Resources & Information


A culture of continuous improvement

Many state medical boards fall victim to the timeworn stereotype that, as monopolies, regulators are free to be mediocre. That’s not the case with the North Carolina Medical Board.

The Board has, for the past few years, been very focused on quality and creating a culture of continuous improvement. When I was appointed, I was pleased to learn that members of the Board were interested in capturing metrics and applying business principles to NCMB’s work. Some of the early discussions about how best to do this contributed to the decision by the Board and staff to invite an independent team of observers, all working in medical regulation in
jurisdictions outside North Carolina, to evaluate the Board’s internal processes and overall operations. The outcome of that review, which took place in 2012, was largely complementary of NCMB, but it did offer several recommendations. Among these was the endorsement of NCMB’s inclination to begin measuring certain work processes to identify opportunities to improve efficiency, quality and service. This in turn led the Board to begin tracking key performance indicators (KPIs) in 2014.

Measuring quality is challenging for a regulatory board. There simply aren’t many recognized external measures of Medical Board quality. Some organizations have used the volume of disciplinary actions taken to rank or grade Medical Boards. Generally speaking, these efforts equate larger numbers of actions with more effective regulation. I think this is ridiculous. Actual quality would be the elimination of all disciplinary actions through a system where licensees know the rules, follow the rules and don’t get into trouble. That, however, is a subject for another day.

The Board’s KPI initiative largely focuses on efficiency. How quickly can NCMB’s staff process license applications? How long do the steps of the complaint and investigations process take to complete? What internal factors slow down NCMB’s work and how can we reduce or eliminate these? What external factors influence the outcomes of the Board’s work and how can we positively affect these? These are just some of the questions NCMB has asked, and the process has driven helpful changes to how the Board manages workflow. I was a strong proponent of the KPIs initiative. As a physician who also completed an MBA I understand that, if you don’t understand your processes you don’t have the opportunity to improve them, and there is no real urgency to do better.

And NCMB is doing better. We know from our KPI data that license application processing times, once all documents and transcripts are received, have improved. We also know that internal review processes associated with NCMB investigations are being handled more efficiently, which means the Board is completing its investigations sooner, offering timely closure for both patients and licensees. We are continuing to gather data and analyze workflow to identify ways to improve.

The latest stage in NCMB’s development as a self-reflective organization is the Board’s adoption of a 2015-2018 strategic plan that sets goals in several areas, including outreach & transparency, financial strength and policy, among others. Each strategic priority in turn has several specific subgoals. The Board reserves time during each Board Meeting to review progress towards goals and discuss challenges and next steps. Writing goals down, determining benchmarks and tracking progress ensures accountability.

I think it’s important for licensees to understand the culture Board Members and Board staff have built and will continue to nurture. This is not an organization that is complacent. We are not a Board that is afraid to take a hard look at how we are doing. We are committed to doing better and being better, and that benefits both licensees and the people of North Carolina.