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

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

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

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

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

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

Improving the Management of Nationwide Drug and IV Bag Shortages

IMPROVING THE MANAGEMENT OF NATIONWIDE DRUG AND IV SHORTAGE In September of 2017, Hurricane Maria struck the island of Puerto Rico where over 50 pharmaceutical factories had previously operated. The impact of this was felt not only in the drastic reduction of products that are produced on the island, but it also exacerbated the supply chain issues for key drugs nationwide. The pharmacy department and supply chain in an academic tertiary care medical center did not have a consistent and reliable process for communication, planning and real-time updates. This resulted in a tremendous amount of wasted staff time at their drug/IV shortage meeting. A team was formed to develop mitigation strategies for navigating these shortages. A root cause analysis was conducted to determine the causes for the inefficient management of the daily information for all drugs considered to be on a shortage. A number of countermeasures were established with the goals to reduce the time spent in shortage meetings and eliminate unnecessary communication between the pharmacy and supply chain outside of the shortage meetings. Through implementation of performance improvement strategies, the target reduction in meeting time was met and a significant reduction in salary cost was realized. Next steps include ongoing use of the newly developed mitigation strategies and interval assessments for sustaining the processes

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

Consistently Using a Transportation Department for Patient Discharge to Sustain Nursing Staffing Levels

IMPROVING PATIENT FLOW BY UTILIZING A HOSPITAL TRANSPORTATION DEPARTMENT FOR DISCHARGES Using a transportation department for transporting patients for discharge is the industry standard. At a large urban hospital, inconsistent use of this department has resulted in frontline caregivers (RNs) having to pick up this function, resulting in potentially unsafe staffing levels on the floor. The goal of this quality improvement project was to improve the percent of discharges with the transport department from ≤10% to 70% by the end is fiscal year 2018 in an academic tertiary medical center. Baseline metrics demonstrated the current state and a root cause of analysis were initiated. As a result of this analysis, it was established that staff did not understand the best practice for transporting patients for discharge. A number of KPIs were developed for the utilization of the department for patient discharge. Post Kaizen pilot implementation, teletracking metrics demonstrated improvements in utilization. Next step is to rollout to all units and monthly reinforcement with continuous educational/data support from transport, access/flow and operational excellence

Increasing Bedside Medication Safety in an Intensive Care Setting

A PERFORMANCE IMPROVEMENT PROJECT FOR INCREASED BEDSIDE MEDICATION SAFETY The convenience of having certain medications directly available at bedside has long been a priority for a medical intensive care nursing team in an academic tertiary medical center. However, it was apparent to new staff and leadership that there was a lack of awareness and interest in securing medications within the department. This posed a risk to patients, families, visitors and colleagues. Baseline metrics on patient safety were collected and a root cause analysis was conducted. Countermeasures included increased education of medication safety as well as a instituting a KPI which read that 100% of the time all medications would be secured. Since the implementation of the unit’s medication safety and quality improvement project, metrics have demonstrated an improvement in medication safety knowledge and practice. Next steps include continued improvement in medication handling practices to ensure a culture of safety and increased perception of safety by staff, patients & visitors