Transcript Organphiliacs

Organphiliacs
Theda Clark Medical Center
Neenah, WI
Eric Nelson, Erin Halpin, Maria Novy,
Rachel Janzen, Sue Broeren
Historical Data
 Theda Clark Medical Center has consistently been a high
performing organ donation hospital in the state of Wisconsin
 Seven time winner of the HRSA medal of honor
 Participated in the 2003 national collaborative
 Five year average conversion rate of 94%
Actual Donor and Potential Donor
Data Analysis
 January – November 2011
 Donors After Brain Death
 Donors After Cardiac Death
 Actual Donors
 Eligible, No Consents
 Actual Conversion Rate
13
3
16
1
94% (16/17)
8
 Potential Donors
 Identified on potential donor detail report
 Potential Conversion Rate
67% (16/24)
Actual Donors + Potential Donors = 24
Pre-work for Forward Focus
Hooray
Headaches
Recognizing an opportunity for donation
early
 Family in the OR for DCD cases;

Passion for donation throughout the hospital

Good working relationships and problem
solving with the UW OTD staff



Fliers to communicate case results within
the different departments

Staff members reminding each other to keep
the option of donation in the back of their
minds



Building a relationship with families;
recognizing when the time is right to
approach
Senior leadership support



OR staff not comfortable
Knowing if a referral was called in
Knowing if a referral was open or
closed
Overall communication line with
UW OTD and keeping families
updated with the most information
available
Re-approaching after getting an
initial no
FPA refusal; no plan or process in
place to support family and staff
while honoring the donors decision
ThedaCare Improvement System
TIS 9 Methods to See and Remove
Waste in a Process within a Value Stream
SIPOC
50,000 ft
Adjust
TAKT TIME
Adjust
FLOW DIAGRAM
Adjust
COMMUNICATION CIRCLE
Adjust
SPAGHETTI DIAGRAM
Sequence and
Continuity
TIME OBSERVATION
Adjust
Adjust
BAR CHART
INCREASING DETAIL
Adjust
STANDARD WORK
COMBINATION
GROUND LEVEL
STANDARD WORK
Visual Management
5S
Draft 6
Adjust
5S
Tools We Used to Prioritize Our Work
 Prioritized our Headaches and Hoorays
Root Cause Analysis Using the 5-Why’s
Problem
Root Cause
Countermeasures
No huddle with OPO and TC before meeting with
the family
Not expected, no standard process
Develop standard for having huddle with OPO
and TC team prior to talking with each family on
each case, even if family not present at hospital
-checklist for process added to donation binders
Inconsistent communication from OPC’s, have to
push them to get information on where we are
at in the process
No communication standard
Work with OPC’s to establish clear guidelines
and expectations for communication during
cases
-specific time points
-specific information
-direct contact information
Lab management process not timely
We don’t have clear expectations established
-Work with OPC’s to establish clear guidelines
and expectations related to lab management
-timely review of labs
-timely communication to RN for interventions
-OPO flowsheet in EPIC
Mindset and understanding of additional testing
unclear
We don’t have clear expectations established
Work with OPC’s to establish clear guidelines
and expectations related to testing management
-Communication related to need for testing
Clarity of case/teams coming/organs
recovered/set-up required unknown to OR
No standard for communication with team
Work with OPO and OR to establish standard for
communication guidelines and expectations
-specific time points
-specific information
OPO to OR communication inconsistent
No standard for communication from OPC to OR
Work with OPO and OR to establish standard for
communication guidelines and expectations
-specific time points
-specific information
PICK Chart
Process Flow Mapping
Began our PDSA (Plan, Do, Study, Act)
 PLAN:
 Team identified the need to focus on communication between
UW OTD and Theda Clark staff
 We collected data on five actual donors (March 2012-May
2012)
 Goals and Targets established
 Have zero occurrences of lost donors post-consent.
 Have one process established for flow of information from Theda Clark to
UW OTD and UW OTD to Theda Clark.
 Reliable and consistent two-way communication during case progression
of the donation process post-consent to recovery.
 No unnecessary delays in donation process due to communication issues.
Developed Our Problem Statement
 During 18/18 organ donation cases for 2011, varied and
inconsistent communication occurred between Theda Clark
and UW OTD during the post-consent to recovery phase of
the donation process. This lead to staff dissatisfaction,
frustration, and additional work. Additionally, 1/18 organ
donation cases was lost post-consent.
What We Started to Work On
 Created and implemented standard work for:
 Lab Management
 Additional Testing
 UW OTD to OR Communication
 Phone Communication with OPC
 DCD Pre-Huddle to OR Recovery
 Family Refusal with a First Person Authorization
 Created and implemented organ donation checklist and OPC
contact list
What is Standard Work
 Standard Work is the Foundation for Continuous
Daily Improvement
 Defines Who, What, When, Where, How and Why
 The Current Best and Safest Way
 A Visible Tool for:




