Sustaining Daily Management with Gemba Walks: A Scheduling Model

SUSTAINING DAILY MANAGEMENT WITH GEMBA WALKS: A SCHEDULING MODEL At an academic tertiary care medical center, there are 110 Operational Excellence teams across 4 campuses. Every weekday, 10 GEMBA walks occur with the 11th on Wednesdays. The expanding program has made daily leadership visits to all KPIs challenging. As a result, consideration of reduced gemba walks to departments who have met specific maturity/performance criteria. The scope of the eight-week pilot consisted of 13 pre-identified teams that have weekly workflows. The teams must have met a baseline level of performance. Performance was scored for 9 variables measuring engagement, PDSA, use of daily management and infrastructure. Teams also must have been live on Operational Excellence for minimum of 6 months The main objective was that teams would maintain or advance their current performance level with the KPI process. A root cause analysis identified barriers to gemba walk participation for frontline and senior leaders. Several countermeasures were developed to include a feedback survey for department leaders one month post pilot start and weekly evaluation of pilot teams. The outcomes supported the conclusion that pilot team performance was similar to teams receiving daily gemba walks. Next steps include continued coaching the pilot teams to ensure performance advancement and conduct quarterly audits. In addition, look to add other units to the adjusted frequency walk that meet the performance criteria

Lean Daily Management: Keeping Quality and Safety at the Forefront During the COVID-19 Pandemic

This storyboard describes how our Operational Excellence Platform pivoted to keep quality at the forefront of the Covid-19 response. Applying the Framework for Safe Effective and Reliable Care, we implemented the following innovations: Daily quality huddles became virtual, with 70-100 frontline leaders sharing alerts, announcements and celebrations Traditional Gemba Walks transformed into daily Executive Gemba Rounds visiting all care teams and focusing on patient and workforce safety. Patient and Workforce safety concerns were resolved real time and those requiring coordinated response were triaged to the Hospital Incident Command System (HICS) for accelerated action. Innovative communication strategies were adopted to clarify changing practice in midst of the pandemic, to message adherence to personal protective equipment standards, and improved operational workflows for efficient problem solving

A Coaching and Team Performance Evaluation Model to Build Capacity for High-impact Lean Improvement

There is abundant evidence that links a strong culture of safety with improved patient and staff experience. However, there has been no clear avenue identified as to how to achieve this metric. A team in a large academic tertiary teaching hospital set about leveraging their daily managing system (DMS) to attain improvement in their institution’s safety. The goals of this quality improvement project were to use DMS to identify and report safety concerns and increase frontline team knowledge and comfort with reporting safety concerns during Gemba walks. A root cause analysis identified 5 areas for improvement and several countermeasures were established to address these areas. Post inception of the countermeasures, several positive outcomes were identified to include 12% increase in safety reports per month and growing comfort with transparently sharing safety concerns. A series of next steps were generated. Amongst them were continued improvement in real time responses to safety concerns and strengthening executive and middle management adoption of “listening to learn” approach to leadership

Patient Fall Prevention

PATIENT FALL PREVENTION STRATEGIES IN AN ACUTE HOSPITAL Every year in the United States, hundreds of thousands of patients fall resulting in injury. Injured patients often require prolonged hospital stays and a resultant increase in medical costs. The purpose of this study was to identify the current state of fall prevention strategies on a hospital inpatient acute care cardiac unit. Through a root cause analysis, some deficiencies were identified and a process improvement plan was implemented. Several positive outcomes were attained as a result of the countermeasures initiated. Patient falls per month and total waste in dollars saw a decline and, subsequently, an increase was realized in dollars saved in medical costs. It is hoped that this study will provide practitioners with additional tools to enhance current fall prevention programs

Improving Type And Screen Specimen Collection Prior To Elective Surgery

To avoid delays in the availability of compatible blood for elective surgery patients requiring transfusion, a type and screen specimen should be completed at least 24 hours prior to surgery. Baseline metrics in an acute care inpatient blood bank demonstrated a significant number of cases with no type or screen completed. The objective of this KPI was to prevent any delays in providing compatible blood products to scheduled surgical patients. Several internal and external system issues were identified as a result of a root cause analysis and a number of actions were initiated. Outcomes have been positive. Data collection post KPI implementation has demonstrated a significant increase in type and screens completed within the 24 hour window mandate. To further streamline the process, work is ongoing to develop a master surgical list of procedures requiring type and screen into the workflow

