12
|
WINTER 2018
WINTER 2018
|
13
Mostly, the charts in the units are marked
in seas of green, invariably interspersed
with occasional clusters of red. “It’s
about continuous improvement so red
is ok,” says Dr. McDonald. “Failures
are not gloom and doom as long as we
learn from them and put in processes to
support sustained improvement.”
Front line staff generally seems to look
forward to the daily face time with the
executive team. “What’s positive is that
they’re willing to air their dirty laundry,”
says Dr. Perlstein, who routinely leads
one of the executive groups. At each
stop, he begins with a brief overview
of how the institution performed in the
four categories over the past 24 hours.
On this day, criteria were met in three
of the four categories – with Least
Waste in red because of a mislabeled
specimen from the ED. When the unit
presents its own measures, Dr. Perlstein
and the executive team listen and offer
advice. They question why one patient
unit has the exact same metrics as
those on another floor. They ask if a
chart all in green might indicate that
it’s time to retire that measure and
move on to something new. In the ED,
the chart measuring the holding of
daily huddles resembles not so much
a Christmas tree, but a vine of ripened
tomatoes. This raises the question of
how the staff might better position the
importance of these huddles in order to
accomplish their goal of 12 each day. The
challenges, direct as they are, focus on
improvement, not on pointing fingers.
The units are asked about barriers to
patient care (the Geri chairs on one
unit, the executive team learns, need
to be fixed) and for “shout outs” to
recognize staff who have exceeded
expectations or made “good catches”
(on one patient floor a resident is
applauded for working well with two
challenging patients; on another, a
nurse who saved a patient from falling
receives kudos).
The radiology department is
particularly engaged. Following the
five minute briefing with the executive
team, they form a circle and, led by
Dr. B. Bobby Chiong, the department’s
chairman, lock arms and give a cheer,
much like a college basketball team
huddling with their coach before going
out on the court.
“I really enjoy it,” says Dr. Chiong.
“It’s compressed into a few minutes,
which is good, and it gives front line
staff a venue to let everyone know what
they know and what they see. I haven’t
seen it like this before, particularly the
way they integrate it into the Quadruple
Aim. I really appreciate it and the way
the hospital is willing to question why
do we do it this way and is there a
better way?”
Less than an hour from when their
rounds began, the executive teams return
to the chief executive’s office to discuss
their findings – which, Dr. Perlstein
is the first to admit, remain a bit of a
mixed bag. Pleased with overall staff
buy-in, he believes the real issue he and
the others on the executive team face is
engaging staff in new processes to facilitate
improvement and reduce waste.
EARLY WINS
In a short time, however, there have
already been several wins. For example,
in dealing with the issue of nurses
getting interrupted while dispensing
medication, the team arrived at a
solution: dedicating two nurses to
handle all distractions. As part of a falls
prevention program, the policy had
been to mark those inpatients at risk
with signs on their door, green bands
around their wrists and green socks.
Only coordinating these elements had
proven problematic; the bands were
often scattered in storage rooms and the
signage and socks located somewhere
in the nurses’ station. So, as the result of
a discussion during LDM rounds, “falls
kits” were created containing all three
elements. This has since made it easier
for staff to identify and observe patients
at risk, leading to a significant reduction
in the falls rate (allowing the hospital to
go 40 days at one point without a fall).
“The disciplined way we do this every
day has really changed the culture, and
that’s great to see,” says Dr. Lombardi.
“I think this has been successful in
seeing some results, but also in getting
front line staff really engaged in the
process. That’s the excitement of it.
It’s saying to them, ‘Your thoughts,
the way you go about your job, is really
important to caring for patients and
you know this better than us.’
“There is a famous quote that goes,
‘Everyone in healthcare has two jobs
when they come to work – to do their
work and to improve it.’ This really
touches on ‘the improve it’ piece.”
Dr. Perlstein realizes it’s not a sprint, but
a marathon. “We know that in certain
units, like in the ED, life doesn’t stop
[when we come in] and to some people,
this will be exhausting,” he says. “But it’s
a fantastic process and we’re only in the
beginning stages.
“I’m confident that people will buy into
this because they recognize they’re here
to make people better. You don’t take a
job like this in this kind of setting unless
there’s something in your soul that says
‘I want to help people.’ With LDM, they
now have a say. It’s their responsibility to
tell me the best way to do it.”
“FAILURES ARE NOT GLOOM
AND DOOM AS LONG AS WE
LEARN FROM THEM.”
“THERE IS A FAMOUS QUOTE
THAT GOES, “EVERYONE IN
HEALTHCARE HAS TWO JOBS
WHEN THEY COME TO WORK –
TO DO THEIR WORK AND TO
IMPROVE IT.”
NEW INITIATIVES
