The FMEA I wish I did
I failed again. This time it’s still too raw for me to embrace the learning quite yet. This will be my therapy: a thousand words or less to help me reflect, discern, and grow.
It was a “right care, right place, right time” project. The literature says that colon cancer screening with an at-home fecal immunochemical test (FIT) is just as effective as a colonoscopy. FITs are much less expensive and invasive for patients so, how do we influence patients to choose FIT? This was the scientific question at the heart of the project. To answer it, the team would mail out different forms of outreach in a randomized experiment to see which is most effective.
Reflection #1: This wasn’t a great project for A3 problem solving. I still made an A3 because, let’s face it, everyone wants to see everything on an A3. But what is my role going to be if we weren’t following the A3 process? I hardly do research projects nor massive outreach projects. I found myself on a project that wasn’t appropriate for the method I’m most comfortable with, so I let the team proceed with no method at all. Oof.
To be clear, this project team put a ton of work into preparation and planning. We process mapped, we made estimates for volume & TAKT time, and we collaborated with the key functional areas: lab, mailroom, population health, and or course clinic operations. Despite our best efforts, disaster struck.
The outreach requires patients use a FIT kit and mail it to our lab. It’s a relatively simple process that can be completely blown up by the smallest oversight: an incorrect address on the pre-labeled envelope. What’s more, the FIT test is time-sensitive which means enough delay in being delivered to the lab can result in a terminated test. There are even more downstream problems which have to do with after-hours notifications to providers about terminated tests which I won’t go into here.
In the aftermath of discovering the incorrect address problem, a relatively new team member commented that we should consider performing an FMEA the next time we do something like this.
Reflection #2: I felt defensive. We DID prepare, a LOT. No, we didn’t follow the FMEA method but so what? Would an FMEA have really caught the address problem? Wait, why am I on defense right now?
Suppose I had performed an FMEA with the team. It is almost a certainty that the patient mailing process would have been identified as a critical process to evaluate. It is also reasonable to assume that, had we brainstormed opportunities for the process to fail, someone on the team would have asked about the mailing address. They may also have asked about patient labeling: Does it matter what kind of pen they use? (spoiler-alert: it matters, it really matters).
Reflection #3: Hindsight is 20/20, which means we ought not try to hold ourselves accountable for having knowledge of the unknowable. Instead, let’s be kind to ourselves and one another and not let the learnings from our failures evaporate behind a smoke screen of our own defensiveness.
Also, let’s do more FMEAs… Here’s when the American Society for Quality Control (ASQ) says they’re most helpful:
Written by Hurley Smith