Transcript Document

Partnering with
Families to
Improve Patient
Safety with Lean
Processing
Miriam Daniel
Jill M. Langle, RPh, MHA
Objectives
> Identify opportunities to partner with
families for patient safety.
> Describe the value of the family
experience in “Lean” process change.
> Use family expertise efficiently to make
improvement opportunities visible.
Partnering with Families for Patient Safety
Families hold a unique piece of the safety
puzzle
– Constant in child’s life and health
– Key expertise and observations
– Commitment to best outcomes for all children
Value of the Family Voice
> Bring data to life --“Tell the Story”
> Challenge assumptions and motivate teams
> Validate and define burning platform
> Make the right decisions as an idea or improvement is developed
> Help providers and staff gain skill in collaborating on challenging
topics
> Share accountability and understanding of Plan-Do-Check-Act
(PDCA) cycle with families
> Validate parent role as active partner in patient care and in best
practices
Listening To Families
> Family satisfaction and other surveys
> Individual interviews
> Advisory groups, focus groups and committee participation
> Panels and presentations
> Family Feedback recorded throughout care experience
– eFeedbackNOW – web-based incident and complaint reporting system
> “Lean” process improvement teams
Safety Improvements with Parent Input
> Family Advisory Council
– Impetus for system-wide initiative to improve
responsiveness to parent concerns
– “Parents Make a Difference” video educating parents on
effective partnering
> Hand hygiene campaign
– Shaped strategy, messaging and visuals
– Improved comfort with being directive toward staff
Use of CPI and “Lean”
> Continuous Performance Improvement is Children’s
improvement methodology; a set of techniques and
tools to remove inefficiencies and waste.
> CPI is based on principles of PDCA.
> Our strategy for CPI is “Lean” (Toyota Production
System).
> With CPI, we don’t let the perfect be the enemy of the
good. We aim for 50% improvement when
implemented then PDCA; striving for 50% again.
> CPI is our culture.
Partnering with Parents in CPI
> Interpreter services
> Ambulatory registration
> Inpatient medicine rounding
practices
> Formula ordering
> Design of medically
complex service
> Pre-surgical anesthesia
induction
> Clinical specialties value
stream design events
> Children with complex
needs
> Clinic Referral and
Scheduling alignment
session
Applying Lean
Processing to
Medication
Reconciliation
The Case for Medication Reconciliation
> While medication reconciliation is a priority
national patient safety goal, our own data and
parent feedback corroborated the need to take
steps.
> To ensure successful process improvement, we
needed to find a way to effectively involve
families in our lean process methodology.
What is Medication
Reconciliation?
1. Collect a complete and accurate list of the patient’s
home medications
2. Compare (reconcile) the home medication list with
any new orders for medications for omissions and
duplications.
3. Communicate the updated list to the next provider(s)
of care
The Evidence
> Medication errors - the most frequently occurring type of
medical error
> Ineffective communication - the most frequently cited causes
of serious adverse events
> Handoffs - the most vulnerable parts of a process
> Studies
– Approximately 46% of medication errors occur during the patient's
admission or discharge.
– Discrepancies are frequent, and as many as half of all hospital
medication errors occur at the interfaces of care (Admission,
Transfer, Discharge)
Miriam – One Parent’s Experience
> Claire and Madeline
> Medication error
> Involvement with “Families as Consultants”
> Medication Reconciliation team
> Challenges and benefits
> Impact of family participation
> Outcomes for patient and family
Rapid Process Improvement Workshop
(RPIW) Team Mission
Every patient should have a
standard, accessible and accurate
Medication History that is verified
and updated at every entry, transfer
and discharge within our system in
order to improve patient safety.
RPIW Accomplishments
> Transformed implementation of Medication
Reconciliation from regulatory requirement to “doing
the right thing”
> Positive family feedback and increased patient safety
> There is a new sense of collaboration in place with our
families, which helps foster staff engagement at work
RPIW Accomplishments
> Lean processing focused the team on the family
experience and forced us to let go of “doing it one way
because that’s what we’ve always done”
> Family voice was very compelling to staff and “drove
the process” as well as provided crucial input to
process design and forms
> Successful implementation of a reliable process
allows us to more easily adjust to make further gains
and improvements
RPIW: Learning Points
Preparing Families
> Thoughtful selection
• Recommendations from staff, self-identification
• Parents who can share their story, give suggestions for
improvement and apply their experience to the bigger picture
• Value the parent’s time and contribution
> Preparation
• Who will be there, process, expectations, location, honorarium,
contact person
> Follow-up
• Debriefing
• Feedback about outcomes
• Ongoing support
RPIW: Learning Points
Preparing Staff
> Top down commitment and expectation
> What to expect
> Families
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–
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Are committed to improving our care and systems
Know more than we imagine, warts and all
Will be well-prepared
Someone will facilitate the process to support staff and parents
> Be aware of own fears, concerns
Challenges
> Changing cultural norm to have families at the table
> Vulnerability that comes with commitment to
transparency, being open and honest about things
that go wrong
> Variance in readiness and starting point
> Leadership and resource commitment
> Family participation, time and expertise are valued
It’s a Journey
> Communicate benefits, especially from voice of
leaders and related to outcomes
> Build on successes
> Communicate and close loop with staff and family
partners
> Look for opportunities, try different approaches
> Plan, Do, Check, Act!
Next Steps
> Expand parent involvement to develop action plan for
new Joint Commission National Patient Safety Goal
– Encourage patients’ active involvement in their own care
as a patient safety strategy.
> Integrate family-centered care into our everyday
practices by enlarging the scope of family involvement
and promoting successful partnerships at all levels of
care and decision-making.
Contact
Jill M. Langle, MHA, RPh
Patient Safety Manager
Seattle Children’s
[email protected]