Application of Six Sigma and DFSS For the Ultimate Patient Safe Environment

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  • 1. Application of Six Sigma and DFSS For the Ultimate Patient Safe Environment Karrie Bruegman-May, RN, BSN,CPHQ SynergyHealth—St. Joseph’s Hospital West Bend, WI Email: [email_address] Phone: 262-306-7760
  • 2. Agenda
    • Background
    • Guiding Principles
    • “Core Process Team” Approach
    • Applications and Experience
    • Impact of Organizational Culture
  • 3. The Impetus for Change
    • Translating what the IOM/ “To Err is Human” means at St. Joseph’s Community Hospital
      • Death in Hospitals from Medical Errors:
        • 1 death for every 343 to 764 admissions
      • Translates to:
        • 5 to 12 patient deaths per year
        • 1 patient death per month
  • 4. The Impetus for Change
    • Translating what “To Err is Human” means at St. Joseph’s Community Hospital
    • Adverse Events in Hospitals:
      • 1 in 27 admits to 1 in 34 admits affected
    • Translates to:
      • 122 to 153 patient events per year or 12 per month
      • 1 patient impacted every 3 days
  • 5. St. Joseph’s Community Hospital West Bend, WI
    • Project: Build and occupy a replacement hospital
    • Objectives:
      • Design a physical environment that supports the achievement of a higher level of patient safety and enhances or creates a “culture of safety”
  • 6. Winston Churchill May 10, 1941
    • “We shape our buildings,
    • and afterwards
    • our buildings shape us.”
  • 7. Project Overview Final Design
    • 143 acre site
    • 173,000 square foot facility
    • 4 floors
    • 80 beds
    • $55 million projected cost
    • Opening 8/7/05
  • 8. Site Plan
  • 9. The Patient Safety Learning Lab
      • Through the collaborative, creative efforts of leading experts in a variety of relevant disciplines…..
      • Create a set of design methods and principles…
      • To support the redesign of the patient care environment…..
      • So as to achieve breakthrough levels of patient safety
  • 10. The Patient Safety Learning Lab
    • The participants:
      • AMA -IHI
      • MGMA -UW-Milwaukee
      • AHA -University of MN
      • WHA -Center for Patient Safety at VA
      • JCAHO -APHA
      • NPSF -ISMP
      • VHA -ASQ
      • PSI
  • 11.
    • Top 10 Recommendations for Facility Design
    • FMEA at each design stage
    • Standardization
    • Involve patients/families
    • Establish a checklist for current/future design
    • Critical information close to the patient
    • Noise reduction
    • Adaptive systems for function in the future
    • Articulate a set of principles
    • Equipment planning Day 1
    • Begin mock-ups on Day 1
    The Patient Safety Learning Lab
  • 12. Applied Patient Safety Design Principles
    • Visibility of patients to staff
    • Standardization
    • Automate where possible
    • Scalability, Adaptive, Flexible
    • Immediate accessibility of information, close to the point of service
    • Noise reduction
    • Patients involved with care
    • FMEA at each stage of design
    • Design for the vulnerable patient
    • Human factors review
    • Minimize fatigue
    • Design Around Precarious Events
  • 13. Learning From Precarious Events
    • Operative/Post-Op Complications, Infections
    • Events Relating to Medication Errors
    • Deaths of Patients in Restraints
    • Inpatient Suicides
    • Transfusion Related Events
    • Correct Tube-Correct Connector-Correct Hole
    • Patient Falls
    • Deaths Related to Surgery at Wrong Site
    • MRI Hazards
  • 14. Decision to Use FMEA
    • St. Joseph’s Community Hospital decided that the framework of FMEA would assist in creating a replacement facility aimed at reducing errors and promoting patient safety and satisfaction through design
  • 15. Design FMEA Failure Mode Effects Analysis
    • Goal:
    • Anticipate, identify, and avoid failures associated with the design of a facility, while still on the drawing board
  • 16. Adjacencies Layout of the Facility As a Whole
    • Guiding principles established
    • Key goals:
        • Patient safety
        • Separation of public, patient, and service traffic
        • Minimize patient transportation
  • 17. FMEA Use at Each Design Stage
    • 1. Adjacencies
    • 2. Schematics
    • 3. Design development
  • 18. FMEA Form - Sample
  • 19. Adjacency Sample Application
  • 20. Adjacency Sample Application - Behavioral Health
  • 21. Adjacencies Plan
  • 22. Other Design Principles
    • Healing Environment
      • Connection to Nature
      • Patients involved with Care
      • Family and Friends with Care
      • Pleasant Diversions
        • music
        • water features
        • window views
      • Elimination of Environmental Stressors
        • Noise
        • Poor Air Quality
        • Lighting Glare
    • Efficient
      • Error Reduction
  • 23. Our Attempt at a Patient Safe Room
  • 24. We have the building on to Process Redesign
  • 25. St. Joseph’s Community Hospital West Bend, WI
    • Objectives:
      • Design/redesign processes that complement and leverage the physical environment.
      • Implement IT solutions for EMR/CPOE, bar-coding, materials management and centralized scheduling.
  • 26. Applied Patient Safety Process Design Guiding Principles
    • Incorporate Lean Thinking where possible
      •   Define Value in terms of the customer. Always define in terms of the patient being the greatest priority.
      •  Identify all parts of the Value Stream for potential impact on process
      •  Change batch processes to continuous flow
      •  Move to a “pull” model instead of “push”
      •  Strive for a defect-free process
      •  Employ Rapid identification & abatement of errors
      •  Apply Mistake-proofing techniques
      •  Consider cross training opportunities
  • 27. Applied Patient Safety Process Design Guiding Principles
    • Use selected data-driven methodologies with measurable performance goals and objectives that is applicable and appropriate.
