causes and collecting input from staff members, manager and patients, the team came up with solutions and began to implement them. For one, the team asked patients themselves which methods to use to calm down potentially violent behavior. The team also developed individualized plans for patients deemed to be at high risk and a plan to consult with staff members involved when a patient required more than two restraints in any 30-day period.

To ward off some lingering attitudes and fears from staff members involved, the CURE Team involved staff members in the planning process, developing practical alternate methods of calming down patients other than restraints. And pizza parties were held for both staff members and patients to introduce the program.

The result: the use of restraints plunged from a high of nearly 80 a month to nine for the month of August -- that's an 89 percent decrease. Tangibly, the hospital also saved $123,000 annually in costs associated with extra staff time involved with restraints. Staff injuries, too, have fallen significantly since the program was implemented, from a high of about 35 to less than 10 a month.

Intangibly, the hospital has also made changes improving the dignity of patients and increased overall satisfaction for both patients and staff members. Seven other mental health hospitals have since approached G. Pierce Wood to study their CURE program in hopes of implementing similar changes.

In addition to G. Pierce Wood's Region 8 win, the teams received awards based on audience rankings:

The Best Team Spirit Award -- The Ritz-Carlton CARE ("Clean and Repair Everything") Team, improved guest satisfaction with Ritz rooms, improved employee satisfaction with getting the job done and raised the revenue available per room.

The Most Significant Reason for Improvement Award -- The G. Pierece Wood CARE Team took on the task or reducing the use of patient restraints while protecting employees.

The Most Impact on Customers Award -- Lee Memorial LEE ("Living the Vision Equals Excellent Patient Satisfaction") Team decreased care response time and customer satisfaction for the 5 North floor.

The Most Effective Use of Quality Tools Award -- The Florida Department of Children and Families District Eight Sanctions Te