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1 An Innovative Lean Six Sigma Approach to Performance Improvement and Patient Safety January 20, 2010 ASQ Philadelphia Danielle Drummond Vice President, Lankenau Hospital
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An Innovative Lean Six Sigma Approach to
Performance Improvement and Patient Safety
January 20, 2010 ASQ Philadelphia
Danielle DrummondVice President, Lankenau Hospital
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Outline of Lankenau’s Journey
I. Lankenau prior to the Journey: 2006-2008
II. Embarking on the Journey: 2008
III. Along the Way: 2008 - Present
IV. Looking ahead to the future
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I. Prior to the Journey
• New President : Elaine Thompson, PhD in Engineering– Opportunity for structured approach to Performance
Improvement – Patient centered approach to care delivery
• Good results and track record, but…
• Increasing number of patient safety, quality, and satisfaction metrics with flat performance– Need for multi-disciplinary approach– Opportunity to bring engineering methods in partnership with
clinical care teams
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• Senior Operations Performance Improvement Team Formation – Fiscal Restraints– Internal resources pooled to form the PI Team
• Prioritization – I want a regression statement – Next best thing: Decision Making Matrix
II. Embarking on our Journey
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Lean Six Sigma Tools: Prioritization Matrix
1: High
2: Moderate
3: Low
II. Embarking on our Journey
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II. Embarking on our Journey
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Charter # 1: Management and Organizational Engagement
The Backbone for Performance ImprovementEngagement and A Call to Action for the Team
II. Embarking on our Journey
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Charter’s Framework• Helping the Management Team Focus
– Keys to Success – Management Retreat – Job Accountabilities – The “infamous” 1:1
• Helping the Executive Team Focus – Climate Sensing Program– Multi-Disciplinary Engagement Council
II. Embarking on our Journey
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Lankenau Hospital’s 5 Principles for Management and Organizational
Engagement
II. Embarking on our Journey
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# 1: Bring your personal passion and commitment to patient safety and best practice each and every day
5 Principles for Management and Organizational Engagement
Your personal call to action
Importance of each individual patient
Do what you do best
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Organizational Communication Model“Communicating the Core Purpose of Patient Safety”
Who
we
shar
e th
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re
sults
with
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akin
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How
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hat w
e’re
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arin
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ow w
e’re
he
arin
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ho w
e’re
hea
ring
from
Governance
Staff
Patient
Physicians
Leadership
Town Meetings
1:1 Employee to Manager Meetings
Purple Packet
Employee Focus Groups
Satisfaction Surveys
Department Meetings
Rounding
· Are our patients safe?· What is happening?· How can we improve?· Good job!
Engagement Council
Engagement Council Agenda1. Dashboard2. What are we hearing from: - Patients - Employees - Physicians - Management3. Communicate the Good4. Analyze the bad - Do we need an improvement team?
· What are we doing well? → Celebrate!· How can we improve? → Fix it!· We heard you and we fixed it!
Lankenau Hospital
Are our patients safe?
Are our patients safe?
Volunteers
Community
Staff
Community
Patient
Physicians
VolunteersLeadership
Governance
Patient Feedback
Unit Councils
Employee Focus Groups
Department Meetings
Town Meetings
RoundingNewsletterUnit
CouncilsPurple Packet
1:1 Employee to Manager Meetings
Making our patients safe
Internet/ Intranet
Internet/ Intranet
# 2: Recruit, develop,
mentor and manage
your team to make sure that they are ready
for the next patient/family member/co-worker at all
times.
5 Principles for Management and Organizational Engagement
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# 3: Design, organize and maintain your departments, the hospital’s physical plant
and supplies to make sure you are ready for
the next patient, their
family and co-workers.
