Clinical Quality

10 guiding principles for leading change management

Almost half of the most sophisticated companies on the planet fail at major change transformations. This recent article in IndustryWeek describes 10 guiding principles for effective change management.

Study: Risk of hospital infections increases at end of work shifts

A study published in the Journal of Applied Psychology reveals that nurses, physicians and other hospital workers tend to wash their hands less frequently as their work shift progresses, with a nearly 9 percent drop in compliance with handwashing protocols from the beginning to the end of a 12-hour shift. Researchers studied three years of hand-washing data on 4,157 healthcare workers in 35 U.S. hospitals. They attribute the decline in compliance to mental fatigue and the fact that hand hygiene is considered a low-priority task among health workers.

Safety culture with supporting processes help lower and prevent HAIs - A Roundtable

Healthcare-acquired infections remain a serious patient care issue and an avoidable high expense. HAIs are preventable, yet many hospitals and healthcare systems are finding it difficult to decrease the number of injuries to patients. Read why HAI prevention and treatment depends less on procedures and more on culture, leadership and organizational commitment.

Newest item on the Gawande checklist: Greater integration

Dr. Atul Gawande has popularized the use of checklists to reduce errors and targeting the sickest and costliest patients as a way of holding down costs. But Monday, he ventured into new territory. In his keynote speech at the Healthcare Financial Management Association's Annual Nation Institute, he challenged finance officers to help lead their organizations toward greater integration and assume financial risk for patient outcomes.

Practice Fusion launches free real-time database

Cloud-based electronic health record vendor Practice Fusion has launched a continuously updated database of de-identified patient information.

ASCO to help cancer docs evaluate treatment value

The American Society of Clinical Oncology's algorithm to help oncologists evaluate the clinical benefits, side effects and costs of a cancer drug or therapy will be fine-tuned over the summer and should be available for public comment by the fall, said Dr. Lowell Schnipper, chair of the society's Value in Cancer Care Task Force.

Online reviews could help fix medicine

The University of Utah was the first healthcare system to post reviews from patients online - the good, the bad, the ugly. Think of it as Yelp for doctors. This sort of transparency can be stressful for doctors - as it would be for anyone whose performance is open to the public - but the positive effects are undeniable.

Clemson University IE department researcher focuses on patient safety initiatives

Clemson University research assistant professor Ashley Kay Childers has been selected to participate in a forum to discuss quality improvement programs in U.S. hospitals that reduce preventable readmissions, prevent medical errors, improve patient outcomes and cut costs.

Can mobile health technologies transform healthcare?

This article in JAMA describes the case for adoption of mobile health technologies (mHealth) and the potential for future application from a clinician's perspective.

Discharge toolkit for patients with atrial fibrillation

Urgent Matters and the American College of Emergency Physicians have developed a discharge toolkit to expedite appropriate care for patients with atrial fibrillation.

Use of Lean and Six Sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center

Researchers applied Lean and Six Sigma methodologies to improve OR efficiency. Multidisciplinary teams addressed minimizing volume variation; streamlining the preoperative process; reducing non-operative time; eliminating redundant information; and promoting employee engagement.

Developing a cost-effective pressure-ulcer prevention program in an acute-care setting

This article in the Wound Care Advisor is a case study describing a cost-effective pressure-ulcer program in a 350-bed acute-care hospital. The authors report that the program they put in place is saving over $2 million annually.

Efficient clinical workflows enhance user acceptance and other EHR benefits

This was a presentation at the 2013 SHS Healthcare Systems Process Improvement Conference
Hospitals and health systems spend millions of dollars to acquire and meaningfully use certified EMRS and EHRS nationwide. This presentation from HSPIC 2013 describes a for-profit health system's experience in deploying efficient workflows that lead to increased acceptance and usage by physicians and other stakeholders to realize many benefits including receiving CMS incentives.

Our daily blood: How can labs tackle utilization of high-volume, low-cost tests?

Clinical Laboratory News
This article describes strategies several hospitals around the country, including Cleveland Clinic, are using to reduce over-utilization of routine lab.

Reducing patient charges by eliminating amylase from lab panels - HBR Blog Network

One hospital was able to reduce patient charges by over $300,000 annually by reducing the frequency of amylase and lipase testing for ED patients with abdominal pain and other conditions.

Can lean tools help crack the medication safety code?

