Transcript Document

How unit-based teams are getting results
Examples of operational success
December 2013
Patient safety: No one walks alone
FEATURED TEAM
Telemetry, San Diego (Southern California)
WHAT THEY DO
By viewing every patient—not just some—
as fall risks, this telemetry UBT successfully piloted
a falls-reduction initiative that has drastically
decreased falls hospital-wide.
RESULTS
Falls in a month
Visit LMPartnership.org for ideas and tools for your team.
UBT roots out workplace injury mystery
FEATURED TEAM
Radiology, Redwood City (Northern California)
WHAT THEY DID
When workplace injuries started cropping up
among technologists in Redwood City’s radiology
department, UBT members worked with the
manufacturer of the newly installed mammography
equipment to make the machine easier to use.
They also worked with ergonomic consultants
to learn techniques for preventing repetitive
movement injuries.
RESULTS
Reduction in workplace injuries
Visit LMPartnership.org for ideas and tools for your team.
Rx refill center boosts efficiency, cuts waste
FEATURED TEAM
Automated Refill Center at Pharmacy
Distribution Center (Georgia)
WHAT IT DID
To reduce costs and the time it takes to stock
medications that come in a variety of sizes, pharmacy
workers:
• Order items in same-size packages (except for two
antibiotics that come in specific quantities that clinic
staff found useful)
• Stock items only in the largest containers available
to reduce waste.
Visit LMPartnership.org for ideas and tools for your team.
RESULTS
Total Health: Counting the time pays off
FEATURED TEAM
Family Medicine, San Mateo (Northern California)
WHAT THEY DID
This UBT got its members up and moving with
a little friendly competition, forming small teams
with four or five people. The teams tracked how
much total exercise they did each week, and the
ones that logged the most minutes or days of
exercise won prizes. Staff members reported that
the wellness activity lowered stress levels, got them
in better shape and improved teamwork.
RESULTS
Approximate employee participation
Visit LMPartnership.org for ideas and tools for your team.
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 onhand 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.
RESULT
UBT reduced cost of on-hand pharmaceuticals
by 69 percent
Lab reduces waste, wait times and unneeded tests
FEATURED TEAM
Laboratory, Skyline Medical Office (Northwest)
WHAT IT DID
Saw 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.
Visit LMPartnership.org for ideas and tools for your team.
RESULT
Team 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.
Visit LMPartnership.org for ideas and tools for your team.
RESULT
Average 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.
Visit LMPartnership.org for ideas and tools for your team.
RESULT
KP.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.
Visit LMPartnership.org for ideas and tools for your team.
RESULT
Average 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.
Visit LMPartnership.org for ideas and tools for your team.
RESULT
The return rate for take-home fecal
immunochemical tests (FIT) kits
Communication among teams improves
mammogram rates
FEATURED TEAM
Adult 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.
Visit LMPartnership.org for ideas and tools for your team.
RESULT
Mammogram 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
RESULT
• Documenting observations in patient charts
Reportable HAPUs
• 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.
Visit LMPartnership.org for ideas and tools for your team.
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
RESULT
• Coordinated transport times with other departments
Patient transport times (minutes)
• Created and staffed a dedicated transporter position.
Visit LMPartnership.org for ideas and tools for your team.
Lab gets quicker on the draw
FEATURED TEAM
Infectious 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.
Visit LMPartnership.org for ideas and tools for your team.
RESULT
Average 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.
Visit LMPartnership.org for ideas and tools for your team.
RESULT
Patient 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.
Visit LMPartnership.org for ideas and tools for your team.
RESULT
Percent 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.
Visit LMPartnership.org for ideas and tools for your team.
RESULT
The number of lost or broken instruments
Team improves nutrition service while cutting waste
FEATURED TEAM
Food 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.
Visit LMPartnership.org for ideas and tools for your team.
RESULT
Monthly 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.
Visit LMPartnership.org for ideas and tools for your team.
RESULT
Favorable 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.
Visit LMPartnership.org for ideas and tools for your team.
RESULT
Improved patient satisfaction and an
unexpected jump in technician courtesy scores