• Master Facility Plan
• Lean 5S Approach
• Unit Rounding
• Auditing
5 Principles for Management and Organizational Engagement
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# 4: Drive us towards performance improvement so that we are better tomorrow than we are today and
that today we are better than what we were yesterday
ModelSuperior Patient Experience =
Best Process + Best Communication & Culture
(Robust Feedback & Accountability)-1
5 Principles for Management and Organizational Engagement
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# 4: Drive us towards performance improvement so that we are better tomorrow than we are today and that today we are
better than what we were yesterday
Performance Improvement Tools
MLHS Superior Patient Experience Dashboard
Monthly 2 Day Senior Operations Team PI Meetings
Performance Improvement Project Charters
Dedicated Personnel – PI & Data Analysis
Project management software with alert capability
Prioritization Matrix for project selection and timing
Determine applicable PI tool(s) using: LEAN, Six Sigma, FMEA, Root Cause Analysis, Queuing Theory
Accountability audits & reports for individuals, processes and outcomes
Communication plan to drive sustainable improvement based on reward and recognition
5 Principles for Management and Organizational Engagement
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Process Steps Plan
1. See/Hear/Touch 2. Prioritize3. Measures
Learn and Do 4. Eliminate Waste5. Determine and Standardize Key
Processes 6. Select Optimal Operational
Engineering Performance Improvement Model for Prioritized Improvements
7. Evaluate Technology Solutions8. Build Accountability 9. Continual People, Process, and
Outcome Measurement Sustain
10.Adherence11.Perseverance
# 4: Drive us towards performance improvement so that we are better tomorrow than we are today and that today we are better than what we were yesterday
5 Principles for Management and Organizational Engagement
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#5: Grow patient volume and be a good steward of our human and capital resources.
5 Principles for Management and Organizational Engagement
• Master Facility Plan
• Improve Patient Satisfaction Scores
• Efficiency
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Lessons Learned
• Buy-in is required right from the beginning
• A multidisciplinary approach is necessary
• Front line staff must be involved
• Change is easier to swallow when it is shown in a positive light
II. Embarking on our Journey
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Charter # 2: Multidisciplinary Care Teams
• Background– Need for improvement in Patient Satisfaction and
Core Measures identified by Quality and Safety Dashboard.
– Inconsistent team of care providers revealed as root cause.
– Inconsistent care team partners for nurses on the inpatient units.
III. Along the Way
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Charter # 2: Multidisciplinary Care Teams• Approach
– Created innovative, collaborative care team model to improve safety, reliability and delivery of patient care.
– Lean Six Sigma Tools• Process Mapping• Value Stream Mapping• Affinity Diagrams
– Sustained process change through communication, and individual accountability and feedback.
III. Along the Way
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III. Along the WayCharter # 2: Multidisciplinary Care Teams
Network/Affinity Diagram
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III. Along the WayCharter # 2: Multidisciplinary Care Teams
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Charter # 2: Multidisciplinary Care Teams
• Design: Multi-Component Charter undertaken – Unit Based Organizational Structure
• Team Safety & Quality reviews• 360 Evaluations
– Formalized Multidisciplinary Care Team• Medicine • Surgery
– Coordinated care team patient rounds• Daily care plan documented• Robust discharge planning• Multidisciplinary clinical education• Quality initiatives
– Medication Reconciliation
III. Along the Way
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Charter # 2: Multidisciplinary Care Teams
• Results
* Statistically Significant at 95% Confidence Interval
Patient Satisfaction at 88th percentile for National Teaching
Peer Group
*
*
***
*
Direction signifies an improvement in that category
III. Along the Way
Superior Patient ExperienceBaseline
(Jan07-May08)ReMeasure
(Jun08-Oct09)
Patient Satisfaction
1. Rate Hospital - HCAHPS 63.7% 72.4%
Clinical OutcomesPostMDCT
(Jun08-Aug09)
2. Mortality Rate Index 0.84 0.76
3. Complication Rate Index 0.99 0.64Core Measures
4. Acute Myocardial Infarction 97.1% 99.2%
5. Congestive Heart Failure 87.8% 93.5%
6. Pneumonia 82.6% 90.6%
7. Hip and Knee 75.0% 92.9%
