Thursday, December 18, 2014

Synchronizing Our Work to Improve Patient Flow

Today, during Lean Daily Management Rounds, Melissa Nichols, the Clinical Unit Coordinator in the Surgical Intensive Care Unit (SICU) was explaining to me how they had tested a change to their process for moving patients from the SICU to a floor bed. The SICU team had initially taken a design from another unit, but they were frequently missing their goal of 30 minutes from “ready to move” until patient departure. 

When the SICU team was studying the causes of missing the goal, they saw on their Pareto chart that transport was frequently arriving late. They asked the question "Why is transport arriving late?" What they learned was that transport was not being given enough time to get to the unit because they were being called too late in the process.

Synchronization is a change concept that brings the players or processes in a design into “harmony.” When we synchronize processes in patient flow, we allow the operators to organize their work so they can be ready to act at a specified time. Melissa, Jen McDonald, the SICU Nurse Manager, and their team moved the notification to transport to a point earlier in the process, allowing transport to “synchronize” its work. Transport can now be prepared to move the SICU patient at the “ready to move” time. You can see that since the SICU changed their design a few days ago, they have not missed a transfer time!

 On a separate note, one of our beloved employees will be leaving us soon. We have all heard the phrase “their work is their passion.”  Those words were written to describe Linda Kelly and her years of service as the Clinical Program Manager for our Sexual Assault Forensic Examiners (SAFE) Program. 

Linda has been the leading force of our SAFE Program since 2006 and has provided an extremely valuable service to the victims of sexual assault in Baltimore County.  Linda established our SAFE Program as a comprehensive service in conjunction with the Baltimore County Police Department, the Baltimore County State Attorney's office, local universities and sexual assault counseling providers to ensure victims are treated professionally and compassionately.  Under Linda’s leadership, the staff at the SAFE Program has provided community outreach and educational programs pertaining to safe dating and recognizing and dealing with violence in a relationship.  Linda has done an excellent job representing GMBC in public appearances and has made a difference in the lives of our patients as well as the community at large.

Please join me in wishing Linda and her husband, Pat, all the best in their retirement.  Linda will truly be missed.

I am also pleased to announce that Laura Clary, RN, will assume the position vacated by Linda.  Laura completed her forensic nursing training at GBMC and joined the SAFE Program as the Clinical Program Manager in 2010.  Please join me in congratulating Laura in her new role!

Thursday, December 11, 2014

How Did We Improve Our Hand Hygiene Rates?

I arrived at GBMC in the summer of 2010 shortly after we received our first “secret shopper” measurement of hand hygiene and learned that it was a toss-up if someone coming into your daughter’s room at GBMC had washed his or her hands before entering. I remember thinking that it wasn’t that people didn’t know to wash their hands nor was it that they didn’t care. The rate was only about 50% because people’s minds were elsewhere…they were busy or they were distracted. I wondered how we would ever get closer to clean hands every time? I couldn’t think of a design change that was likely to work.

We tried the “technology” route in the MICU. We worked with a vendor that had software that would measure the rate and prompt the individual. We ended the test concluding that the MICU rate was no better than rates without the technology. We started to get traction when units started doing audits on a few trips in and out of a room on a daily basis. It seems that the staff doing audits generated better engagement and it started to lock in the habit.

Our run chart of hand hygiene compliance is one of the best examples of healthcare improvement that I have ever seen. I am still reflecting on the drivers of this change so I asked some GBMC colleagues. More awareness and people looking out for each other…measuring on a unit LDM board…extra focus…spreading knowledge about hand hygiene….culture change…the realization that we were not washing our hands….making it more personal for you…. turning handwashing into a fun game….calling it out among colleagues….these are the reasons my colleagues listed for this great improvement. The rate of almost every hospital acquired infection that we measure has been reduced as our hands have been getting cleaner. I am very grateful to all of my GBMC colleagues for this improvement work.

I would love to hear your ideas on how we accomplished this because it is in learning what works that we can make more improvements faster!

Gilchrist Hospice Care and Gilchrist Greater Living continue their spectacular work in leading the region in compassionate, evidence-based care to seniors and those at the end of life. I applaud all the hard work that Gilchrist Hospice has done over the years to help so many individuals and families through the end of life. Gilchrist not only provides world class medical care to patients in their final days, but they also provide emotional and spiritual support.  In the past 20 years, Gilchrist Hospice Care has cared for over 40,000 patients and approximately 100,000 loved ones.

Please come and show your support for Gilchrist’s work by attending the Holly Ball this Friday, Dec. 12 at the Baltimore Marriott Waterfront.  This year’s black-tie event, which starts at 7:00 p.m., will benefit the Gilchrist Towson inpatient center. For more information on the Holly Ball, please go to . I hope to see you there!

Wishing all those who celebrate the Festival of Lights next week a very Happy Hanukkah!