Monday, August 16, 2010

Designing Our Systems

Last week, I had the great pleasure of attending the report out session for our team that was redesigning our discharge process. Many patients come to us needing inpatient care. Frequently, we don't have a bed ready for them when they need it so.........they wait. Sometimes, we actually do have a bed for them, but it hasn't been cleaned yet. We knew that our process for getting a discharged patient on her way and then cleaning the bed for the next patient was not well designed. We also knew that it had too many steps......but we didn't know how many.

The wonderful team in the photo above found that the process had 109 steps!

The Team realized that the system was never really designed in the first place so there were many steps that were not necessary or were being done more than once. Until the Team got all the steps written down, we did not know what the whole process looked like. The Team then set out to remove all of the waste.....the steps that didn't help get the patient on his or her way and then get the room ready for the next patient. The Team redesigned a process that had about 40 fewer steps! They are now testing their changed system to make sure that it works well and then we will roll it out to the whole hospital.

We are now using the science of continuous improvement as the way we move GBMC forward toward our goal of being the healthcare organization that treats everyone, every time the way we want our own loved ones treated. Since we don't want our own loved ones to wait for a one should wait for a bed.

This science, whose fathers included W. Edwards Deming, and Walter Shewhart, has four main components.

The first is a focus on the person you are serving. In our case, we are serving patients. We must make sure that our work stems from what our patients need and want and to be careful not to focus on our own needs and wants.

The second component is the notion of design. High performing organizations don't get closer to perfection by relying on hard work and good intentions alone. Every system is perfectly designed to get exactly the results that it gets. If our patients are waiting, exhorting our people to move faster is not very smart. Our Team pictured above knows this, so they redesigned the existing system to reduce waiting.

The third component of continuous improvement is the use of measurement. Measurement provides the answer to the question: "How will we know if our change is an improvement?" The team is measuring the time from when a discharge order is written until the room is ready for the next patient. They plan to display the data on our inpatient units so that our people can see how we are doing.

The fourth component is teamwork. The hospital is a complex set of interconnected parts with many people doing specialized roles......just like the Ravens. Imagine what would happen if the Ravens tried to win as individuals, without the planning, practice, camaraderie, and collaboration that is required to win. We need the same in our healthcare organization.

The last component is empowerment. In winning organizations, people come to work saying "Its interesting how well we did might we do it better today". They don't wait for the boss to tell them what or how to change...they see generating meaningful change as part of their job.

Our teams are using Lean tools in their improvement work. The tools help us to get the waste out and to make things better for us and those we are serving....our patients!

I am very proud of our discharge process design team! We should all thank them for making things better.


  1. Dr. Chessare, I have not had the opportunity to meet you yet. I make it a point of meeting and getting to know the people I work with in the organization. I started off as a nursing assistant in the ER in 1976 before the ER had Emergency Physicians. After nursing school, I worked at Hopkins in the ER for 7 years and returned to GBMC to the ER in 1985. I continue to work in the ER and received my master's certificate in nursing education at Towson University. I now also teach at Towson University and have the opportunity to bring my students to GBMC on U54 for clinical. GBMC is a great place to work and I relay that to everyone I come in contact with in the community. I believe that word of mouth is a very powerful tool in maintaining GBMC as a positive choice for healthcare in the community. I enjoyed reading your blog about focusing on the person you are serving and treating them as if they were a member of your family. I also believe in empowerment and teamwork. I try to teach this to my students so that when they become nurses, they will treat me with a caring, respectful attitude. Welcome!! Janet RN

  2. Thanks very much, Janet. I am grateful for all of your hard work.



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