using lean to positively impact patient safety

Using Lean to Positively Impact

Patient Safety

Denver Health Medical Center

Jessica VastolaLean Facilitator

May 2010

Denver Health Medical CenterDenver Health Medical Center

�� Community safety net Community safety net hospitalhospital

�� 500 beds500 beds

�� Approximately 5,000 Approximately 5,000 employeesemployees

�� Worry 1

� One of DH’s greatest strength is its employees’ commitment to our mission

BUT

� The mission could be in jeopardy because of growing cost of uninsured and decreasing resources

Denver Health Medical CenterDenver Health Medical Center

Denver Health Medical CenterDenver Health Medical Center

�� Worry 2� We are doing things essentially the

same way as when our CEO was an intern

BUT� Other successful industries have

changed their processes dramatically in the last three decades

Denver Health Medical CenterDenver Health Medical Center

�� Worry 3

�We want to continuously improve the system to ensure quality of care/patient safety

BUT

�We haven’t developed a coordinated approach for system improvement

Denver Health Medical CenterDenver Health Medical Center

�Worry 4

�We have issues with customer service

BUT

�Just repeating Press Ganey hadn’t been getting us where we needed to be

Denver Health Medical CenterDenver Health Medical Center

�Worry 5

�We are facing local and national workforce shortages

BUT

�We haven’t developed an approach to be employer of choice

Getting It RightGetting It RightPerfecting the Patient ExperiencePerfecting the Patient Experience

RightPeople

Right Communication

and Culture

Right Process

Right Reward

Right Environment

IT

What is lean?What is lean?

A systematic approach of continuous improvement, utilizing specific tools and

techniques to identify and eliminate waste

Why did we choose lean?Why did we choose lean?

� A philosophy, set of principles and a tool set

� Philosophy fits for health care

� Tool set is intuitive

� Meaningful employee engagement

� Initial rapid results

� Power to change culture

Learn to See WasteLearn to See Waste

Most processes are NINE parts non-value added to ONE part value added

Definition of Non-Value Added� Anything that consumes time or

resources but the patient is not willing to pay for

Definition of Value Added� Any activity that directly contributes to

satisfying the needs of a patient

Focus on removing the non-value added activities

The The ‘‘big ideabig idea’’ of of LEAN LEAN

THINKINGTHINKING

Total Lead Time to Customer

90 % 10%

VA

Need Identified

Need Met

It’s about adding value for our customersNVA

8 Targeted Wastes

� Unused Human Talent

� Waiting

� Inventory

� Transportation

� Defects

� Motion

� Overproduction

� Processing

�� Team Members:Team Members:�� Infection Control ManagerInfection Control Manager

�� Nurse Anesthetist SupervisorNurse Anesthetist Supervisor

�� Nursing Research CoordinatorNursing Research Coordinator

�� Medicine Service Line AdministratorMedicine Service Line Administrator

�� Industrial EngineerIndustrial Engineer

Rapid Improvement EventSurgical Site Infection Prevention

Reason for Action

Improve the existing processes of Improve the existing processes of

administering prophylactic antibiotics within administering prophylactic antibiotics within

one hour prior to surgical incisionone hour prior to surgical incision

Initial Condition

� Prophylactic antibiotics are given per the traditional physician order to “Give on call to the OR”

� RN responsible for administering prophylactic prophylactic

antibiotics; nonantibiotics; non--standardizedstandardized

�� Consistent with CDC guidelines in 67% of cases Consistent with CDC guidelines in 67% of cases

Target Condition

� Percent antibiotic prophylaxis administered within one hour of the first surgical incision in 100% of cases

� Standard process for meeting CDC guidelines

Gap Analysis

� “Moving target”

� APC RN “guesstimates” the one-hour time frame prior to the first incision

� Lack of communication between departments and staff

Solution Approach

� Rapid Improvement Event � 4 days

� Multidisciplinary team with process focus

� Lean Tools and Techniques� Waste Walk

� Process Mapping

� Identification of Value Added vs. Non-Value Added Activities

� Communication Circle

RIE – Rapid Improvement Event

� Report of issues, interventions, and results to executive staffDay 5

� Implemented new process� Observed new process in place

� Received positive feedback from APC nursing staff!

� Established methods for monitoring ongoing metrics� Created standard work for new process

Day 3 & 4

� Obtained feedback from front-line RNs and physicians� Developed “ideal state” and “future state” maps

� Confirmed with key stakeholders

Day 2

� Developed current state map indicating the pre-operative process for administration of prophylactic antibiotics

� Reviewed cases to establish baseline “success rate”

� Walked through the process (“waste walk”) and confirmed current state map

Day 1

Rapid Experiments

� Anesthesiologist to administer prophylactic antibiotics to the patient in the operating room

� Revised the pre-operative written physician order form to facilitate the new process

� Communicated changes & trained staff

Successful changes and implementations!

Confirmed State

SCIP-1 Antibiotics within 60 minutes prior to incision

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Q1 06 Q2 06 Q3 06 Q4 06 Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09

DHMC UHC median National median

Questions?