An Innovative Lean Six Sigma Approach to Performance Improvement and Patient Safety

1. An Innovative Lean Six Sigma Approach to Performance Improvement and Patient Safety January 20, 2010 ASQ Philadelphia Danielle Drummond Vice President, Lankenau Hospital

2. Outline of Lankenau’s Journey • Lankenau prior to the Journey: 2006-2008 • Embarking on the Journey: 2008 • Along the Way: 2008 - Present • Looking ahead to the future

3. I. Prior to the Journey • New President : Elaine Thompson, PhD in Engineering • Opportunity for structured approach to Performance Improvement • Patient centered approach to care delivery • Good results and track record, but… • Increasing number of patient safety, quality, and satisfaction metrics with flat performance • Need for multi-disciplinary approach • Opportunity to bring engineering methods in partnership with clinical care teams

4. II. Embarking on our Journey • Senior Operations Performance Improvement Team Formation • Fiscal Restraints • Internal resources pooled to form the PI Team • Prioritization • I want a regression statement • Next best thing: Decision Making Matrix

5. II. Embarking on our Journey Lean Six Sigma Tools: Prioritization Matrix 1: High 2: Moderate 3: Low

6. II. Embarking on our Journey

7. II. Embarking on our Journey Charter # 1: Management and Organizational EngagementThe Backbone for Performance ImprovementEngagement and A Call to Action for the Team

8. II. Embarking on our Journey Charter’s Framework • Helping the Management Team Focus • Keys to Success • Management Retreat • Job Accountabilities • The “infamous” 1:1 • Helping the Executive Team Focus • Climate Sensing Program • Multi-Disciplinary Engagement Council

9. II. Embarking on our Journey Lankenau Hospital’s 5 Principles for Management and Organizational Engagement

10. 5 Principles for Management and Organizational Engagement # 1: Bring your personal passion and commitment to patient safety and best practice each and every day Your personal call to action Importance of each individual patient Do what you do best

11. 5 Principles for Management and Organizational Engagement # 2: Recruit, develop, mentor and manageyour team to make sure that they are ready for the next patient/family member/co-worker at all times.

12. 5 Principles for Management and Organizational Engagement # 3: Design, organize and maintain your departments, the hospital’s physical plant and supplies to make sure you are ready for the next patient, their family and co-workers. • Master Facility Plan • Lean 5S Approach • Unit Rounding • Auditing

13. # 4: Drive us towards performance improvement so that we are better tomorrow than we are today and that today we are better than what we were yesterday 5 Principles for Management and Organizational Engagement Model Superior Patient Experience = Best Process + Best Communication & Culture (Robust Feedback & Accountability)-1

14. # 4: Drive us towards performance improvement so that we are better tomorrow than we are today and that today we are better than what we were yesterday 5 Principles for Management and Organizational Engagement

15. 5 Principles for Management and Organizational Engagement # 4: Drive us towards performance improvement so that we are better tomorrow than we are today and that today we are better than what we were yesterday Process Steps • Plan • See/Hear/Touch • Prioritize • Measures • Learn and Do • Eliminate Waste • Determine and Standardize Key Processes • Select Optimal Operational Engineering Performance Improvement Model for Prioritized Improvements • Evaluate Technology Solutions • Build Accountability • Continual People, Process, and Outcome Measurement • Sustain • Adherence • Perseverance

16. 5 Principles for Management and Organizational Engagement #5: Grow patient volume and be a good steward of our human and capital resources. • Master Facility Plan • Improve Patient Satisfaction Scores • Efficiency

17. II. Embarking on our Journey Lessons Learned • Buy-in is required right from the beginning • A multidisciplinary approach is necessary • Front line staff must be involved • Change is easier to swallow when it is shown in a positive light

18. III. Along the Way Charter # 2: Multidisciplinary Care Teams • Background • Need for improvement in Patient Satisfaction and Core Measures identified by Quality and Safety Dashboard. • Inconsistent team of care providers revealed as root cause. • Inconsistent care team partners for nurses on the inpatient units.

