Ex­ecs share in­sights they’ve gained in the qual­ity im­prove­ment process

Modern Healthcare - - NEWS -

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.

Paul Barr:

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?

Mark Ro­bitaille:

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?

Nancy Kim­mel:

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?

Julie Morath:

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.





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