theda clark medical center neenah, wi eric nelson, erin halpin, maria novy, rachel janzen, sue...
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Theda Clark Medical CenterNeenah, WI
Eric Nelson, Erin Halpin, Maria Novy, Rachel Janzen, Sue Broeren
Organphiliacs
Historical DataTheda Clark Medical Center has
consistently been a high performing organ donation hospital in the state of Wisconsin
Seven time winner of the HRSA medal of honor
Participated in the 2003 national collaborative
Five year average conversion rate of 94%
Actual Donor and Potential Donor Data AnalysisJanuary – November 2011
Donors After Brain Death 13Donors After Cardiac Death 3Actual Donors 16Eligible, No Consents 1Actual Conversion Rate 94% (16/17)Potential Donors 8
Identified on potential donor detail reportPotential Conversion Rate 67% (16/24)
Actual Donors + Potential Donors = 24
Pre-work for Forward Focus
Hooray Headaches Recognizing an opportunity for
donation early Passion for donation throughout the
hospital Good working relationships and
problem solving with the UW OTD staff
Fliers to communicate case results within the different departments
Staff members reminding each other to keep the option of donation in the back of their minds
Building a relationship with families; recognizing when the time is right to approach
Senior leadership support
Family in the OR for DCD cases; OR staff not comfortable
Knowing if a referral was called in
Knowing if a referral was open or closed
Overall communication line with UW OTD and keeping families updated with the most information available
Re-approaching after getting an initial no
FPA refusal; no plan or process in place to support family and staff while honoring the donors decision
ThedaCare Improvement System
Draft 6
TIS 9 Methods to See and Remove Waste in a Process within a Value Stream
Adjust
Adjust
Adjust
Adjust
Adjust
Sequence and Continuity
50,000 ft
GROUND LEVEL
INCREASING DETAIL
STANDARD WORK
Adjust
5S
SIPOC
TAKT TIME
FLOW DIAGRAM
COMMUNICATION CIRCLE
SPAGHETTI DIAGRAM
TIME OBSERVATION
BAR CHART
STANDARD WORK COMBINATION
5S Visual Management
Adjust
Adjust
Tools We Used to Prioritize Our Work
Prioritized our Headaches and Hoorays
Root Cause Analysis Using the 5-Why’sProblem Root Cause Countermeasures
No huddle with OPO and TC before meeting with the family
Not expected, no standard process Develop standard for having huddle with OPO and TC team prior to talking with each family on each case, even if family not present at hospital-checklist for process added to donation binders
Inconsistent communication from OPC’s, have to push them to get information on where we are at in the process
No communication standard Work with OPC’s to establish clear guidelines and expectations for communication during cases-specific time points-specific information-direct contact information
Lab management process not timely We don’t have clear expectations established -Work with OPC’s to establish clear guidelines and expectations related to lab management-timely review of labs-timely communication to RN for interventions-OPO flowsheet in EPIC
Mindset and understanding of additional testing unclear
We don’t have clear expectations established Work with OPC’s to establish clear guidelines and expectations related to testing management-Communication related to need for testing
Clarity of case/teams coming/organs recovered/set-up required unknown to OR
No standard for communication with team Work with OPO and OR to establish standard for communication guidelines and expectations-specific time points-specific information
OPO to OR communication inconsistent No standard for communication from OPC to OR Work with OPO and OR to establish standard for communication guidelines and expectations-specific time points-specific information
PICK Chart
Process Flow Mapping
Began our PDSA (Plan, Do, Study, Act)PLAN:
Team identified the need to focus on communication between UW OTD and Theda Clark staff
We collected data on five actual donors (March 2012-May 2012)
Goals and Targets establishedHave zero occurrences of lost donors post-consent. Have one process established for flow of information from
Theda Clark to UW OTD and UW OTD to Theda Clark.Reliable and consistent two-way communication during case
progression of the donation process post-consent to recovery.
No unnecessary delays in donation process due to communication issues.
Developed Our Problem Statement
During 18/18 organ donation cases for 2011, varied and inconsistent communication occurred between Theda Clark and UW OTD during the post-consent to recovery phase of the donation process. This lead to staff dissatisfaction, frustration, and additional work. Additionally, 1/18 organ donation cases was lost post-consent.
What We Started to Work OnCreated and implemented standard work for:
Lab ManagementAdditional TestingUW OTD to OR CommunicationPhone Communication with OPCDCD Pre-Huddle to OR Recovery Family Refusal with a First Person Authorization
Created and implemented organ donation checklist and OPC contact list
What is Standard WorkStandard Work is the Foundation for
Continuous Daily ImprovementDefines Who, What, When, Where, How and
WhyThe Current Best and Safest Way A Visible Tool for:
TrainingCoachingAuditing Identifying Opportunities for Improvement
Fosters Employee Engagement Reduces Variation and Eliminates Waste
This is How We Do it at ThedaCare
Diagram, Work Flow, Picture, Time Grid Team Safety Critical Step WIP Tollgate Tip
Standard work is created
Determine process
owner for training
Define audience
for training
and learning
Establish training needs
Comment: This process flow is for the training of standard work(SW). SW is a specified process content, performed in a specific sequence, with consideration for takt time and work in process.
Determine method of training
Seek out education
resource if the learning requires advanced critical
thinking skills
Develop training plan
(initial & ongoing)
Develop plan for applying PDSA for learning
Communication with OR During OPO Case-Standard Work Examples
;
High Level Process Flow
Diagram, Work Flow, Picture, Time Grid Team Safety Critical Step WIP Tollgate Tip
Consent for organ
donation obtained,
ICU RN Calls OR lead to
give a heads up
Organ Procurement Coordinator calls OR to arrange OR
time
OR lead RN calls
anesthesia on-call
provider Brain
Death Case
DCD case
Can the case be done at agreed
upon time?
YES
NO
Ensure adequate OR staff
available to do case
Anesthesia suggests a new time
OR lead RN calls OPC to change time
NO OR does not
have adequate staff to
cover case
OR to call for additional
staff or have staff stay
over as extra
OR lead RN to communicate with ICU RN if time of
case needs to change or problems
arranging time Time is
confirmed with OR and
OPO
OPO calls OR lead RN prior to both take
off and landing of
team
OPO arrives at TC and brings TC
OR team to ICU
Team meeting in
TC ICU multi-
purpose room
OPC goes to OR to
inform staff that all is
ready
Patient is taken to OR
Organ Recovery Begins
YES Can the case be done at agreed
upon time?
Ensure adequate OR staff
available to do case
NO OR does not have
adequate staff to
cover case
OR to call for additional
staff or have staff stay
over as extra
Time is confirmed
with OR and OPO, OR lead Calls anesthesia on-call to notify of OPO case
Reflections Since Starting Our Journey…What Has Forward Focus Taught Us. Increased teamwork within departments and cross
departmental Work has brought donation to the forefront of people’s
mindsIncreased communication and working relationships with
UW OTD and OPCsAfter action reviews have occurred with increased
participation Rapid recovery was possible and we were successful with
a donor on 1/28/2013We and the team understand and have more influence
on the processes of organ donation
How Will We Continue Our Journey….
Donation committee meetings every other month with additional time allocated to discuss Forward Focus work
Continue after action reviews with all donors
Increased interdepartmental participation with all donation work
Continue to attend offered learning sessions
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