Bridges Curriculum Ambassadors Summer 2014 @UCSFBridges

Introduction

Leading System-wide Change at SFGH at the Kaizen Promotion Office

Matthew Cummings (P3), Julie Wu (MS2)

Results

Discussion

● Hospitals have begun implementing more efficient, patient-centered care models following passage of the Affordable Care Act.

● Lean: a quality improvement approach designed to eliminate waste from workflow through continuous improvement, or kaizen

● Kaizen Promotion Office (KPO): established 2012 at SFGH○ Use and teach Lean principles with goals of decreasing wait times

and waste, increasing patient safety and satisfaction, and increasing workplace communication

○ Value streams in 6 departments: Outpatient Pharmacy; Urgent Care Center; Radiology; OR; 3M Surg Clinic; 4D Med-Surg Unit

○ 3P Workshops for transition to new hospital; Kaizen workshops● Curriculum Ambassador (CA) program: a pilot program for the new

Bridges curriculum focused on experiential systems-based learning

Methods

● Week-long Kaizen events with department to identify wastes, brainstorm and test solutions, report prioritized solutions to the hospital

● Week-long Kaizen 3P workshops with staff, stakeholders to design the layout and flow of their department in the new hospital

● Kaizen principles represented by the Lean House:

● Value stream mapping: detail steps in process, time spent, work inputs

● Observations and data collection at the site

● Weekly check-in meetings and planning meetings for events

Participated in Kaizen events and 3P workshops: Emergency Department 3P Workshop; Maternal and Child Health 3P Workshop; Outpatient Pharmacy Kaizen; OR Documentation Kaizen. Results of two are highlighted below:

3P Workshop: Maternal and Child Health

● Current state (left), future state (right)● Developed 7 priority areas for

transitioning to the new hospital:

Kaizen Event: Outpatient Pharmacy

● Introduced 11 new forms of standard work

● Decrease in initially observed prescription wait times

● Implemented color-coordination, visual workflow management

● Cross-trained pharmacy techs for flexible workflow coverage

1. Shared documentation system2. Integrated rounding3. Team-based assessments, care planning4. Cross-training nursing staff5. Patient/family-centeredness6. Efficient, welcoming registration process7. Integrated leadership, management,

governance structure

● Learned and applied the Kaizen model of management● Developed interprofessional communication and collaborative skills● QI projects allow students to gain broad perspective of workflow in a hospital

and gain transferable skills to identify and address any major wastes● Integrating systems-based experiential learning into medical curricula will

prepare students to practice medicine in the 21st-century