How unit-based teams are getting results Examples of operational success October 1, 2013

How unit-based teams are getting results Examples of operational successOctober 1, 2013

Vision team sees way to cut supply costs

FEATURED TEAM

Vision Essentials, Wheatridge Medical Office (Colorado)

WHAT IT DID

To reduce the cost of excess inventory of medications, the team:

•Reviewed all standing supply orders•Tracked the cost and number of items ordered for on-hand pharmaceutical use•Consulted with providers and reduced the amount and cost of ordered and stocked pharmaceuticals.

Visit LMPartnership.org for ideas and tools for your team.

RESULTUBT reduced cost of on-hand pharmaceuticals by 69 percent

FEATURED TEAM

Laboratory, Skyline Medical Office (Northwest)

WHAT IT DIDSaw an opportunity to save time and money by addressing a systems issue: Orders from Oncology were marked as “standing” so tests were repeated—even if a patient did not need the same tests done each time. Forty-five percent of tests done between February and June 2013 turned out to be unnecessary.

Collaborated with Oncology to start using a “golden ticket” to identify the specific tests a patient needs and expedite the process when patients go to the lab for their blood draw.


Lab reduces waste, wait times and unneeded tests

RESULTTeam avoided processing 65 unneeded tests in four months, for annualized savings of $23,500

Patient education helps wait times plummet

FEATURED TEAM

Oncology Clinic, Moanalua Medical Center (Hawaii)

WHAT IT DID

To decrease wait times and sustain service improvement over time, this team:•Advised patients to complete lab work at least one or two days in advance of their appointments•Recruited medical assistants to help physicians track lab orders and ensure lab tests are completed•Restricted most same-day appointments to treatments lasting 60 minutes or less, and reserved a two-hour window for lengthy appointments that cannot be postponed due to a patient’s schedule•Staggered patient appointment times to address staffing shortfalls.


RESULTAverage daily patient wait time

Meeting the KP.org challenge

FEATURED TEAM

Point Loma Primary Care, Module B (Southern California)

WHAT IT DID

To increase patient and members’ enrollment in kp.org, this team:•Involved all UBT members in efforts to sign up health plan members on kp.org•Posted signs at the registration kiosk encouraging sign-ups•Used patient visits , elevator wells and waiting areas to the lab, radiology and pharmacy as opportunities for sign-ups•Took advantage of “smart phrases”—short, standardized scripts—in KP HealthConnect to prompt caregivers to discuss kp.org with patients.


RESULTKP.org enrollment

Scanning team reduces patient record errors

FEATURED TEAM

Scanning, Fresno Medical Center (Northern California)

WHAT IT DID

The team significantly reduced average errors rates in just six months by:•Tracking, graphing and posting department-wide errors monthly•Changing workflow to check for errors at each step of the process•Huddling regularly to review errors and discuss potential solutions•Reducing the number of patient records processed at a time.


RESULTAverage errors per month

Storytelling helps with early cancer detection

FEATURED TEAM

Primary Care, North Lancaster Medical Office (Northwest)

WHAT IT DID

To increase the number of members completing the home test for colorectal cancer, this team:•Identified members between the ages of 50 and 75 eligible for colorectal cancer screening•Scripted a story about how physicians in the clinic had tested positive—but because the disease was detected early, they got treatment in time and are doing well•Tracked distribution of the kits and followed up with members who hadn’t returned them.


RESULTThe return rate for take-home fecal immunochemical tests (FIT) kits

Communication among teams improves mammogram rates

FEATURED TEAMAdult Medicine, Shady Grove Medical Center (Mid-Atlantic States)

WHAT IT DID

This UBT in Rockville, Md., worked with Primary Care and Radiology to resolve scheduling conflicts that caused patients to be turned away from same-day mammogram appointments. The team:•Worked with Radiology on a process for sharing schedule information so the best days and times for same-day mammograms can be identified•Set clear boundaries. For example, the Adult Medicine unit agreed not to send patients for mammograms after 3:45 p.m., when one radiology technician is trying to close out the day’s appointments without incurring overtime.


RESULTMammogram screening rate

Getting to zero pressure ulcers

FEATURED TEAM

Respiratory Care, San Jose Medical Center (Northern California)

WHAT IT DID

To reduce reportable hospital-acquired pressure ulcers (HAPUs), the team set a goal of sustaining at least a 90 percent completion rate for patient skin assessments . They did this by:•Conducting four skin integrity assessments per patient during each 12-hour shift•Documenting observations in patient charts•Electronically tracking assessments on a weekly basis•Auditing assessments on a monthly basis•Posting results with names of corresponding respiratory therapists•Providing counseling and encouragement for those not meeting the goal.


