A Hospital with Everything in its Place

I am so proud of my colleagues in the GBMC HealthCare system for all the progress we have made towards high reliability (what should happen always happens and what should never happen doesn’t happen). An example of this progress, that we have discussed previously, is our reduction of catheter-associated urinary tract infections (CAUTI’s). Back in 2011, CAUTI’s happened a few times a month at GBMC. Since then, because of the creation of standard methods for deciding who will really benefit from a catheter and standard methods for maintaining the catheter once it is put in, these hospital-acquired infections are now rare. But we still have work to do.

We are still prone to want to do things the way it feels comfortable to us in the moment. This is especially true of people like me who have been in health care quite a while and can remember when nothing was standardized. Back in the “good old days” almost everything was happening by chance and almost nothing was happening by design. We had workarounds for everything. When I was a resident back in Massachusetts in the 1980’s we didn’t trust the lab to get us results in a timely fashion, so we ordered almost every lab test “stat.” We didn’t realize that once every test was ordered stat, nothing was truly stat. Our work-around corrupted the system and actually made things worse. It is very hard to get people to understand that when they drift, cut corners and do not follow the design, it just creates problems for themselves or others although it may not be apparent to them in the moment.

Last week, I was having a discussion with a colleague about a broken bed being left in a narrow corridor on a nursing unit. I was concerned that this bed was blocking the egress of our patients if there was ever a fire. My colleagues on the unit, who were all outstanding doctors, nurses and techs and who were all working very hard, had come to accept the fact that beds would occasionally be blocking the corridor. They knew that the system for expeditiously removing unneeded beds was unreliable. What they didn’t understand was that their “tolerance” of the beds not being where they belonged was actually making the problem worse.

Since it's so hard in a large complex organization to get everyone to follow a disciplined and standard process, most improvement experts believe that leaders should start with the technique known as 6S, that we have discussed in this blog a number of times before.

1. Sort: eliminating everything not required for the work being performed.
2. Separate: efficiently placing and arranging equipment and material.
3. Shine: tidying and cleaning.
4. Standardize: standardizing and continually improving the previous three.
5. Sustain: establishing discipline in sustaining workplace organization.
6. Safety: creating a safe work environment.

6S is seen as part of our foundation because the daily practice of making sure that your workspace is clean and organized takes discipline and the effects are easy for all to see. When the senior team goes on LDM rounds, we all look for litter on the floor and we pick it up and dispose of it when we find it. We are also intolerant of clutter and we are in action to get everything in its place. Here is a photo of a linen cart that was left in a corridor right next to a sign (an “affordance”, a reminder that is visible in the moment, also known as level two mistake proofing) that says “No equipment storage allowed in this area.”

Why do you think one of our colleagues left the linen cart there? Of course I don’t know but I suspect that the person was working hard and needed to go and do something else and decided in the moment that it was ok and probably did not think of the downstream effect of leaving it there. It was not blocking an egress but what if a few hours later a colleague needed a cart and couldn’t find it? What if a patient’s family member saw it and thought less of GBMC because of the clutter?

We have set cleanliness as an annual individual goal for all GBMC employees in this fiscal year. We each need to own 6S in our workspace wherever that is. What can we do to make this happen? Please let me know your thoughts.

GBMC United Way 2017

Finally, I encourage all GBMC HealthCare employees to consider participating in our United Way campaign which started this past Monday and runs through Sunday, Feb. 5th   Each year we partner with the United Way to give back to those who need our help the most, whether it be contributing to your favorite GBMC program or giving to the community and helping families stay in their homes and out of shelters, for example.

This year's campaign will feature a raffle, special Jeans Days, and a "ski-off" competition between various groups within our system.

Click here to view instructions on how you can make an ePledge today.

With your help, we can reach more people than ever! Thank You.