achieving excellence in patient care: empowering the front line maureen broms, ms, rn vice president...
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Achieving Excellence in Achieving Excellence in Patient Care: Empowering Patient Care: Empowering
the Front Linethe Front Line
Maureen Broms, MS, RNMaureen Broms, MS, RNVice President Vice President
Health Care Quality and Health Care Quality and Patient SafetyPatient Safety
New England Baptist New England Baptist HospitalHospital
June 23, 2009June 23, 2009
Our Journey Toward Our Journey Toward ExcellenceExcellence Our VisionOur Vision Where We WereWhere We Were The Zero ChallengeThe Zero Challenge Empowering the Front LineEmpowering the Front Line ResultsResults
What Drives Us?What Drives Us?
Our Vision Our Vision
New England Baptist Hospital New England Baptist Hospital will be known as a premier will be known as a premier Orthopedic Center of Excellence, Orthopedic Center of Excellence, providing the highest quality providing the highest quality medical and surgical care. medical and surgical care.
How were we doing?How were we doing?
Superior performance in surgical Superior performance in surgical site infection eliminationsite infection elimination
Nationally 94Nationally 94 – 98% compliance with SCIP– 98% compliance with SCIP SSI rate – 0.51* vs NNIS database rate 1.5SSI rate – 0.51* vs NNIS database rate 1.5
Patient Fall Rate and Hospital Patient Fall Rate and Hospital Acquired Skin Breakdown less than Acquired Skin Breakdown less than the national averagethe national average
Superior patient satisfaction resultsSuperior patient satisfaction results* All SSIs* All SSIs
The “Zero” ChallengeThe “Zero” Challenge
The Board of Trustees challenged us to do The Board of Trustees challenged us to do betterbetter
Our staff felt agreed improvement was Our staff felt agreed improvement was possiblepossible
Ultimate goal – avoid preventable harmUltimate goal – avoid preventable harm Areas to explore, assess, and monitor Areas to explore, assess, and monitor
included:included:– Reducing HAIsReducing HAIs– Reducing medication eventsReducing medication events– Eliminating post-operative DVT and PEsEliminating post-operative DVT and PEs
What Would It Take?What Would It Take?
Required out-of-the-box thinking Required out-of-the-box thinking and a new philosophical approach and a new philosophical approach
Front-line empowermentFront-line empowerment Eliminate:Eliminate:
– lack true ownership by front-line stafflack true ownership by front-line staff– natural tendency to slide back to old natural tendency to slide back to old
habitshabits– Hawthorne effectHawthorne effect
Great CompaniesGreat Companies
For great companies – For great companies –
“There was no miracle moment. “There was no miracle moment. Instead, a down-to-earth, pragmatic, Instead, a down-to-earth, pragmatic, committed-to-excellence process -- a committed-to-excellence process -- a framework -- kept each company, its framework -- kept each company, its leaders, and its people on track for the leaders, and its people on track for the long haul.” long haul.” Jim CollinsJim Collins
Our ApproachOur Approach
Develop a new framework and stick to Develop a new framework and stick to itit– TPS LEANTPS LEAN– Focused approach – med eventsFocused approach – med events
Develop a mechanism for staff and Develop a mechanism for staff and physicians to call out problems as they physicians to call out problems as they occurred occurred
Implement real-time problem-solvingImplement real-time problem-solving Ensure improvements happen at the Ensure improvements happen at the
level closest to the patient, i.e. Out of level closest to the patient, i.e. Out of the conference roomthe conference room
FrameworkFramework
Agreed upon principles applied Agreed upon principles applied carefully and consistently:carefully and consistently:– To each and every phase of To each and every phase of