Joanie Ching, RN MN, Administrative Director of Quality and Safety, blogs about how Virginia Mason Hospital in Seattle is abandoning batch administration of medications to improve patient safety. By going to just-in-time medication administration, nursing workload has been leveled, medication errors have been reduced, and nurses are better able to respond to patient needs.
Editor's note: Workload leveling and smaller batch size, like many other "lean tools," are industrial engineering concepts that have been well understood for many decades. It appears that a lean approach has helped Virginia Mason to discover the benefits in this novel application. 

Lean Six Sigma tools improve more than turnaround-time for ED blood draws

This case study from the Healthcare Systems Process Improvement Conference presents the analysis of the ED-LAB blood draw system for a large tertiary teaching hospital.

Sepsis Toolkit, Sepsis Program Implementation Guide for NSW Healthcare Facilities

Sepsis continues to be a disease with high mortality, low clinical standard adherence, and high cost variation for many healthcare organizations. This Sepsis Toolkit from down under may be a useful reference for organizations looking to improve the quality of care for treating sepsis.

How's the health of your state?

The America's Health Rankings website has an interactive map that shows the relative status by state for a number of health-related conditions and environmental factors including overall death rate, incidence of cancer and STDs, and levels of pollution.

Driving value through clinical practice variation reduction: A case study for total joint replacement process improvement

This paper and presentation delivered at the 2013 Healthcare Systems Process Improvement Conference describes work done in the Ochsner Health System to reduce orthopedic joint replacement costs and improve quality for the patient. High quality care at an affordable cost is an attainable goal that is both in the best interest of the patient and the healthcare system. Driving value through minimization of clinical variation enabled OHS to meet a higher standard of patient care while ensuring the long-term financial stability of the organization.

IIE member research abstract promoted via YouTube

IIE Member and doctoral student Avinash Konkani is featured in a YouTube video describing research he is doing to reduce noise and medical device alarm fatigue. Avinash is attending Oakland University and is doing research at Crittenton Hospital in Rochester, Mich. Avinash is also a member of the SHS Newsletter committee.

Management tools for internists, designing the patient schedule

This article describes best practices for setting up a productive internal medicine clinic. Many of the practices described in this article can be applied for improved throughput and patient satisfaction in other types of ambulatory clinics.

Vertical value stream analysis to chart a course to patient centered medical home

This presentation at the 2013 Healthcare Systems Process Improvement Conference provides a case study in the use of vertical value streams for large, complex improvements. Vertical value streams are a multi-layered value stream approach using rigorous project management. Boulder Community Hospital applied this methodology to the opening a Patient Centered Medical Home.

Case study series on pneumonia care improvement measures: Improvement strategies of top-performing hospitals

The following synthesis of performance improvement strategies is based on a case study series published on The Commonwealth Fund website, The hospitals profiled in this series were identified based on their performance on the pneumonia care improvement measures that are reported to the Centers for Medicare and Medicaid Services. Please see the case studies for a full description of the selection methodology.

Visualizing Conversation Structure across Time: Insights into Effective Doctor-Patient Consultations

In this study we used a highly efficient and time economic automated computer visualization measurement technique called discursis to analyze conversational behavior in consultations.

The importance of communication for patient satisfaction

This research investigates the effect of communication complexity level on patients' perceived quality. The amount of communication was measured by self reports regarding the patient's visit.

Shortening hospital stays for lower-risk patients after a severe heart attack

This guest post in the Harvard Business Review describes how the Minneapolis Heart Institute has started to use a validated risk-prediction tool to distinguish between patients who require an extended hospital stay after a severe heart attack and those who can safely go home within 48 hours.

Sepsis Toolkit, Sepsis Program Implementation Guide for NSW Healthcare Facilities

Sepsis continues to be a disease with high mortality, low clinical standard adherence, and high cost variation for many healthcare organizations. This Sepsis Toolkit from down under may be a useful reference for organizations looking to improve the quality of care for treating sepsis.

A framework for reducing suffering in healthcare – HBR blog

The authors post that the time has come to deconstruct suffering by breaking it down into meaningful categories that reflect the experience of patients and help caregivers identify opportunities to reduce it. The authors propose a framework for major types of patient suffering so that health care providers can organize themselves to address suffering more effectively. 

Developing a cost-effective pressure-ulcer prevention program in an acute-care setting

This article in the Wound Care Advisor is a case study describing a cost-effective pressure-ulcer program in a 350-bed acute care hospital. The authors report that the program they put in place is saving over $2 million annually. 

