Quality Progress - June 2014 - 46

QUALITY IN THE FIRST PERSON BY GLENN MAZUR Saying Goodbye to Dad Family uses quality method to make difficult end-of-life decision MY DAD'S health was on the decline for care option, we should identify and priori- in terms of "easy on Mom," and "Dad is many years. But last spring, his heart's tize the criteria we use to determine "best." free from pain." Home options were highly condition deteriorated rapidly after a fall. We brainstormed ideas, structured rated for "can interact with family and At first, he just needed some help balancing them into a hierarchy, gave our opinions as he walked around the house. Within a and voted pair-wise, taking the geometric week, he needed help getting into and out average of our votes when we could not AHP model. The AHP model prioritized of bed. By the following week, he could reach consensus. Criteria (and weights) options by synthesizing the best care barely get up on his own. Because my Mom included, "easy on Mom" (0.256), "Dad is choice based on the prioritized criteria. was the only one home with him, the bur- free from pain" (0.409), "can interact with The leading option was hospital in the den of lifting and moving a grown man was family and friends" (0.196) and others. hospice with a priority of 0.283 and an ac- devastating to her back problems. Plus, there was the possibility she'd drop him. Pairing took some time to complete because of the emotions involved. We friends" and "comfortable surroundings." We spent less than two hours on the ceptable inconsistency ratio of 0.07. Dad was admitted to the hospital in the were frequently interrupted by visitors hospice, and we spent the last few days of to help Dad and provide input on his care and phone calls from well-wishers. AHP his life emotionally enjoying one another options. At first, a nurse's aide came to allowed us to pick up exactly where we instead of running around and taking care the house. We also considered hospice left off without rehashing agreed-upon de- of his physical needs. Dad died in his hos- care, but Dad was not ready to give up (a cisions. We didn't argue with one another pice bed with Mom and I at his bedside. requirement of hospice care). because we did not have to reach consen- He was lucid until the day before he finally sus and could individually vote based on exhaled and never inhaled. My two brothers and I went back home As we explored our options, differing opinions of family members created friction. My older brother, who had watched our opinions. Averaged results were entered in the Later, Mom raved to their rabbi about how I helped the family through this his father-in-law die of cancer in the AHP matrix. Using natural language (such difficult time. He was astounded because hospital, emphatically felt that Dad should as moderately or extremely) instead of decision making can cause incredible spend his last days at home among familiar numbers helped keep this on a human friction within grieving families. Decisions surroundings. Mom, who had the ongo- level rather than become a mathematical often take days or weeks and can alienate ing burden of caregiving, wanted him in a exercise. We could even address judgment some family members. place where he could be tended to by pro- inconsistency (a > b, b > c, c > a). Our fessionals strong enough and able-bodied inconsistency ratio was 0.08, an accept- strength and solidarity to stand up to the enough to do the job. My younger brother able level. healthcare system, which often gave us The AHP process gave my family disparate and conflicting advice. We pre- and I had mixed emotions, but primarily we wanted whatever would extend Dad's Coping as a family sented one face and one decision that we life. Dad wanted whatever was best for After the decision criteria were priori- expected to be honored. QP Mom. Our biggest wish-for Dad to live tized, we reviewed the healthcare options: forever-was unfortunately not an option. nurse or nurse's aide in the home, hospice As a former college professor and con- in home, nursing home, hospital, hos- sultant who teaches the analytic hierarchy pice and hospital in the hospice, a new process (AHP), I suggested AHP to help us but seldom mentioned option. Based on evaluate the choices and agree on the best brochures, websites, interviews and our solution. In short, AHP is a method to de- experiences during the previous weeks, rive ratio scales from paired comparisons. we evaluated each option in terms of how It took less than five minutes to explain that it met the decision criteria. instead of trying to directly select the best 46 QP * www.qualityprogress.com Institutional options were highly rated GLENN MAZUR is the executive director of the Quality Function Deployment (QFD) Institute and president of Japan Business Consultants Ltd., both in Ann Arbor, MI. A senior member of ASQ and the Japanese Society for Quality Control, he holds an MBA from the University of Michigan in Ann Arbor. He is one of two certified QFD Red Belts in the United States and is a certified QFD Architekt by the QFD Institute in Germany. He is the convener of technical committee (TC) 69, subcommittee 8, ISO working group 2 responsible for writing the international QFD standard, and a member of TC 176 responsible for the ISO 9000 series. http://www.qualityprogress.com

Table of Contents for the Digital Edition of Quality Progress - June 2014

Up Front
LogOn
Expert Answers
Keeping Current
Mr. Pareto Head
No Weak Links
Need for Speed
Solid Base
Insurance Policy
3.4 per Million
Quality in the First Person
Career Corner
Statistics Roundtable
2014 Software Showcase and Directory
QP Toolbox
QP Reviews
Back to Basics

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