20 June 2016

Communication and Transparency in Lean Process Improvement

A recent article in Modern Healthcare discussed the importance of data transparency and communication in targeting process improvements effectively. One of the examples highlighted was the Project Zero campaign launched in 2011 by St. Luke’s Health System in Boise, Idaho to eliminate hospital-acquired infection in the orthopedic service line. By allowing orthopedic surgeons to routinely monitor the system's infection rate after knee and hip replacement surgeries, laminectomy procedures and spinal fusion surgeries, St. Luke’s was able to reduce the rate from 1.08 percent to 0.57 percent in two years. In addition to tracking data, effective communication and collaboration were key to success. Dr. Kevin Shea, an orthopedic surgeon co-leading the zero-infection work with Dr. Howard King, explained: “Making the systematic, end-to-end changes in the surgical process, which has involved everything from air flow through operating rooms to the number of times doors open during a case, to apparel, has entailed enormous amounts of time spent communicating and building consensus in new ways and among many groups and individuals.” The Project Zero initiative not only improved patient outcomes but also saved approximately $2.8 million in costs that would have been incurred to treat infections following joint procedures.

Given the sweeping changes associated with the transition to value-based care, hospitals and health systems need to capture, use and share data efficiently and effectively, not only for quality reporting but also to help drive process improvements to achieve better outcomes and patient satisfaction at a lower cost. Sheridan has long been a leader in this area. For example, the Inspire Quality (IQ) system we developed at Jupiter Medical Center enables efficient tracking of emergency department clinical quality data. The system makes it easier and more efficient to identify trends in patient care and physician performance. Its user-friendly interface allows physicians to access, track and record patient data and to proactively evaluate their own and their departments’ performance. The Jupiter staff has found it to be such a powerful tool for enhancing patient care quality that we have rolled out the IQ system across the entire emergency medicine division.

Another example of using data as a strategic tool for lean process improvement is PremiEHR™, Sheridan’s proprietary web-based neonatal electronic medical record system that gives physicians real-time information on neonatal patients and allows doctors to record consistent, searchable notes. PremiEHR was used to help Sheridan’s leadership reduce the incidence of chronic lung disease (CLD) rates in very low birth weight infants by 61 percent at our partner hospitals, and to collectively outperform the Vermont Oxford Network (VON) mean for premature infant survival by 14 percent. There also were significant associated cost savings. These achievements were the result of a combination of data transparency and effective communication. Sheridan’s neonatology team collected baseline data from all the NICUs and asked each NICU to choose one of four evidence-based strategies for reducing the risk of CLD among newborns. In addition to collecting and tracking data by querying the PremiEHR clinical database, Sheridan’s neonatology team also conducted quality site visits that incorporated team building exercises to align the nurses, respiratory therapists and physicians and ensure consistent understanding of the program, goals and division of new responsibilities by all members of the care team. Weekly communications from the hospitals kept care team members informed of each patient’s status and fostered more effective distribution of care responsibilities.

When driving process improvement, it is important to create an atmosphere that constantly communicates positive accountability. Every individual must understand that he or she is an integral member of a team that is dedicated to ensuring high-quality patient outcomes with efficiently delivered care. Ongoing acknowledgment of the contributions of staff in the pursuit of operational efficiency helps them to internalize the importance they necessarily bring to the team. In Sheridan’s Kaizen lean process initiatives, a “softball coach” is assigned to catch people engaging with the process correctly after changes have been implemented. Those “caught” doing their jobs correctly are given soft rewards in the form of praise or acknowledgment. While it is not entirely necessary to have a designated “softball coach,” it is important to recognize staff members for the value they contribute to the successful implementation and maintenance of new, leaner processes and for modeling the desired behavior for other team members. Furthermore, when lean process improvements are implemented, “softball coaching” helps reinforce understanding of changes and the actions that each team member must take to ensure proper operations. So creating positive accountability serves both to strengthen individual commitment and to help ensure understanding of the process by all team members.

The definition of what qualifies as useful data has been narrowing, partly due to the preeminence of big data in large-scale policy making. However, we have found that a hospital unit does not have to stall its improvement approach for lack of access to the high-tech, high-skill data collection methods reserved only for those with massive resources and large budgets. In fact, the majority of our process improvements have been identified through the most basic data collection methods: direct observation and time studies. Many people believe have the false belief that electronic data capture is the only form of data capture. However, measuring waste, and therefore opportunity for better patient, staff, family, information and material flow, is best done through one’s own eyes and with one’s own measurements. Sheridan has the advantage of being able to maximize both forms of data collection. We have advanced systems that capture large data, and we have the facilitation expertise to engage participants in process improvement through a hands-on method in which they collect information for themselves before beginning to develop solutions.

While it is important to create an atmosphere of positive accountability, it is equally important to identify and communicate to the team any areas for improvement. Data must be available for physicians and departments to evaluate performance. Communication and data go hand-in-hand in the effective pursuit of lean process improvement.

For more information on how to promote a positive atmosphere in your organization, see our blog posts on developing quality IT infrastructure and celebrating process improvements.