Professors use industrial lean methods to re-engineer clinic

What began as an MBA class project at Purdue University's Krannert School of Management ended up with participants applying factory management techniques that hold promise for improving medical clinic productivity and quality. The research was supported by the Regenstrief Center for Healthcare Engineering at Purdue's Discovery Park. The improvements improved the capacity of the clinic by 37 percent with no additional resources. 

A tool to improve mobility in hospitalized patients

This post on the HBR Blog Network describes a visual tool at Virginia Mason Medical Center in Seattle that has accelerated patient mobility. Research has shown that early mobility is an important aspect for improved patient outcomes and shortened length of stay.

Hospital inpatient waste identification tool

The Hospital Inpatient Waste Identification Tool provides a systematic method for hospital front-line clinical staff, members of the financial team, and leaders to identify clinical and operational waste and subsequently prioritize and implement waste reduction initiatives that will result in cost savings for the organization.

Driving unwarranted clinical variation out of a hospital: Key strategies

This article is a summary of the discussion from a webinar hosted by Becker's Hospital Review with experts from Objective Health, a McKinsey Solution, on strategies for hospitals to reduce unwarranted clinical variation. The strategies and analyses presented in the webinar focused on hospitals' unwarranted variation, which involves treatment protocols, physicians' clinical supply choices and resource utilization. The article also provides links to view or download the webinar as well as a copy of the presentation.

Hybrid field: Nursing and industrial engineering

In this article, Patti Brennan, the Lillian L. Moehlman Bascom Professor in the School of Nursing and College of Engineering at the University of Wisconsin, discusses the intersecting fields of industrial engineering and clinical care with members of University of Missouri's Industrial and Manufacturing Systems Engineering Department.

Patient handover from surgery to intensive care: Using Formula 1 pit-stop and aviation models to improve safety and quality

This article, in the British publication Pediatric Anesthesia, describes how patient safety can be improved using race car pit stop and aviation analogies based on a prospective study. A new handover protocol was developed that reduced technical and informational errors by up to 50 percent.

Central line infection reduction using Lean Sigma at Presbyterian Healthcare Services, Albuquerque, N.M.

A multidisciplinary group at Presbyterian Healthcare Services teamed together to meet the Joint Commission National Patient Safety Goal and to reduce the central line infection rate to less than 1 per 1,000 patient days. The team used a Lean Sigma improvement methodology to identify a number of countermeasures including checklists, education, defined observer, and a standardized central line kit. In the first six months of the project, the central line infection rate was reduced to .22 infections per 1,000 patient days.


 Transforming care at the bedside: increasing patient satisfaction through employee engagement and teamwork at Our Lady of Lourdes Medical Center, Camden, New Jersey

Nursing leaders at Our Lady of Lourdes Medical Center in Camden, New Jersey, engaged staff to improve patient and employee satisfaction and reduce staff turnover on a medical-surgical unit using the Transforming Care at the Bedside (TCAB) model developed by Robert Woods Johnson Foundation and the Institute for Healthcare Improvement. The team focused on a set of directed methodologies and conducted a number of experiments that resulted in dramatic improvement.


Industrial and systems engineers cure some of healthcare's ills - Watson Institute for Systems Excellence at Binghamton University

A recent feature in Binghamton's Watson Review describes ongoing healthcare improvement research at the Watson Institute for Systems Excellence (WISE). Ongoing healthcare research at WISE includes research in ED throughput and supply chain. WISE researchers collaborate with a number of hospital systems including Vitua, Mayo, and Wilson and Binghamton General Hospitals.Thirteen research assistants in the WISE program have recently been placed in healthcare organizations.

What makes a hospital great

In a recent New York Times article, Dr. Pauline W. Chen makes a case that organizational culture is more important than technique and technology in providing quality healthcare.

Cowboys and pit crews: 2011 Harvard Medical School commencement address

Popular author and speaker Atul Gawande challenged the 200 graduates of the 2011 Harvard Medical School to pursue a more systematic approach to delivering healthcare. He used pit crews and cowboys as examples of working as a system.

Meaningful Use: A brief overview for Society of Health Systems

Prevailing misperception is that implementing any EHR complies with HITECH ACT requirements and incentive qualification. EHR implementation is only one part of meaningful use. Meaningful Use depends on workflow, evidence based clinical practice, measurement and reporting. In this presentation prepared for SHS by Kevin Martin, meaningful use is described along with the practical applications for organizations providing clinical care.