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Charter # 11: Infection Prevention
• Issues:– Improvement required in device related
infections identified by Quality and Safety Dashboard
– Lack of standardized data collection and management practices
– Demand for process improvements in infection prevention
III. Along the Way
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Charter # 11: Infection Prevention• Approach
– Created multi-component charter to lead multi-disciplinary redesign of Infection Prevention and Control
– Prioritized charter components to optimize improvement and results realization
– Use of Lean Six Sigma Tools• 5S: Sort, Set in Order, Shine, Standardize, Sustain• Value Stream Mapping of Infection Reporting Process• Fishbone Diagrams
– Sustained process change through communication, individual accountability and feedback
III. Along the Way
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Assessment13 component charter undertaken with multi-
disciplinary Performance Improvement team:
President’s Infection Control
Committee
Hospital-wide advertising & hand-washing
Efficient data collection
Employee & Medical Staff Accountability Targeted clinical
programs for device
associated infections
Antibiotic Stewardship
MRSA Strategic Plan
Enhanced environmental
cleaning
Clinical Informatics
support
Communication of measures &
activities
Biomedical engineering
partnership with Drexel University
Focused Critical Care
initiatives
Development of Infection
Prevention workforce
Healthy Patients
Affinity Diagram
III. Along the Way
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Methods 1 of 2Example Components• Concurrency of Surveillance
– New process initiated to ensure streamlined physician/patient notification and involvement
– Simplified (Targeted) physician review of infections
• Enhanced Environmental Cleaning– Monthly deep-cycle ICU cleaning– Hygenia Luminometer in use– Expanded robust cleaning education and audit programs
• Critical Care• Operating Room• Procedure Areas• Emergency Department
– Stethoscope location trial ongoing
III. Along the Way
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Methods 2 of 2Example Components• Targeted Clinical Programs
– CA-UTIs (Catheter Associated Urinary Tract Infections)• Clinical Information System utilized to prompt and capture information related
to prevention methods.
– VAP (Ventilator Associated Pneumonia)• Daily VAP Bundle Compliance• ZAP VAP 12 in 24 program (oral care)• CHG toothpaste
– CL-BSI (Central Line Associated Blood Stream Infections)• Clinical Information System IV documentation and data collection tool in
development• Insertion carts loaded and available on unit• Targeted process surveillance
– SSI (Surgical Site Infections)• Expanded data capture structure to include pre-operative “health” elements
(Pre-Albumin, pre-op Glu, etc.)• CHG pre-op cloths trial with Orthopedics
III. Along the Way
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5S Example
III. Along the Way
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5S Environmental Audit ToolIII. Along the Way
282930
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2625
2423
2221
2019
1817
161514
1312
1110
98
76
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2 1
ICU/CTICU Nursing Station
ICU Dietary
ICU CUR
Shared CUR
Eqp Room
ICU SUR
CTICU CUR
CTICU SUR
CTICU Dietary
EN
TR
AN
CE
Organization & Visual ManagementY = Compliant, N = Not Compliant
(All “N” responses must include comments)
Common Areas: Y N General Comments:
ICU/CTICU
Clean Utility: Y N
Combination = 1-5-2-4
Soiled Utility: Y N
Eqp Storage: Y N
Combination = 1-5-2-4
Nursing Stations: Y N
Dietary: Y N
Combination = 1-5-2-4
CTICU Nursing Station
ICU
Nursing
Station
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Charter # 11: Infection Prevention
• Early Results
* Statistically Significant at 95% Confidence Interval
Rate/1000 Device Days
CY08 Jan - Oct 09
CA-UTI(symptomatic only)
4.25(Jul-Dec only)
1.73 *
BSI 2.58 1.1 *
VAP 9.47 2.11 *
Direction signifies an improvement in that category
III. Along the Way
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IV. Looking Ahead to the Future
• Lankenau Hospital Center for Patient Safety, Reliability, and Best Practice – Multi-institutional Research Center – Three areas of research focus:
• Development of engineering solutions for decreasing hospital acquired infection
• Nurturing the “smart” of our “SMART Chart” • Improving the ability to communicate to our team,
providing robust feedback, and holding each other accountable
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Questions?
Contact Information:
Danielle Drummond
Vice President, Lankenau Hospital
Email: [email protected]
