Execs share insights they’ve gained in the quality improvement process
Executives share their insights on quality-improvement processes
Editor’s note: Following is an edited excerpt of a Sept. 21 editorial webcast, “Mastering High Performance,” conducted by Modern Healthcare. The panelists were Nancy Kimmel, director of quality and patient safety at Missouri Baptist Medical Center, St. Louis; Julie Morath, chief quality and safety officer at Vanderbilt Health System, Nashville; and Mark Robitaille, president and CEO of Martin Memorial Health Systems, Stuart, Fla. In an exchange moderated by reporter Paul Barr, the panelists discussed strategies to improve patient safety and quality of care while controlling operating expenses. The webcast was sponsored by Thomson Reuters. Sponsors are not involved in the development or publication of editorial content.
I’m wondering how was it that 80% of the process improvement ended up in the hands of your associates? Was that something that was planned as part of a process or did it just work that way in part of a bottom-up fashion?
Two ways. One is we visited a number of healthcare organizations across the country that really had a journey longer than ours. We came to realize from them their key to success was really associate-driven performance improvement. And so we felt that the focus that we needed to do was to have everybody educated on the processes, but have our associates engaged so we could continue and sustain performance improvement. It really has to have tremendous buy-in from the associates who are at the tip of the sphere. And if we can do that by constantly educating and involving them, that will translate throughout the organization and as we get into larger, more complex projects, it ends up with a lot more buy-in because they understand on an incremental basis how it’s improved their workday, their work flow within their own particular area of responsibility.
It’s a very big cultural shift into becoming a Lean organization. How did that go?
Our shift into working into Lean was a natural shift for us, to move into that process-improvement trigger. I think also having the staff working on Lean and engaging your front-line staff in the process improvement also creates buy-in. It also creates a venue in which you will hear more information coming to you about what is not working for the staff because they know they have a venue now in which to improve that.
What is the process for choosing your benchmarks for performance, and is there a regular process for evaluating and changing them?
Yes, we use multiple sources for benchmarking. The UHC is one of our primary benchmarks as well as Thomson Reuters as well as the Joint Commission. We track very carefully how others are performing, and one of the questions we like to ask is: Who’s doing this better than us? And what can we learn from them?
What is a gemba visit? If you could explain that briefly. I think Nancy might have mentioned it as well.
With Lean, of course, there was the Lean management process that was developed by Toyota management and, of course, therefore, a lot of Japanese terminology. But gemba is really a rounding process where management and staff get together in a specific area: nursing station, a business office station, the emergency department, and literally observe firsthand what’s occurring and discuss the operation firsthand to be done within your own organization, which certainly could be the majority of those visits, but also we visit other institutions where we go and do gemba visits and look at how they operate. So it’s really hands-on visual observation of what’s happening and a discussion among those people who have not only a hands-on—it links your management leadership team with your staff at the point of the arrow where things are happening.
Many providers have reportedly struggled with usability issues for too many alerts associated with clinical decision support. Have you experienced this, and how have you responded to it?
The alerts are actually going to very specific individuals, so, for an example, we have about 100,000 rules that are in this database that we created that’s sitting on top of all of the computer systems that exist in my organization. Those alerts have to go through multiple rules in which to get a violation. Once the violation occurs, it goes to a specific pager or it goes to a specific department to address—so those alerts are not firing real time to the front-line caregiver. We actually are kind of partitioning off alerts to people as part of their job address alerts.
Does Vanderbilt use Lean in its process?
We do. We use many of the tools and methods of Lean, but we do not have a comprehensive production system of Lean throughout the medical center.