Undergraduates in action - Utilizing lean techniques for improved patient and information flow, UMass Memorial Hospital

Students at Worcester Polytechnic Institute and in coordination with UMass' Center for Innovation and Transformational Change examined how lean tools can eliminate non-value added work, improve resource management, and create lean flow at the UMass Memorial Hospital. After implementing a number of changes, the team saw a reduction in patient throughput time, elimination of defects in the chart tracking process, and a decrease in stocked inventory.

Improving pediatric emergency department patient throughput and operational performance

A multidisciplinary team working at the Rady Children's Hospital in San Diego, Calif., was formed to improve ED throughput. Based on comprehensive variability analysis the team implemented a number of changes including daily performance reporting, a fast track for lower acuity patients, and standardized nurse and physician rounding. The changes resulted in a 10 percent lower length of stay and a 50 percent reduction in left without being seen. These changes are planned to improve revenue by $782,000 to be budgeted in the next fiscal year.

Total productive maintenance in the OR - a case study at Kadlec Regional Medical Center

A team at Kadlec Regional Medical Center in Richland, Wash., took a lean approach to improving the availability and reliability of anesthesia related equipment in the OR. The team included physicians, staff, and external consultants. The article describes the background of total productive maintenance and how it was applied by a multidisciplinary team including physicians, OR staff, and clinical engineering. View related photos 

How to ace your joint commission survey with lean 

In this Ezine article author Gerald Leone describes how lean tools and principles were successfully applied in preparation for a Joint Commission Survey.

Evaluation of industrial engineering students' competencies for process improvement in hospitals

In an article recently published in the Journal of Industrial Engineering and Management, the authors concluded that while IE students working in hospitals focused on technical approaches to improvement, mastery and application of softer skills may be more beneficial.

The journey to eliminating preventable harm - Nationwide Children's Hospital

In this presentation at the 2011 Society for Health Systems conference, Cindy Hafer provides a comprehensive look at how Nationwide Children's Hospital in Cincinnati is moving to eliminating all preventable harm to patients through a comprehensive safety initiative.

Case Study on transforming care at the bedside (TCAB), Good Samaritan Hospital

At a recent Premier Breakthroughs Conference and Exhibition, clinical and performance improvement staff at the 370-bed Good Samaritan Hospital in Suffern, New York presented a case study of improvement on a nursing unit using the TCAB model.

University of Windsor Industrial and Manufacturing Systems Engineering students help to improve lab processes in the ED at Sunnybrook Health Sciences Centre

Sunnybrook Health Sciences Centre is considering implementing recommendations made by three fourth-year students at the University of Windsor Industrial and Manufacturing Systems Engineering as part of their capstone project. Ben de Mendonca, Josh Vandermeer and Andrew Phibbs, conducted an intensive examination of the system used by the emergency department to collect and label patient blood samples.

Indiana hospital pharmacy saves $1 million annually with lean improvements

Pharmacy leaders at Elkhart General Hospital, in Elkhart, Ind., applied a number of lean concepts resulting in lower operational costs and improved patient care. Examples of improvements cited in the Modern Medicine e-zine article were to redeploy two pharmacists to clinical roles, consolidate unit medications, and reduce batching of IV medications.

Study finds high quality hospitals deliver trauma care at lower cost

A recent study in the Annals of Surgery found that high quality hospitals deliver lower cost care to trauma patients, according to a news release by the University of Rochester Medical Center.

Human factors engineering to reduce patient falls

In a recent presentation at the 2011 SHS Conference, Brian H. Fillipo delivered a presentation on a comprehensive approach to reducing patient falls across seven Bon Secours hospitals in Virginia. 

Case study on patient flow improvement, streamlining admissions from the emergency department

In a case study on the AHRQ website, the 340-bed Forbes Regional Campus of Western Pennsylvania Hospital developed a number of strategies to reduce delays in patient admission and discharge resulting in improved patient flow. The improvements were made during a weeklong kaizen blitz.

Helping a hospital shine

In an article previously published in Industrial Engineer magazine, industrial engineering researchers at Clemson University assisted Cannon Memorial Hospital in Pickens, S.C., in a number of hospital-wide and service specific improvements resulting in increased efficiency.

40 hospital benchmarks

Becker's Hospital Review recently compiled a list of 40 hospital benchmarks derived from recently reported information in the public domain. This limited benchmark provides some comparison of performance in quality, patient experience, finance and operations.

