Shar­ing Lean ideas to im­prove qual­ity

Modern Healthcare - - INNOVATIONS - By Adam Ruben­fire

If a hospi­tal is fac­ing a prob­lem with qual­ity or safety, chances are an­other fa­cil­ity is hav­ing the same prob­lem. That’s es­pe­cially the case with hospi­tal-ac­quired in­fec­tions, which can kill over 100,000 pa­tients a year.

So, a group of providers is team­ing up to share best prac­tices on how to fix those prob­lems in a way that en­lists Lean man­age­ment, a phi­los­o­phy of elim­i­nat­ing waste through con­stant im­prove­ment and in­cre­men­tal changes to an or­ga­ni­za­tion’s pro­cesses.

The Catal­y­sis Health­care Value Net­work is made up of 72 providers who en­gage in on­go­ing dis­cus­sions around qual­ity and safety. Catal­y­sis, an Ap­ple­ton, Wis.-based not-for­profit, con­nects health sys­tems, pro­vides ed­u­ca­tion and coach­ing about Lean trans­for­ma­tion and co­or­di­nates on-site vis­its at mem­ber health sys­tems so mem­bers can see the real so­lu­tions in ac­tion. Mem­ber­ship costs $25,000 a year. Catal­y­sis or­ga­nizes about 20 on-site vis­its a year, in ad­di­tion to host­ing we­bi­nars and a two-day con­fer­ence.

One of the so­lu­tions cur­rently be­ing dis­sem­i­nated across the Catal­y­sis net­work at­tempts to limit blood­stream in­fec­tions that orig­i­nate from a pa­tient’s cen­tral line catheter, a long-term in­tra­venous med­i­ca­tion line placed into a large vein in the pa­tient. U.S. hos­pi­tals have made strides in re­duc­ing the rate of cen­tral line-as­so­ci­ated blood­stream in­fec­tions, or CLABSI, but the deadly com­pli­ca­tion still af­fects over 30,000 pa­tients a year and has a 12% to 25% mor­tal­ity rate, ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Prevention. That has cost the U.S. health­care sys­tem over $1.8 bil­lion since 2001.

Catal­y­sis mem­ber Salem (Ore.) Health is re­solv­ing its CLABSI prob­lem by stan­dard­iz­ing pro­cesses and im­ple­ment­ing fre­quent eval­u­a­tions of pa­tients’ need for a cen­tral line. The re­sult is a 64.3% drop, from 14 in­fec­tions in its fis­cal 2015 to five in­fec­tions in 2016, ac­cord­ing to Deb­bie Goodwin, Salem Health’s in-house Lean ex­pert.

As a part of the so­lu­tion, Salem staff out­lined spe­cific roles and steps for cen­tral line clean­ing, chang­ing, or re­moval that should be fol­lowed the same way ev­ery time for ev­ery pa­tient. Clean­ing staff are taught a stan­dard­ized pro­ce­dure, to en­sure that room con­di­tions aren’t the root cause of in­fec­tions. So­lu­tions across the Catal­y­sis net­work of­ten stress stan­dard­iza­tion be­cause a cul­ture of bad habits or ne­glect can spread across an or­ga­ni­za­tion and lead to poor out­comes, said Paul Pe­jsa, di­rec­tor of the Catal­y­sis net­work.

As a part of its Lean so­lu­tion, Salem also uses daily “hud­dles” where staff mem­bers dis­cuss the con­di­tion of each pa­tient with a cen­tral line and whether that line can be re­moved. Pe­jsa es­ti­mates that over 80% of Catal­y­sis mem­bers have a CLABSI prob­lem and are work­ing to re­duce it through strate­gies like those used at Salem. “By think­ing and act­ing dif­fer­ently, these rates can be re­duced,” he said.

Many of the so­lu­tions de­vel­oped by Catal­y­sis mem­bers tend to stress the in­volve­ment of an en­tire fa­cil­ity in solv­ing ma­jor prob­lems, not just a par­tic­u­lar unit or depart­ment, Pe­jsa said. It’s cru­cial that the hospi­tal’s most se­nior lead­ers un­der­stand and are open to the Lean trans­for­ma­tion process so that they can make sig­nif­i­cant changes that must be ini­ti­ated by top ex­ec­u­tives.

“Where we see Lean trans­for­ma­tion fail is lack of en­gage­ment from the most se­nior lead­er­ship,” Pe­jsa said. “If they don’t demon­strate them­selves and they’re not out (mak­ing rounds) … we find it ex­tremely hard to sus­tain that Lean trans­for­ma­tion.”

Or­ga­niz­ing and stan­dard­iz­ing ex­ec­u­tive “rounds” of the hospi­tal, known by the Ja­panese term “gemba” in Lean lingo, is one of Salem Health’s next projects, Goodwin said. She plans to reach out to Catal­y­sis mem­bers to see how they’ve han­dled the re­spon­si­bil­ity.

Be­ing a part of Catal­y­sis has helped Salem Health en­rich its un­der­stand­ing of Lean and find so­lu­tions to some of its most sig­nif­i­cant prob­lems, Goodwin said. The health sys­tem de­vel­oped its CLABSI so­lu­tion largely on its own, but vis­its and feed­back from other sys­tems have helped im­prove it.

“We find that many of our prob­lems are com­mon,” Goodwin said. “It has helped to have the abil­ity to par­tic­i­pate in that net­work and have that re­source, their staff, who can let us know of some­one else who might be work­ing on a sim­i­lar prob­lem.”

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