RESULTReportable HAPUs

Transforming transport

FEATURED TEAM

Adult Medicine, Capitol Hill Medical Center (Mid-Atlantic States)

WHAT IT DID

To reduce staff time spent transporting patients by wheelchair from the unit to the lab, pharmacy, hospital entrance or public transit stop, the team:•Tracked transport times by staff members•Obtained new, wider wheelchairs to accommodate more patients•Coordinated transport times with other departments•Created and staffed a dedicated transporter position.


RESULTPatient transport times (minutes)

Lab gets quicker on the draw

FEATURED TEAMInfectious Disease/Oncology UBT (Northern California)

WHAT IT DID

To shorten wait times for blood draws, this Gilroy Medical Offices UBT:•Shifted staff schedules so the lab opens earlier•Staggered lunch breaks to spread out the loss of staff on the floor•Educated physicians to improve the clarity of lab orders and reduce duplicative orders•Cross-trained staff members so everyone can register patients and process specimens as well as draw blood. If eight or more patients are waiting to have blood drawn, the team goes into “all hands on deck” mode.


RESULTAverage daily wait time (minutes)

Standing together to prevent patient falls

FEATURED TEAM

Ortho/Neuro Surgical UBT(Southern California)

WHAT IT DID

To radically reduce the number of patients who fall, the team at Fontana Medical Center conducted several tests of change, including:•Calendar posts to make problems known to all when they occur, whether day shift or night shift•Daily huddles include a patient safety briefing to air concerns or potential problems•Blame-free debriefings after a fall to discuss what happened and how to prevent it•Quick response to bed alarms indicating that a patient has gotten up.


RESULTPatient falls decreased by nearly 40 percent

Medication reconciliation keeps patients safe

FEATURED TEAM

Infectious Disease/Oncology UBT(Georgia)

WHAT IT DID

To reduce duplicate medications listed in patient records, members of this team at the Cumberland Medical Office Building in Atlanta started by manually cleaning up patient charts. Then they instituted a new process for checking medications:•Licensed practical nurses and medical assistants ask patients to bring their medications to office visits•MAs and LPNs review patient medications and note on member’s chart which ones the patient is or is not taking •Providers confirm medications with the member and remove the duplicate oncology medication from the patient’s record•MA prints out the patient’s medications and gives the list to the nurse practitioner who, with the clinical pharmacist, reviews it and removes expired medications.


RESULTPercent of duplicate medications per office visit

Assigning ownership of surgical instruments saves thousands

FEATURED TEAM

Head and Neck Surgery(Colorado)

WHAT IT DID

To reduce the number of surgical instruments lost before and after surgeries, nurses in this Franklin Medical Office UBT in Colorado now “own” a set of instruments.

Team members are responsible for counting the instruments at the beginning and the end of the day, similar to reconciling a cash box in a retail environment.


RESULTThe number of lost or broken instruments

Team improves nutrition service while cutting waste

FEATURED TEAMFood and Nutrition department(Northern California)

WHAT IT DID

This San Jose Medical Center team identified ways to prevent costly food waste, where unused formula, supplements and food end up in the garbage. Small tests of change included: •Conducting a “wasted meal study” to learn how much money was being lost to unused meals ($16,000 a year)•Improving communication with unit assistants about patients’ eating patterns and discharge data•Paying closer attention to expiration dates on supplements and adjusting the ordering accordingly.


RESULTMonthly food expenses cut by 10 percent

UBT helps new members navigate KP

FEATURED TEAM

Adult Primary Care, Falls Church(Mid-Atlantic States)

WHAT IT DID

To improve member retention and help Kaiser Permanente grow, members of this UBT:•Involved Spanish-speaking staff in welcoming 3,200 new Spanish-speaking members•Used the New Member Identifier tool in KP HealthConnect™ so staff could help orient new members, or those who haven’t been in for a while•Called new members to set up appointments, help refill prescriptions and address other needs•Sent welcome letters and a road map on how to get started as a Kaiser Permanente member and patient•Passed out a new member kit with contact numbers.


RESULTFavorable patient satisfaction scores

Wait times down, courtesy scores up

FEATURED TEAM

Laboratory(Northwest)

WHAT IT DID

To cut wait times that could sometimes exceed 45 minutes, the Mt. Scott Medical Office lab moved to a one-on-one model in which:•A technician stays with each patient from check-in to blood draw•The technician returns to the check-in desk to take the next patient•More team members are freed up to reduce the queue, rather than having a dedicated member working the computer.


RESULTImproved patient satisfaction and an unexpected jump in technician courtesy scores

Documents

How unit-based teams are getting results Examples of operational success October 1, 2013