Inpatient Care

Labor and delivery nurse staffing as a cost-effective safety intervention

Numerous studies have identified a relationship between staffing levels and nurse-sensitive outcomes for medical and surgical patients, but little has been published on the impact of nurse-sensitive outcomes for the childbearing family and even less that examines the relationship of intrapartum staffing on adverse perinatal outcomes.

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.

Hospitalists as industrial engineers

The president of the Society of Hospital Medicine identifies attributes of industrial engineers that make for a better hospitalist and where to acquire tools and skills to succeed in a multifaceted role.

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 the 2013 SHS Healthare Systems Process Improvement Conference describes a for-profit health system's experience in deploying efficient workflows that lead to increased acceptance and usuage by physicians and other stakeholders to realize many benefits including receiving CMS incentives.

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.

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.

Engaging frontline employees in problem solving to provide ideal care in the PICU - East Tennessee Children's Hospital

This poster presented at the 2013 Healthcare Systems Process Improvement Conference describes a staff-driven approach for improving patient care in a pediatric intensive care unit (PICU). Thanks to Mark Graban for identifying this poster.

Through the eyes of the workforce - creating joy, meaning, and safer healthcare

"Workplace safety is inextricably linked to patient safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams."

This report addresses what can be done and what is being done to improve the physical and psychological harm to healthcare employees that ultimately impacts the safety and quality of Patient care. The report provides a list of strategies and supporting tactics to improve conditions impacting the health and safety of the workforce.

Learning from every death: Six Sigma approach to mortality rate reduction

This presentation at the 2013 Healthcare Systems Process Improvement Conference highlights the reduction in mortality rate at Mayo Clinic, in Rochester, MN as the result of learning from every death. A multidisciplinary, mixed method approach to mortality review was developed to learn as much as possible about system improvements that could save lives. This rich data source is a critical component of effective our DMAIC initiatives for mortality rate reduction.

Routine Incorporation of Pulsed Xenon UV(PX-UV) after standard cleaning of rooms previously occupied by patients with C. Difficile or Vancmyhcin resistant infections or colonizations

The purpose of this study was to determine if the use of PX-UV in place of bleach would adversely impact the incidence of C. diff. infections, and to also determine its impact on HA-VRE rates.

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.

Delivering consistent and lower cost care in the post-acute and long-term care setting

This presentation at the 2013 Healthcare System Process Improvement Conference addresses labor productivity in the post-acute setting. As labor rates continue to rise and represent the highest expense in the post-acute and long term care industries, providers are turning their attention to scheduling solutions that more appropriately align their workforce to patients' need. Traditional Industrial Engineering tools such as work measurement are leveraged to provide a more accurate definition of cost of care as well as staffing models that closely align labor to patient care demands.

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. 

JAMA - Lean management systems could actually save lives

Management systems focused on standardization strategies like lean result in better health outcomes and lower mortality rates, according to a new JAMA report based on a study from the Oregon Health and Science University.

Allocating limited inpatient bed capacity 

Many academic hospitals struggle to maintain a mix of patients that satisfies their teaching, research, and financial needs. One such hospital received dispensation from the government to partition its inpatient beds into wings. Each wing is allocated a fixed number of beds and can admit only a fixed set of clinical specialties. This presentation delivered at the 2012 Healthcare Systems Improvement Conference describes how a model was developed to investigate how best to form wings so as to optimize patient mix.

Using electronic health records to improve quality and efficiency: The experiences of leading hospitals

This report from the Commonwealth Fund describes recent experiences of leading hospitals in implementing electronic health records.

Surviving the global healthcare perfect storm

The authors describe the application of operational planning and capacity management methods to improve patient care, improve revenue, and lower costs. Article 

Real-time forecasting of pediatric intensive care unit length of stay using computerized provider orders

The authors conducted a retrospective cohort study to describe a model to provide real-time, updated forecasts of patients' intensive care unit length of stay using naturally generated provider orders. The study was based on more than 2,000 admissions to a pediatric intensive care unit. The model was designed to be integrated within a computerized decision support system to improve patient flow management.

A lean look at hospital readmissions

Physicians at Denver Health provide a presentation on reducing readmissions using a lean approach. Denver Health has been applying lean methods to clinical and nonclinical improvement for more than seven years and is nationally recognized for performance in patient safety and outcomes among large teaching institutions. 

Application of lean Six Sigma in healthcare, improvement of nursing shift directors - a graduate-level-directed project experience 

In this graduate-level-directed project, the workload of nursing shift directors (NSD) has been analyzed. The purpose of the study is to create a baseline metric of the existing process; collect operational data and analyze ways to improve the work efficiency by eliminating the non-value-added tasks from the daily workload; automate some of the tasks performed by NSD; and monitor and provide control methodologies for sustainability. 

Keeping everyone informed: Scheduling inpatient testing and therapy appointments 

A value stream activity mapping inpatient flow at Hennepin County Medical Center in Minnesota showed that patients, nurses, physicians, testing departments, and therapists were unaware of the plan for the day for inpatients and often competed for patients' time. Through changing workflow and electronic information-sharing, collisions-of-care were reduced, interdepartmental coordination improved, and the patient experience was enhanced.

