Upload
dubai-quality-group
View
1.024
Download
4
Embed Size (px)
DESCRIPTION
Breakthrough Process Improvement case study submitted by Tawam Hospital during 3rd Continual Improvement & Innovation Symposium organized by Dubai Quality Group's Continual Improvement Subgroup to celebrate World Quality Day 2011.
Citation preview
The Surgical Admission Process
A Cultural Shift Paradigm
Breakthrough Process Improvement Case
About Tawam Hospital
• 477-bed tertiary hospital in Al Ain
• Highly specialized and well trained doctors and nurses.
• In affiliation with Johns Hopkins Medicine from 2006
• JCI accredited since 2006 and reaccredited in 2009.
• Recognized as Baby Friendly Hospital.
• An educational hospital and training center for faculty of medicine and health sciences- UAE University
1.Project Selection
2.Current Situation Analysis
3. Solution Develop
ment
4.Implementation
PROJECT SELECTION & PURPOSE
T Data And Quality Tools Used To Select The Project
Define Measure Analyze Improve Control
Data Reason for use
Operational reports, KPI
indicators (as LOS, Delays in OR
start time, # of surgeries, # of
admissions ), patients feedback,
To take evidence based decisions considering a balanced view
of the process at hand.
Tools Reason for Use
Multidisciplinary team Pool of subject matter expertise to ensure comprehensive
understanding of the problem, broad generation of innovative
ideas and easy buy in during implementation
Brainstorming & Group discussion Proven effective tool to generate big number of ideas from all
stakeholders Prioritization matrix To select important projects based on objective and
comprehensive criteria to consider projects impact from all
aspectsProject Charter To clearly communicate, define goals, targets, scopes, and
expectations. To identify project responsibility and
accountability
SIPOC To identify the scope, inputs, outputs internal and external
customers, and main process steps.
Subject Matter Expert (SME) To consider the project form all aspects, with a professional
view
Involvement of potential stakeholders
in project selection
Surgery Quality Committee including:
• Division chiefs
• Nursing representatives
• Administration representatives
• Pharmacist
identified “Bed management” and OR booking” as two of the top five priority projects for the Surgery
Define Measure Analyze Improve Control
Why The Project Was Selected
• To select the priority projects a group consensus using a prioritization matrix consisting of 10 criteria was applied: – Patients needs & expectations – Outcome – Mission /Vision/Strategic Plan – Regulatory compliance – High Risk / Volume – Problem prone – Cost – Impact – Ease of implementation
Define Measure Analyze Improve Control
Why The Project Was Selected – 2
Define Measure Analyze Improve Control
Score of > 18 = Top Priority
Score of 15-18 = Moderate Priority
Score of 10-14= Low Priority
Score of < 10 = Not a Priority
ALIGNMENT WITH THE ORGANIZATION'S GOALS, PERFORMANCE MEASURES, AND/OR STRATEGIES
Affected Organizational Goals
Define Measure Analyze Improve Control
IDENTIFICATION OF POTENTIAL STAKEHOLDERS
Potential Internal & External Stakeholders
Define Measure Analyze Improve Control
Team analyzed:
•Patients flow •Areas affected by the project •+/- impact •Inputs /outputs/process steps
How
•Brain storming
•SMEs
•SIPOC
•Process Flow Chart
SIPOC
Types Of Potential Impact On Stakeholders & Potential
Define Measure Analyze Improve Control
1.Project Selection
2.Current Situation Analysis
3. Solution Develop
ment
4.Implementation
THE APPROACH/PROCESS THE TEAM
USED TO IDENTIFY THE POTENTIAL ROOT CAUSES/IMPROVEMENT OPPORTUNITY
Innovative Methods And Tools Used To Identify Possible Root Causes 1/2
Define Measure Analyze Improve Control
Process walk through
• Patients view
Cause & Effect Diagram
• Possible causes of the problem
Pareto
• Prioritize possible contributing factors
Structured Data Analysis
• Evidence based
Staff Shadowing
• In-depth understanding- provider view
Innovative methods and tools used to identify possible root causes2/2
Define Measure Analyze Improve Control
Describe The Team’s Innovative Analysis Of Data To Identify Possible Root
Define Measure Analyze Improve Control
Data analysis included an extensive assessment of:
• KPI results (including OR Cancellation Rate & number
of elective surgical admissions).
• Reasons of surgical cancellations on day of surgery.
• Reasons for “patients no show”(by calling the
patients).
• Available vs. needed” Surgical education materials”.
THE TEAM ANALYSIS OF INFORMATION TO IDENTIFY THE FINAL ROOT CAUSES
Tools Used To Identify The Final Root Cause(s)
Define Measure Analyze Improve Control
Team’s Analysis Of Data To Select The Final Root Cause(s)
Define Measure Analyze Improve Control
• The old process was inefficient
– No proper communication between various stakeholders (patient, or scheduling office, anesthesia clinic and financial clearance office).
• The OR elective cancellation rate (on day of surgery) was 20%.
– System errors accounted for a significant percentage of cancellations.
How The Team Validated Final Root Cause(s)
Define Measure Analyze Improve Control
Score
Strong Impact 9 Moderate 3 Low 1
Relationships
1.Project Selection
2.Current Situation Analysis
3. Solution Develop
ment
4.Implementation
METHODS USED TO IDENTIFY THE POSSIBLE SOLUTIONS/IMPROVEMENT ACTIONS.
Methods And Tools Used To Develop Possible Solutions /Improvement Actions
Define Measure Analyze Improve Control
• Run comprehensive literature review to identify other healthcare (HC) systems approach to similar problems.
• Used the PICO Model (Population Intervention Comparability
Outcome) to validate our comparison with HC systems similar to our environment.
