SaferPatients

In the just-released 2013 Industry Survey: Strategic Imperatives for an Evolving Industry, a survey of health executives reveals that the 3 biggest priorities for hospitals are 1) patient experience, 2) clinical quality 3) cost reduction.

Chief Financial Officers for surveyed hospitals estimated the percentage reduction of operating costs for the next 3-5 years.

The average was set at 11%.

How are hospitals going to do this? Lean + TeamSTEPPS. Lean for process improvement to drive out the waste. TeamSTEPPS (or CRM) to create a culture of accountability to make sure the waste stays driven out.

We typically see an average ROI on Lean process improvement work of 4 to 1. One dollar spent on improving processes return $4 on waste reduction and volume increases.

Unfortunately, you only keep that $4 improvement every year if you have an operational culture where peers hold one another accountable to adhere to the new waste-free, efficient process. Otherwise, your organizational culture will eat your process improvement efforts for lunch. This is one of the true values of an effective TeamSTEPPS program. Tt creates a culture of cross-check, accountability, stop-the-line when standardized work is ignored.

Everyone has processes. Everyone is doing Lean. Everyone has bundles (CLABSI, CAUTI, VAP, SCIP, etc..). Everyone has protocols. Everyone has checklists. Everyone has medical expertise and training. What everyone doesn’t have is “culture.”

Culture is what separates the profitable and on-going, from the broke and going-out-of-business. What are you doing today to change your culture? If the answer is nothing, be prepared to be looking for new employment by 2015.

TeamSTEPPS, done well, is high value to hospitals, and ideally suited for the challenges facing American health care– patient care quality/safety coupled with financial pressures.

The challenge for any hospital wishing to implement a truly effective TeamSTEPPS program is that although the documented impact of TeamSTEPPS is desirable, the installation of TeamSTEPPS in hospitals can’t be cost-free, (it can’t be done by downloading free materials from the AHRQ web site) and therefore competes with other hospital (survival) priorities for precious diminishing financial resources.

This is the main reason hospitals should implement the powerful combination of Lean (Toyota Production System) and TeamSTEPPS.

Why? It is easier to gain and demonstrate the financial returns of Lean (see a few at this link). In effect, successful Lean projects fund the TeamSTEPPS implementation to improve the patient care quality/safety that is and should be at the core of every American hospital’s reason for existence.  Besides, the cultural approach of Lean is highly synergistic with TeamSTEPPS, so reinforcing and so compatible that doing both Lean and TeamSTEPPS will be seamless to hospitals.

Not everyone knows how to seamlessly integrate both. LifeWings does.

Urgent care clinics: It seems like everywhere you turn, there’s a new retail clinic like CareNow, Patient First and CVS’ Minute Clinic. These clinics allow people to get the care they need without having to make a doctor’s appointment or wait for hours in the emergency department.

A new Harris Interactive/HealthDay survey reports the number of people who use retail health clinics has jumped from 7 percent in 2008 to 27 percent.

Why?

Convenience.

People are looking for ways to fit health and wellness into their busy schedules. Hospitals that develop efficient, reliable, fool-proof processes and services with this in mind will build their brand and customer loyalty.

The others will go out of business.

But how to get better?

If you are depending on individual clinicians to spectacularly rise, on their own, to the challenge of the massive changes in reimbursement (e.g. Value Based Purchasing) or quality data transparency, you will fail.

Doing what you did to get here, WILL NOT GET YOU THERE.

Sustained results will only come from a systems approach that hard-wires daily habits all of personnel. if you don’t know how to do this, it might be time to get some help.

At Brigham & Women’s Hospital in Boston, team-based inpatient care has resulted in dramatic reductions in inpatient mortality, significantly lower lengths of stay, and higher satisfaction for physicians and nurses.

Team-based care dissolves the hierarchical, traditional structure that exists among nursing, physical therapy, pharmacy and medical staff, social work staff and others to empower individual members of the team to contribute equally to the optimal outcomes for the patients.

At Brigham & Women’s Hospital and its sister Faulkner Hospital, a team-based model of care has been adopted for almost all general medicine units. This system replaces the “chaotic model,” in which residents, attending physicians and interns rotated on different cycles; physicians and nurses did not know one another; and the admissions department assigned patients to whatever beds were available.

Each unit now has a team made up of attending physicians, residents, interns and medical students, pharmacy students and a faculty supervisor, nurses, a social worker, an RN care coordinator and a physical therapist. All members of the team are assigned to work together on a specific unit for at least four weeks at a time.

Two other key changes were instituted: The admissions department assigns a patient to an intensive care unit team only if there is a bed available on its unit and interdisciplinary rounds are structured sequentially by nurse, rather than by room number.

Also, under a team-based care model the expectation is that you don’t discuss a patient until the nurse is present, Another expectation is that before a physician articulates the [patient's care] plan that you get the nurse’s input. The physician team leader will always address the nurse and ask, “Do you have anything to add about this patient?”

The perspective of other team members is equally valued, depending on the patient’s diagnosis and care plan. Sometimes the most important clinician is the physical therapist. The physician may be writing the orders and doing some of the direction, but under the team-based care model the physician does not work alone, but as part of a team.

This approach requires new standardized processes, extensive teamwork and communication training, and strong support and leadership action from top administrators.

Watch a Three-minute movie about LifeWings

You can’t get to 100% on your core measures.

The usual mantra is to ‘try harder’. Trying harder is impossible when you’re already trying as hard as you can.

But you can always try different.

In addition to my work for LifeWings I also fly an MD-11 for FedEx. We guarantee your package will be there overnight. On time. A 99.99% success rate won’t cut it. If we deliver 7 million packages a day, that means 700 will not make it on time to the right place and right person. These 700 service failures would be honest mistakes, made by smart, dedicated people working as hard as they can.

No matter how hard we try, we wouldn’t do better than 99% on effort alone. So we rely on a system completely different from what most organizations do. Same number of people, same number of hours working, 100% accuracy.

We added teamwork to the mix. The type of teamwork and collaboration wherepeople cross-check one another,  speak up when needed, and catch the inevitable slips, trips, and lapses that humans make - to detect and correct errors before the package is late. Or, before the patient doesn’t get antibiotics on time, or doesn’t get an aspirin on check in.

If it’s not working, harder might not be the answer. Creating a culture of accountability might be.

I am traveling today on an airline. It will come as no surprise to you that I am writing this while sitting in the gate area - waiting to board.With a little time on my hands, my thoughts drifted to the hundreds of times this exact scene has repeated itself in my life. Read more »