At a recent meeting of the partners of the firm, a person brings up the problem of finding documents related to one client's case in a different client's file. We can sympathize with this because we get medical records that belong to one patient's file but are located in someone else's chart. Many law firms are challenged by the need to keep up with the flow of paper. This article discusses a systematic quality improvement process that you can apply to your firm.

The "Plan Do Study Act" model can be used in many types of businesses. Let's apply it to misfiled documents. First, assemble a team to look at the problem. Include representative members- someone in a clerical role responsible for filing, an attorney, and a paralegal, for example. Look at the problem for several angles, consistently asking why a certain process is in place or a certain thing happens. This is called drilling down to get to the root of the problem. For example, one explanation for misfiling is that people don't pay attention to last names. But deeper reflection may show that the way of indicating names is not clear; there may be insufficient time allotted to filing; the filing may be done by people who have not been trained, and so on.

Step 1: Brainstorm in the planning stage. Determine your objective of doing a pilot test of a change in the procedure. For example, your team may decide that it recommends a scanner on one administrative assistant's desk so she can scan every document that comes in for a limited number of clients. State your objective of this test: to eliminate paper filing and the risk of mislaid papers. Make a prediction about what you think you'll find from your test.

Step 2: Do the test. Try it out on a small scale, and document problems or unexpected findings. For example, you may determine your method of storing electronic files is confusing and inconsistent. We avoid this at our legal nurse consulting firm by giving every electronic file three levels of folders: The full name of the law firm, the full name of the attorney, and the full name of the patient. We don't have trouble finding files since everything is consistent.

Step 3: Study the results. Look at the data, analyze it and compare it to what you predicted you'd find. What did you learn from the test? Did you find the scanning piled up? Did the scanner work well?

Step 4: Act. Refine the change. Perhaps you'll decide to implement a plan of scanning all documents as they come in the law firm. You may need a larger server with more storage space, in addition to scanners. Decide a realistic plan for implementing the change, and plan the next test.

Careful examination of your processes will teach you what you need to change. Listening to everyone's perspective and sharing the results of your test will result in a stronger solution.

Patricia Iyer is a legal nurse consultant in Flemington, NJ. Before Pat Iyer became president of Med League, she was a nursing quality improvement coordinator. She is the author of several medical legal books, including the newly released 4th edition of Nursing Malpractice. She can be reached at http://www.medleague.com