The section in Griffith and White, pages 178,179, dealing with improving patient management protocols indicates strategy to improve clinical organizational performance.  This is particularly significant as the PRO uses hospital data in a comparative mode to exert "peer pressure" to improve the hospital's practices for certain disease processes.  The figure 5.6 in the text has proven effective in achieving "buy in" of ordering physicians for  core measures involving CHF, SCIP, pneumonia, etc.  The protocol can not be simply adopted by the organization.  It mus be developed by the clinicians in the institution. 

Quantitative management:

We have the tools for Rules; Risk management principles; Qualitative performance process; we have clinical pathway management of successful approach; we do the utilizations, and more and more, but we should not forget, all of above are based on the three premises:

They are the community at large must establish the level of the economy; the community decision cannot be intelligent made without extensive input and advice from healthcare professionals; and the last the control of cost and quality depends on the entire institutional infrastructure.

Dianne Kelly spoke a bit about Evidence-based Management and the need to integrate research-informed management practices into our leadership.  

 

My question: how are real-life leaders supplementing themselves with a diet of evidence-based management information?  Is there a source that you go to aside from the NY Times Bestseller list on business management or the HBR?  I am looking for low cost, sharp and efficient sources of evidence-based management information, written for the busy healthcare manager.  

 

Thanks!  ~CP

 

What process do others have in place to identify issues that require follow-up through an RCA process and how are the lessons identified from that shared or implemented throughout the organization for organizational learning?

 

We currently use a home-grown system known as the Patient Safety Net and have had great results from it. The system doubles as a hub for reporting patient complaints/compliments, as well as patient safety issues identified by employees and medical staff. Each entry is ranked using a 1-2 harm-score rating that then prioritizes level of response from a biweekly leadership team that involves members from the medical staff, hospital administration and the clinical effectiveness office. As incidents are identified for improvement, the individuals involved are brought together under the leadership of a trained facilitator to review the events, identify the process steps that may have aligned to facilitate the untoward event and action steps are then implemented to avoid future occurrence. As lessons are learned, the data is shared in aggregate through identification of trends/patterns at the quality committee, medical staff leadership group, as well as through organizational clinical dashboards. Over time, this process has been very instrumental in supporting a culture of safety where individuals are encouraged to report incidents without fear of retribution.  

A trend I have noticed in hospitals I have worked is the tendency to implement lots of QA/QI programs (until this section in the tutorial, I thought they were the same thing) but unable to sustain any given one's momentum. 

A great new program will be implemented, everyone is enthusiastic, and it's dead in 6 months.  Another program will be implemented, and the whole process repeats itself. 

Over time the staff become cynical of any new program, because they know it's the "flavor of the month" or "program of the month".

Has anyone else noticed this type of thing?

We were one of the first organizations to implement a rapis response teams. We are memebrs of IHI and were tone of the alpha sites. We have had RRT for several years and in the most recent year added the family as individuals who can activate the RRT as well. We do not get many calls from families and that is good because it may mean that the change in conditions are beng caught early by clinical staff. There are specific job functions for the RRT staff(ICU staff assigned to be RRT without patient assignment 24/7) and they complete a document which is used to track metrics to monitor effectiveness of program. One of the key metrics is the number of codes because yoiu want to see RRT numbers go up and codes go down. We also look at response time, how long the RRT was on unit, was patient transfered to higher level of care etc. This program has been very successful and great for new staff who need a second opinion. Our RRT alos responds to our inhouse stroke and heart alerts as well.

I noticed a recent post on Lean and Six sigma being applied in healthcare and pros/cons of each. I have been trained as a Black Belt and have also received Lean Six sigma training at my previous health system. That health system actually employed Black belts to roll out this methodology across the system and complete various projects. There were some great successes and some hurdles along the way as well. My feeling on the issue is the methodology and statistical tools used can be very beneficial and infuse a more data driven approach into a culture. Furthermore, the focus on the processes involved can uncover hidden barriers and non value added steps in the processes. The major hurdles encountered were related to change management and lack of support from senior level admin., which seemed to decide the fate of these projects instead of the methodology itself.

I was curious if others have had favorable/unfavorable experiences with either of these performance improvement methodologies? Thoughts?