Barnes-Jewish Hospital featured for process improvement efforts

The website recently featured efforts at Barnes-Jewish Hospital in St. Louis to provide improved patient-centered-care using a number of lean management principles. A number of examples of process improvement in the OR and peri-operative services are discussed.

Video presentation on models, measurement techniques, and tests for analyzing adherence and performance of evidenced based medicine

In this 2010 presentation at the Dartmouth School of Engineering, SHS contributor and past president, James Benneyan, Ph.D., from the School of Mechanical, Industrial and Manufacturing Engineering at Northeastern University discusses that challenges of measuring performance of evidenced-based medicine and provides solutions to address these challenges.

University of Wisconsin-Madison researchers post final report on Industrial and Systems Engineering (ISyE) in Health Care

In research sponsored by the Agency for Healthcare Research and Quality (AHRQ), UW researchers summarize findings and associated research from a 2009 conference in a report entitled Industrial and Systems Engineering and Health Care: Critical Areas of Research.

Using Lean to Identify Process Improvement Opportunities and Improve Effectiveness of Transfusion Professionals  

Susan F. South, senior consultant, ValuMetrix® Services and Jo Ann S. Hegarty, worldwide marketing director, ValuMetrix® Services provide a description of improvements in blood transfusion processing by applying lean concepts at 14 different laboratories in three different countries. Average savings per site was over $190,000 excluding savings associated with improved inventory management.

Improving Medical Equipment Availability at Barnes-Jewish Hospital

One hospital details improvements to their medical equipment retrieval, cleaning and distribution process.

Optimizing Caregiver Workflow in a PICU

Physician and nursing roles and responsibilities within a PICU are redefined using lean tools to decrease LOS while increasing outcomes.

5 Projects, 5 Hospitals: Using DMAIC for Rapid Quality Improvements

Pressure ulcer, falls, catheter-associated UTI, central line infection and objects left in surgery are addressed using process improvement methodologies.

Beginning the Lean Improvement Journey in the Clinical Laboratory

Using examples from several clinical lab redesigns, the sequence of steps utilized during a lean improvement effort are described.

Medication Administration and the Complexity of Nursing Workflow

This article studies the work processes of nurses involved in the administration of medication. The goal is to reduce errors and improve efficiency.

Linking Records from Separate EHRs Becomes a Reality

An EMR is described that links physician and hospital records so that the same information is available in both doctors' offices and hospitals whenever the patient presents.

A Four-Arm Framework to Implement Rapid Response Teams

One implementation of rapid response teams is discussed.

In by 9 out by 6 - Load Leveling

Detailed description of a lean project to improve TAT in the CT Scan department.

Building Bridges to Clinical Improvement

Clinical improvement results are discussed for glucose control, rapid response teams, vent bundles and bloodstream infection projects.

Improving Pharmacy Operations through Simulation

A pharmacy is simulated and the results are discussed.

The Journey toward a Lean ED

A 100,000-annual-visit hospital ED is redesigned using lean principles. Wait times decrease and pt satisfaction and revenue increases. Simulation shows further viability of new processes. This presentation is made by an M.D. who became a lean coach.

A Revolution in ED Patient Throughput Management

ED throughput process improvement projects are discussed. The presenter is an M.D.  Several changes are shown with great results.

Using Six Sigma to Improve ICU Patient Flow

A lean Six Sigma project focusing on ICU throughput times is completed. Lessons learned and successes are shared.

Improving Patient Care - Case Carts and the Operating Room

Reasons for delay in creation of case carts are addressed. SPD often has inefficient workarounds as part of their daily routine.

Managing Variability in Patient Flow - Data, Process, Sustainability

Methods of confronting and smoothing the variability of patient flow are discussed.

Optimizing Cargiver Workflow in a New Pediatric Intensive Care Unit

A lean project generated proposals for rescheduling the providers' workload. During testing of the proposals, daily departmental volume was completed significantly earlier in the day.

Our Lean Journey Continues and What A Year It's Been!

Lean projects at Kaiser Permanente are detailed and discussed. The report is a system-level presentation showing many departmental improvements.

"Never Events" and HACs - You Break It, You Buy It

Medicare's changes to payment require a higher degree of awareness from hospitals nationwide. This presentation addresses some of the concerns and discusses mitigation efforts currently under way.

Measuring the Success of Hospital-Acquired Pressure Ulcer Prevention

Pressure ulcers are a known issue with long hospitalizations. This presentation deals with several issues surrounding eliminating their occurrence.