• Held one to one discussions with the process owners. • Generated and captured possible solutions during brain storming sessions & 5 Whys Exercise
Team’s Analysis Of Data To Develop Possible Solutions
Define Measure Analyze Improve Control
• Improvement actions were based upon extensive review of:
– Base line KPIs and process related data
– Results of the studies done by the various team members about the reasons for the delay, cancellation rate and source by wards, etc.
– Possible impact on the results
– Easiness of implementation
– Impact on patients safety and satisfaction
– (as mentioned in 2A b & 3Ac).
Criteria The Team Decided To Use In Selecting The Final Solution(s)
Define Measure Analyze Improve Control
• Criteria for selection were chosen in a balanced approach considering:
– Financial
– Operational
– Customer
– Quality perspectives
Criteria The Team Decided To Use In Selecting Final Solution(s) 2/3
Define Measure Analyze Improve Control
HOW THE FINAL SOLUTIONS IMPROVEMENT ACTIONS WERE DETERMINED
Tools Used By The Team To Select The Final Solutions
Define Measure Analyze Improve Control
Tools Rational for use
Provided a holistic qualitative approach for identifying the possible solutions considering the 5
Ms and E and in relation to the Identified causes under the same categories. It also helped in
generating ideas for improvement.
During discussion on the possible root causes, all ideas generated were listed then they were
prioritized by the team using the Prioritization Matrix.
Prioritizati
on Matrix
This useful technique used to rank the solutions based on important criteria to identify the most
important solutions to work on first: (kindly refer to the scoring in 3Ac)
Fish Bone
Diagram
Define Measure Analyze Improve Control
Team’s Analysis Of Data To Select The Final Replicable Solution(s)/Improvement Actions 1/2
For example, Ortigo et al , found in a study including 6053 patients that the implementation of a Surgery Admission Unit for patients undergoing major elective surgery has proved to be an effective strategy for improving bed management, improving the proportion of patients admitted on same day as surgery and a shorter length of stay
Benchmarking with evidence based proven practices
Define Measure Analyze Improve Control
Team’s Analysis Of Data To Select The Final Replicable Solution(s)/Improvement Actions 2/2
FINAL SOLUTIONS VALIDATION
1.Project Selection
2.Current Situation Analysis
3. Solution Develop
ment
Implementation
Define Measure Analyze Improve Control
• Resistance from various stakeholders was both expected and encountered:
– Multiple meetings were held
– The SAU team identified physicians who presented a challenge. This was addressed to the Director of Peri-Operative Services.
– Protocol was strictly enforced such that surgeons who followed the protocol were able to get more cases on the schedule while those who were resistant lost operative time.
– Surgeons and staff were encouraged to counsel patients on the benefits of this process.
Types Of Resistance Identified And Addressed
The final solutions, validated through literature review and impact analysis included:
• Enriching the current function of the Day Case Unit by adding the function of a Surgical Admission Unit.
• Remodeling of the elective surgical admission process. All elective surgical admissions unless otherwise medically indicated will be admitted on the day of surgery.
• Developing a Surgical Admission Office
• Improving surgical educational materials
Define Measure Analyze Improve Control
Improvements Implemented
Define Measure Analyze Improve Control
• Centralize – Surgical Scheduler (medical background)
– Admissions/Bed Board Officer
– Insurance Specialist
– Patient Advocates
Improvements Implemented
Define Measure Analyze Improve Control
Surgery scheduled and communicated electronically to the office by surgeon
Patient seen in office, oriented, assigned patient advocate
Patient flow through system virtually shadowed by office
Patients called 1wk, 48, and 24hrs prior to surgery
Improvements Implemented
Define Measure Analyze Improve Control
Patients called to arrive 2 hours prior to surgery based on schedule
Goal set for patient arrival to being ready for transport to OR: 20 min
Ambulatory patients discharged efficiently based on nursing care pathways
Improvements Implemented
Define Measure Analyze Improve Control
Patient removed from schedule if not cleared and empty space communicated to surgeons
Surgical Schedule communicated electronically to entire organization at 48 and 24 hours
Charts available night before scheduled surgery and reviewed by nurse-Problems Identified
Beds allocated night before based on expected admissions
Improvements Implemented
RESULTS ACHIEVED
Define Measure Analyze Improve Control
Tangible Results
Other Results
Define Measure Analyze Improve Control
• Increased patients satisfaction
• Increased staff satisfaction
• Better hospital reputation and word of the mouth
• Increased efficiency
Creation And Installation Of A System For Sustaining Results
Define Measure Analyze Improve Control
Results of the following KPS were reviewed weekly by a core team :
• OR utilization
• OR start times
• Patient arrival times
• Patient transport times
• Reasons for cancellations
• Sharing of successes and recognition at Tawam and national levels
• At SEHA level won the Golden Medal
• Transparency
• Learning form challenges
• Next step: move the Pre-anesthesia clinic closer to the surgical admission office.
Define Measure Analyze Improve Control
Project Closure
Lessons Learnt
• Chronic problems are always associated with high resistance to change
• When incremental improvements are not effective, a process reengineering should be considered
• Team work is the fuel for success
Team Leader : Dr. Waleed Hassen, Chairman of Urology Team Members: • Alexander Jankuloski RN, Associate Director of Nursing
• Alec Napier, Operations Officer • Aysha Al Ameri, Administrative clerk, Surgical Admissions Office • Susie Delgado, Nurse Manager, Surgical Admissions Unit • Urszula Allen, Nurse Manager, Operating Room
• Mervat Mansour, Section Head, Quality Improvement &
Innovation ,DPI.
The Project Team
Any Questions?
Thank you