medication pathway redesignmedication pathway redesign– To real-time problem-solvingTo real-time problem-solving
Real-time Problem-Real-time Problem-solvingsolving Implemented mechanisms to call out Implemented mechanisms to call out
problems as the occurred problems as the occurred – Help ChainHelp Chain– Problem logProblem log
Improvements occur at the level Improvements occur at the level closest to the patient and toward the closest to the patient and toward the characteristics of an ideal processcharacteristics of an ideal process– With front-line staff leading the With front-line staff leading the
improvement (those who do the work)improvement (those who do the work)– In the work area (allows for observations)In the work area (allows for observations)
Help ChainHelp Chain
Mechanism by which problems Mechanism by which problems are addressedare addressed
Begins at level closest to patient Begins at level closest to patient and moves toward CEOand moves toward CEO
Creates safety by requiring cross Creates safety by requiring cross level communication, i.e. level communication, i.e. manager to manager or director manager to manager or director to directorto director
Patient
Staff(Ordering Practitioner, RN, RPH Secretary)
Clinical Resource Nurse
Problem
New England Baptist Real-Time Root Cause Problem Solving Help Chain
Clinical Manager
Director of Patient Care Services
SVP of Patient Care
Services
CEO Dept. Chief
Problem LogProblem Log
BenefitsBenefits Makes problems visibleMakes problems visible Creates “pull” from leadership Creates “pull” from leadership
vs. “push”vs. “push” Allows others to learn from Allows others to learn from
solutions and key pointssolutions and key points
Surgical Site Infection Surgical Site Infection Prevention FY06-FY09Prevention FY06-FY09
Results:Results: FY06 46 orthopedic SSI in 9027 cases FY06 46 orthopedic SSI in 9027 cases
(0.51%)(0.51%) FY07 39 orthopedic SSI in 9027 cases FY07 39 orthopedic SSI in 9027 cases
(0.43%)(0.43%) FY08 37 orthopedic SSI in 8884 cases FY08 37 orthopedic SSI in 8884 cases
(0.42%)(0.42%) FY09* 9 orthopedic SSI in 3620 cases FY09* 9 orthopedic SSI in 3620 cases
(0.21%)(0.21%) (*Oct-Feb 2009)(*Oct-Feb 2009)
ResultsResults
NationalNationalBenchmarksBenchmarks NEBH FY07NEBH FY07 NEBH FY08NEBH FY08
NEBHNEBHFY09 YTDFY09 YTD
PulmonaryPulmonaryEmboliEmboli 3.7%3.7% 2.3 % (9)2.3 % (9) 0.8% (3)0.8% (3) 00
Deep VeinDeep VeinThrombosisThrombosis 12%12% 4% (16)4% (16) 00 00
NEB Medication Pathway NEB Medication Pathway RedesignRedesign
CHART
NURSE
PATIENTORDERING PRACTITIONER
PHARMACISTUNIT SECRETARY
PACU ResultsPACU Results
Time Spent on Addressing Problems
33.71%
10.13%
0%
10%
20%
30%
40%
PRE POST
Per
cent
age
of T
ime
PACU ResultsPACU Results
Calls to Clarify
26
4
44
14
0
10
20
30
40
50
PRE POST
Tota
l Num
ber
of C
all O
uts
PACU Results PACU Results
Medication Orders That Could Not Be Processed
28.7
16.67
9.3
1.1
0
5
10
15
20
25
30
35
PRE POST
Rat
e P
er D
ay
Hold Acknowledgement
"Pending Clarification"
Hospital-wide Outcomes – Hospital-wide Outcomes – Patient SatisfactionPatient Satisfaction
Improvement in Patient Satisfaction
88
88.5
89
89.5
90
90.5
91
4/07 - 6/07 7/07 - 9/07 10/07 - 12/07 1/08-3/08 4/08-6/08 7/08-9/08 10/08-12/08 1/09 - 3/09
Quarter
Mea
n S
core
Overall Hospital Mean Score
Audacious Goal
Kick-off
One of our Proud One of our Proud Moments!Moments! 2008 recipient of the Press Ganey 2008 recipient of the Press Ganey
Summit AwardSummit Award– Three consecutive years above the Three consecutive years above the
9595thth percentile or greater (nationally) percentile or greater (nationally) – First Hospital in Massachusetts First Hospital in Massachusetts
to receive the award to receive the award for inpatient satisfactionfor inpatient satisfaction