Transcript Document

Creating a UBT Culture
June 24, 2013
Welcome
Lisa Schilling, Vice President
Center for Health Systems Performance
Rancho Cordova Eye Surgery Center
Got Errors?
Our Team
Name
Title/Classification/Union
Dawnell Grant
Certified OR Tech, SEIU-UHW,
UBT member
Teresa Lee
RN, staff nurse III, subject-matter
expert
Steve Metzger
RN Manager, management
co-lead
Lisa Wilson
UBT Co-Lead, Central Processing
Tech
Jenee Mateo
UBT member, OR Tech
Vicki Green
UBT member, Surgery Scheduler
Nit Kharka
UBT member, OR Tech
Our SMART Goal
Rancho Cordova Eye Surgery Center will
identify, share and evaluate at least five errors
per month that could have led to patient harm or
injury, by November 30, 2012.
Our Team Culture Was…
• Efficient and safe
• Lacked transparency in the department and among
each other
• Awareness suffered as a result
• In a year period, had one never event and two near
misses
Motivating questions
• How many errors potentially happen daily?
• What do we do to prevent near misses?
• How do we increase staff awareness?
Our Small Tests of Change
Test of Change
Results
Created and used the citation form to
record errors
In four months, prevented:
•5 potential wrong-site surgeries
•3 patient identity issues
•3 potential medication errors
•1 surgical time-out issue
Challenges
Staff reluctant to use form for various reasons:
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“Flavor of the week”
Busy
Why mess with a good thing?
Punitive
Overcoming challenges
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Depersonalized the event
Education
Awareness
Testing “good catch” theme
Our Team Culture Now…
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Increased awareness
Better understanding of the project
Enhanced team work
Better communication
More transparency
Staff feel more empowered
Our Key Learnings
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Teamwork + awareness=safety
Education is key
Trust is essential
Use a safe word or phrase
Always room to improve
Our NQC Experience
• Involvement of entire staff is key to culture
change.
• Partnership and standardization plays a leading
role in quality and service.
• The everyday work you do has great impact on
quality and patient satisfaction
Emergency Department, Sunnyside Medical
Center (Northwest)
Our Team
Name
Title/Classification/Union
Jay Ravarra
Manager
Ally Degatata
RN, OFNHP
Our SMART Goal
Kaiser Sunnyside Medical Center Emergency
Department will decrease the patient length of
stay from a baseline of 2.7 hours to a goal of
1.5 hours by the end of the year (2012) .
Our Team Culture
• High physician and management turnover
• Low morale and low service scores
• Non-functional UBT
Our Small Tests of Change
Test of Change
Results
Locate triage area and fast track team
together
Adopt
Develop new fast track criteria
Adopt
Patients receive focused assessment;
brought to X-Ray quickly
Adopt
Patients are only in treatment rooms while
being treated
Adopt
Fast track rooms protected for fast track
patients only
Adopt
Our Small Tests of Change
Test of Change
Results
Trial medical office beds
Abandoned – didn’t like the beds
Trial paper rolls to cover beds
Abandoned – preferred linen for patient
comfort
Fast Track Results
Standardizing Rooms
Sort: Bins for each item,
label each item, conduct
regular inventory
Set in Order: Establish
permanent home for
specialty carts, IV cart
prototype
Shine/Sweep: Rearrange
room set up, develop cart
checklist
Standardize: Clear roles
for RNs and techs
Standardizing Rooms
From
To
23
23
Our Team Culture Now…
• More satisfied patients
• More open environment for offering ideas for
improvement, as demonstrated in improved responses to
key People Pulse question
• Those initially most resistant to change became the biggest
champions of change
Our Key Learnings
• What worked: holding offsite meetings to establish
our new vision, hiring new managers, electing new
UBT co-leads, redesigning patient rooms and stock
rooms
• Early wins are important
• Must clarify expectations and roles, have process
owners with clear accountability
• Physician engagement is crucial
Voice of the Customer
Staff Perspective
60%
2012 %Fav
50%
2011 %Fav
40%
30%
20%
53%
30%
28%
27%
15%
38%
16%
12%
10%
0%
Employees are
encouraged to offer ideas
about quality care to
members
Work procedures are
efficient
Department operates
effectively as a team
Department is encouraged
to suggest better ways for
getting our work done
Our NQC Experience
• Working in a unit-based team and becoming high
performing is hard work. Once you reach your
goal, it isn’t over. You have to continue to work
on improvements and re-build when people leave
or processes change.
Histology Department
(Northwest)
Our Team
Name
Title/Classification/Union
Saundra Ellis
Supervisor
Kristen Mose
Histology Tech,
OFNHP-Technical
Mary Kilo, MD
Chief of Pathology
Our SMART Goal
KP Northwest regional histology
lab will improve slide turnaround time from a baseline of
68.6 percent in 2011 to a goal of
90.0 percent by the end of 2012.
Our Team Culture Was…
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Plagued by inefficient workflows
Pathologists did not feel supported by the staff
Did not focus on quality assurance
Low People Pulse scores on Work Unit Index
measures
Specimen Life-Cycle
Specimen
Collection
Gross
Exam
Recuts, Specials,
Processing
Embedding
Immunohistochemistry
Path
Review
Case
Sign-out
Accessioning
Microtomy
Transportation
Staining
Case Match/
Case Assembly
Storage/
Archive
Our Small Tests of Change
Test of Change
Results
Visual notification system
In progress
Added TAT and quality reports to
daily huddles
Adopted
Weekly project team meeting
Created engagement with sponsors
Surveys of Pathologists and staff
satisfaction
Performed quarterly surveys for 18
months then transitioned to People
Pulse and Physician Work-Life
Balance surveys
Performance Improvement Tools
Histology Slide Turn-around Time by 8:00 am
120%
Jump Start Phase
One
Jump Start Phase Two
100%
80%
60%
40%
Extreme variation = short staff and/or high slide volume
20%
% Slides Distributed by 8:00
0%
2/1/2011
3/1/2011
4/1/2011
5/1/2011
Target
6/1/2011
Median
7/1/2011
8/1/2011
AB&T
Our Team Culture Now…
Measures
Results
Turnaround Time
(TAT)
Improved from 68.8% to 80.6% April 2013
Staff Satisfaction
Average favorable rating increased from 40% on
2011 People Pulse survey work unit index to 70%
on 2012 People Pulse survey work unit index
Pathologist
Satisfaction
Increased overall satisfaction from 11% on 2010
Pathologist Work life Survey to 58% on 2012
Pathologist Work life Survey
Our Key Learnings
• The UBT identified, planned and executed all PDSAs.
• Strengthened alliance between Histology and Pathology, and
the active involvement of Pathologists
• Resources (time, money, expertise) vary in supply and pose
barriers
• Labor-to-labor communications strengthened engagement and
commitment to the project.
• Given adequate information, the UBT knows what
improvements will make a difference.
Our NQC Experience
• Opportunity to learn from other teams
• Sharing the journey of our team with others
• Recognizing engaged sponsors, physicians and
UBT team members as the key to success
Closing Thoughts
Lisa Schilling, Vice President
Center for Health Systems Performance