Interprofessional Engagement in Lean Improvement in an Academic Healthcare Organization

STRATEGIES TO INCREASE ENGAGEMENT OF PROVIDERS IN LEAN APPLICATIONS IN AN ACUTE TERTIARY CARE HOSPITAL Engaging care providers in interprofessional LEAN applications in an academic tertiary hospital results in safe, reliable and effective patient care. An initial success measure was established to increase LEAN application engagement to 36%, with the goal of reaching 50% within 3 years of their operational excellence go-live. A root cause analysis established several causes for low involvement. Using operational excellence strategies, a number of countermeasures were created, rolled out and completed. As a result, follow up metrics demonstrated a marked increase in the number of provider-engaged boards. It was felt that the engagement of the chief medical officer and other chiefs as stakeholders was the greatest contributor to the improved outcomes within the established timeline. Next steps include reaching a target goal of 50% engaged within the established timeline

Aligning Opioid Prescribing Pathways

There is a drug epidemic sweeping the State of Maine and it continues to worsen each passing year. In 2017, the Maine legislature passed Public Law Chapter 488 to strengthen the controlled substance prescription monitoring program. An outpatient pharmacy, located in a large acute care hospital, created a performance improvement project to clarify opioid prescription and resolve any non-compliance with Chapter 488. After a root cause analysis, several KPIs were established to include tracking the number of phone calls made by pharmacists to non-compliant providers to clarify scripts, provide one on one education and ultimately resolve non-compliance. Repeat offenders were also tracked and individually counseled. Since hardwiring the new approach, a significant decrease in the percentage of opioid prescriptions requiring follow-up was achieved. Ongoing monitoring is planned to make sure compliance is maintained

Strategies to Improve Timeliness for Cleaning Inpatient Rooms Following Patient Discharge

STRATEGIES TO IMPROVE THE TIME FRAME FOR CLEANING INPATIENT ROOMS BY ENVIRONMENTAL SERVICES In an inpatient rehab hospital, it was noted that Environmental Services (EVS) was delayed in cleaning rooms between patient discharges and admissions. This resulted in the frequent use of a “stat clean” order that allows only 50% of the normal cleaning time , forcing patients to wait and impacting patient flow. A root cause analysis demonstrated lack of communication between the rehab hospital and the contracted cleaning services. A number of counter measures were initiated with the goal that cleaning would be started within 20 minutes of all discharge patients. As result of the countermeasures hardwired through KPIs, significant improvement was realized. To sustain and hardwire the process to produce culture change, hospital leadership and EVS are committed to weekly meetings and the establishment of a formal partnership

Identification Strategies For The Very High Fall Risk Patient In An Acute Inpatient Psychiatric Unit

Patients falling as a result of geriatric and psychiatric impairments are at a much higher risk than the average patient population. An acute care inpatient psychiatric team used baseline metrics to demonstrate increasing fall rates per month that surpassed the unit’s target number. As a result, a quality improvement project around falls was felt to be warranted. The overall goal of this study was to improve patient safety by reducing falls for their very high risk fall population. A root cause analysis determined that this population was not being properly identified and several tools were developed and employed to better assess and visually identify this group of patients. Post KPI implementation, the unit reported a 95% reduction in falls of those patients deemed very high fall risk. Next steps involve hard wiring the countermeasures to obtain outcome sustainment

A Provider-driven Approach to Preventative Oral Care in Nursing Home Facilities

Oral care is an essential part of preventative medicine as it minimizes risk for pneumonias and other infections. In nursing home settings, often oral health care is not routinely provided due to a number of issues. A health care system that either owns or contracts nursing home facilities initiated a performance improvement plan to address this patient care concern. The first goal of this project was to reduce the variation in oral care between nursing home facilities within the system. The second goal was 100% of their patients will have one oral health care exam documented in EPIC once a year. Baseline metrics bore out the low number of oral exams routinely performed and a root cause analysis examined the various reasons why nursing home patients do not receive oral care during routine care. A number of countermeasures were implemented to include the creation of a flowsheet for oral exams, automated EPIC reminders to conduct oral exams and a monthly report on oral care exams distributed to providers by the nursing home director. As a result of the interventions, the baseline of 6% in July 2018 was up to 70% in May 2019. It is expected that the goal of 100% will be met by October 2019. In addition, assessment variation between facilities saw a reduction. Some of the next steps include integration of a second oral healthcare assessment per year as a practice standard and continue to assess and reduce variations in assessments between facilities