19. III. Along the Way Charter # 2: Multidisciplinary Care Teams • Approach • Created innovative, collaborative care team model to improve safety, reliability and delivery of patient care. • Lean Six Sigma Tools • Process Mapping • Value Stream Mapping • Affinity Diagrams • Sustained process change through communication, and individual accountability and feedback.

20. III. Along the WayCharter # 2: Multidisciplinary Care Teams Network/Affinity Diagram

21. III. Along the WayCharter # 2: Multidisciplinary Care Teams

22. III. Along the Way Charter # 2: Multidisciplinary Care Teams • Design: Multi-Component Charter undertaken • Unit Based Organizational Structure • Team Safety & Quality reviews • 360 Evaluations • Formalized Multidisciplinary Care Team • Medicine • Surgery • Coordinated care team patient rounds • Daily care plan documented • Robust discharge planning • Multidisciplinary clinical education • Quality initiatives • Medication Reconciliation

23. III. Along the Way Charter # 2: Multidisciplinary Care Teams • Results Patient Satisfaction at 88th percentile for National Teaching Peer Group * * * * * * * Statistically Significant at 95% Confidence Interval Direction signifies an improvement in that category

24. III. Along the Way Charter # 11: Infection Prevention • Issues: • Improvement required in device related infections identified by Quality and Safety Dashboard • Lack of standardized data collection and management practices • Demand for process improvements in infection prevention

25. III. Along the Way Charter # 11: Infection Prevention • Approach • Created multi-component charter to lead multi-disciplinary redesign of Infection Prevention and Control • Prioritized charter components to optimize improvement and results realization • Use of Lean Six Sigma Tools • 5S: Sort, Set in Order, Shine, Standardize, Sustain • Value Stream Mapping of Infection Reporting Process • Fishbone Diagrams • Sustained process change through communication, individual accountability and feedback

26. III. Along the Way Assessment 13 component charter undertaken with multi-disciplinary Performance Improvement team: Efficient data collection Employee & Medical Staff Accountability Affinity Diagram Hospital-wide advertising & hand-washing Targeted clinical programs for device associated infections Healthy Patients Antibiotic Stewardship President’s Infection Control Committee Development of Infection Prevention workforce MRSA Strategic Plan Focused Critical Care initiatives Clinical Informatics support Biomedical engineering partnership with Drexel University Enhanced environmental cleaning Communication of measures & activities

27. III. Along the Way Methods 1 of 2 Example Components • Concurrency of Surveillance • New process initiated to ensure streamlined physician/patient notification and involvement • Simplified (Targeted) physician review of infections • Enhanced Environmental Cleaning • Monthly deep-cycle ICU cleaning • Hygenia Luminometer in use • Expanded robust cleaning education and audit programs • Critical Care • Operating Room • Procedure Areas • Emergency Department • Stethoscope location trial ongoing

28. III. Along the Way Methods 2 of 2 Example Components • Targeted Clinical Programs • CA-UTIs (Catheter Associated Urinary Tract Infections) • Clinical Information System utilized to prompt and capture information related to prevention methods. • VAP (Ventilator Associated Pneumonia) • Daily VAP Bundle Compliance • ZAP VAP 12 in 24 program (oral care) • CHG toothpaste • CL-BSI (Central Line Associated Blood Stream Infections) • Clinical Information System IV documentation and data collection tool in development • Insertion carts loaded and available on unit • Targeted process surveillance • SSI (Surgical Site Infections) • Expanded data capture structure to include pre-operative “health” elements (Pre-Albumin, pre-op Glu, etc.) • CHG pre-op cloths trial with Orthopedics

29. III. Along the Way 5S Example

30. III. Along the Way 5S Environmental Audit Tool

31. III. Along the Way Charter # 11: Infection Prevention • Early Results * Statistically Significant at 95% Confidence Interval Direction signifies an improvement in that category

32. IV. Looking Ahead to the Future • Lankenau Hospital Center for Patient Safety, Reliability, and Best Practice • Multi-institutional Research Center • Three areas of research focus: • Development of engineering solutions for decreasing hospital acquired infection • Nurturing the “smart” of our “SMART Chart” • Improving the ability to communicate to our team, providing robust feedback, and holding each other accountable

33. Questions? Contact Information: Danielle Drummond Vice President, Lankenau Hospital Email: drummondd@mlhs.org