Sepsis alert program leads to more timely diagnosis and treatment, reducing morbidity, mortality, and length of stay - Christiana Care

An AHRQ Healthcare Innovations article describes how a sepsis alert program at Christiana Care has reduced mortality by over 70 percent and average length of stay by almost 50 percent. Key features of the initiative are prompt screening and early administration of the appropriate antibiotic.

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.

Lessons learned from moving to Web-based surgical requests

The authors delivered a presentation and paper at the 2011 SHS Conference providing a comprehensive case study of how the Sir Mortimer B. Davis-Jewish General Hospital in Montreal, Quebec, moved from a paper surgical request process to a web based system. The lessons learned described by the authors will be valuable for anyone undertaking a similar large scale IT change.

Undergrauates 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.

Original films of Frank B. Gilbreth

Part 1 & Part 2
From Internet Archive website, these films are essentially a summary of work analysis films which were taken by Frank B. Gilbreth between 1910 and 1924 showing a number of industrial operations from which the motion study technique was developed.
This movie is part of the collection: Prelinger Archives.
Producer: Presented by James S. Perkins in collaboration with Dr. Lillian M. Gilbreth & Dr. Ralph M. Barnes
Sponsor: Chicago Chapter of the Society for the Advancement of Management

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.

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.

Purdue industrial engineering researchers investigate using surgeon hand gestures to improve surgery

Vision based recognition of hand gestures is being researched at Purdue University to control a robotic scrub nurse and access images during surgical cases. The research could lead to short case lengths and reduced infections according to the Purdue University News website.

Audible alarms and workplace noise in nursing units: An environmental factors case study

A case study for reducing workplace noise on a pediatric nursing unit and maintaining appropriate noise levels.

Using Material Pull to Improve a Pharmacy Process

Replenishment of IV fluids and medications can be more methodical than repeated visual inspections.

Improving Medical Equipment Availability at Barnes-Jewish Hospital

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

Sustaining VAP Bundle Compliance in the ICU: A Model of CQI

Using Lean Six Sigma tools, a hospital redesigns and implements new ICU protocols for patients on mechanical ventilation.  The article details how the initial sustainability effort failed, but was brought back into long-run control.

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.

 In by 9 Out by 6 - Level Loading

A CT scan department has its demand smoothed.

A Four-Arm Framework To Implement Rapid Response Teams

One implementation of Rapid Response Teams is discussed.

Attacking Waste and Variation Hospital-Wide: A Comprehensive Lean Sigma Deployment

Improvement projects in surgery, nursing, and the ED are discussed. The process of moving a hospital towards adoption of Lean Six Sigma is also described.

Data Driven Decision Making to Control Pharmacy Costs

Pharmacy decision-making is discussed, with focus on controlling costs.

In by 9 out by 6 - Load Leveling

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

Building Lean From the Ground Up

The surgical admitting process is targeted with a lean event.  Current and future state is described, the process of improvement is shown, and results are discussed.

Using Lean Methodology to Improve Patient Safety and Clinical Quality

Three successful lean projects are discussed in detail.  Specimen Labeling, Surgery and Endoscopy Pre-Op, and Inpatient Nursing Crash Cart projects all demonstrate significant improvement.

Achieving a Shared Baseline: Implementing Evidence Based Clinical Practices

The authors propose a methodology for shortening the time gap between discovery of new evidence-based clinical results and hospital (provider) utilization of the new practice.

Building Bridges to Clinical Improvement

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

Establishing Nursing Staffing Requirements in an Imaging Environment

A study is done to improve the communication between and expense of the nursing staff associated with all imaging modalities.

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.

IS CPOE Safe for Patients?

CPOE is implemented and results discussed.

Weekend Services: The Patient is Here, So Why Aren't We?

A 848-bed hospital is experiencing long LOS and targets ancillary service availability as one potential source of improvement. The project discussed tracks the data, demonstrates immediate results, and suggests future improvements.

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.

Engaging Staff in Lean Improvements for Patient Care Settings

4 lean projects were performed - pharmacy, lab, outpatient clinic, and telemetry unit. Each project was meticulously documented in the presentation. Pre- and post- metrics are included, as well as a discussion of sustainability.

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.

Lean in the Laboratory and Radiology: A Patient Throughput Imperative

Lean improvements within the radiology suite and laboratory workspace yield notable improvements. Project benefits are discussed.

Under Pressure - Efforts to Reduce Hospital Acquired Bed Sores

Root cause analysis was conducted to determine reasons for bed sores. This presentation and paper is the result of their team's effort. Sustainability and ongoing improvements are discussed.

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

System-wide implementation of Lean Six Sigma has resulted in many successes. This presentation discusses the rationale for their overall strategy.

Sustaining VAP Bundle Compliance in the ICU: A Model of CQI

The IHI Bundle was implemented; metric changes are documented and discussed. Several nursing practices were also changed.

"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 underway.

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.