Training
Coaching
Auditing
Identifying Opportunities for Improvement
 Fosters Employee Engagement
 Reduces Variation and Eliminates Waste
This is How We Do it at ThedaCare
Diagram, Work Flow, Picture, Time Grid
Tip
Tollgate
WIP
Critical Step
Team Safety
Comment: This process flow is for the training of standard
work(SW). SW is a specified process content, performed in a specific
sequence, with consideration for takt time and work in process.
Standard
work is
created
Determine
process
owner for
training
Define
audience
for
training
and
learning
Establish
training
needs
Determine
method of
training
Seek out
education
resource if the
learning requires
advanced critical
thinking skills
Develop
training plan
(initial &
ongoing)
Develop
plan for
applying
PDSA for
learning
Communication with OR During OPO
Case-Standard Work Examples
Communication with OR during OPO case
Trigger
Done
Performed By
Consent obtained for organ donation
Organ recovery starts
OPO, OR lead RN, ICU RN
Last Updated
Rev. Number
Revised By
7/10/2012
1
TC ICU OPO
Owner
Takt Time
TC ICU OPO
Work
In
Process
;
High Level Process Flow
Diagram, Work Flow, Picture, Time Grid
Tip
Tollgate
YES
Consent for
organ
donation
obtained,
ICU RN Calls
OR lead to
give a heads
up
Organ
Procurement
Coordinator
calls OR to
arrange OR
time
Brain
Death Case
OR lead RN
calls
anesthesia
on-call
provider
Can the
case be
done at
agreed
upon time?
NO
DCD case
Can the
case be
done at
agreed
upon time?
NO
YES
NO
WIP
Critical Step
Ensure
adequate
OR staff
available to
do case
Anesthesia
suggests a
new time
OR does not
have
adequate
staff to
cover case
Ensure
adequate
OR staff
available to
do case
OR does not
have
adequate
staff to
cover case
Team Safety
OR to call for
additional
staff or have
staff stay
over as extra
OR lead
RN calls
OPC to
change
time
OR to call for
additional
staff or have
staff stay
over as extra
Time is
confirmed
with OR and
OPO, OR
lead Calls
anesthesia
on-call to
notify of
OPO case
Time is
confirmed
with OR and
OPO
OR lead RN to
communicate with
ICU RN if time of
case needs to
change or problems
arranging time
OPO calls OR
lead RN prior
to both take
off and
landing of
team
OPO arrives
at TC and
brings TC
OR team to
ICU
OPC goes to
OR to
inform staff
that all is
ready
Team
meeting in
TC ICU
multipurpose
room
Patient is
taken to OR
Organ
Recovery
Begins
Reflections Since Starting Our
Journey…What Has Forward Focus
Taught Us.
 Increased teamwork within departments and cross departmental
 Work has brought donation to the forefront of people’s minds
 Increased communication and working relationships with UW
OTD and OPCs
 After action reviews have occurred with increased participation
 Rapid recovery was possible and we were successful with a donor
on 1/28/2013
 We and the team understand and have more influence on the
processes of organ donation
How Will We Continue Our Journey….
 Donation committee meetings every other month with
additional time allocated to discuss Forward Focus work
 Continue after action reviews with all donors
 Increased interdepartmental participation with all donation
work
 Continue to attend offered learning sessions