      • Six Sigma DMAIC or DMADV
        • Making the decision to use Lean Six Sigma
      •  Rapid Action Planning (RAP)
      •  PDCA
      •  FMEA
  • 28. Applied Patient Safety Process Design Principles
    • Consider Human Factors
    •  Reduce Noise
    •  Minimize interruptions
    •  Minimize fatigue/boredom
    •  Simplify
    •  Use forcing factors
    •  Employ recovery factors
    •  Use affordances and natural mapping
  • 29. Applied Patient Safety Process Design Guiding Principles
    • Standardize (specific exceptions for vulnerable patients as part of the process)
    • Make it Scalable, Adaptable, Flexible (for new technology or systems)
    • Assure Accessibility of information, close to point of service
  • 30. Applied Patient Safety Process Design Guiding Principles
    • Assure Visibility
      • Know locations of patients, staff, inventory, equipment
      • Involve patients/customers in the process
    • Automate where possible
      • Pharmacy systems: Bar coding, CPOE, automated MAR
      • Scheduling
  • 31. Applied Patient Safety Process Design Principles
    • Incorporate Fiscal accountability
      • Define Project as cost savings, revenue increase, or “soft dollars” only
      • Take into account budget issues (ability to add staff or equipment)
    • Consider impact on current list of precarious events .
  • 32. Using the PUGH to help with Guiding Principles
  • 33. “Core Team Concept”
    • Selection Criteria:
    • Creativity, enthusiasm, visionary
    • Willingness to challenge and change the status quo
    • Ability to work in a team setting
    • Willingness to learn new methodologies including Lean/Six Sigma/Human Factors
    • Ability to make a 30-month commitment
    • Availability for actual relocation and transition period
    • Application and interview process
  • 34. Process Design and Transition Team
    • Barb Knutzen, COO
    • Karrie Bruegman May RN, Quality and Patient Safety Coordinator, Resident Black Belt
    • Paula Doyle RN, ICU
    • Pat Gardner MD, VP Medical Affairs
    • Linda Lange, PTA, Rehab Services
    • Tom Ruplinger, Environmental Services
    • Louise Schut RN, Emergency Department
    • Misty Stortz, Sonographer, Radiology
  • 35. Process Design and Transition Team
    • Role and Responsibilities:
    • Participate as core team members in four major projects
    • Provide oversight for all other organizational process redesign
    • Attend weekly process reporting meetings
    • Provide support and expertise for department directors (facilitation, coaching, tool use)
    • Team leader during relocation and transition in 2005
    • RAP Facilitators
    • Team Start Date October 1!!!!!!
  • 36. Process Redesign—Key Processes
    • Emergency Services
      • Patient Throughput
      • Diagnostic Services
      • Other opportunities identified
        • 2 hour average admission process for med/surg units
        • Outpatient Services
    • Issues
      • 30 minutes to 6 hours LOS
      • Triage had taken on a life form of it’s own
      • Patient satisfaction scores
      • Variability in radiology result times
      • Admissions will be completed in ED or OPPA
  • 37.
    • ED project objective
      • Decrease door to Doc time
        • When triage initiated to 20 min.
        • When not initiated 10 min.
  • 38. Process Redesign—Key Processes
    • Admission/Scheduling
      • Centralized scheduling
          • Present state everyone keeps their own paper schedule, no coordination of Patient Services 19 different scheduling portals
          • Rework by multiple department
      • Rapid admission concept
      • Emergency Department delays
      • Project Objective
        • Reduce to 2 scheduling portals or <
  • 39. Process Redesign—Key Processes
    • Pharmacy System
      • Totally manual ordering process
        • 18 ways to order, 14 ways to receive meds
      • Upgrade of IS technology 2004
      • Bar-coding technology 2005
      • Electronic MAR 2005
      • CPOE 2006
      • Project Objective:
        • Reduction in errors on prescriptions, medications, turn-around-time
        • Integration of information technology
  • 40. Process Redesign—Key Processes
    • Logistics 24/7
      • Materials Management
        • New IS system 2004
        • Service to multiple campuses 2005
      • Food Service
        • Room service concept for all patients 2004
      • Environmental Services
      • Future additions
        • Patient transportation 2006
        • Air traffic control concept 2006
    • Project Objective
      • 100% Availability of medical supplies at bedside
  • 41. Other Six Sigma Projects that we found along the way…
    • Radiology Thru-put
    • Patient Transportation
  • 42. Results of Core Team Concept
    • Developed expertise in methodologies
    • Understanding of organizational processes and issues
    • Increased employee acceptance of process
    • Multidisciplinary
    • Became “ambassadors”
    • Confusion of department directors
    • Greater expertise than management team
    • Resistance to process change by directors
    • Required active role of executive champion
  • 43. Creating a Culture of Safety
    • Shared Values and Beliefs about Safety within the Organization
    • Always Anticipating Precarious Events
    • Informed Employees and Medical Staff
    • Culture of Reporting
    • Learning Culture
    • “ Just” Culture
    • Blame-Free Environment Recognizing Human Infallibility
    • Physician Team Work
    • Culture of Continuous Improvement
    • Empowering Families to Participate in Care of Patients
    • Informed & Activated Patient
  • 44. Impact on Patient Safe Culture
    • Anonymous Reporting
      • (facilitated thru joining IHI)
    • Executive Walk Arounds
    • System Redesign
    • Patients Involved with Care
    • Disclosure
    • Human Resource Management Around Patient Safety
    • Physicians Involvement
      • West Bend Clinic
      • EPIC
      • Evidence Based Medicine
    • Public reporting of outcomes
  • 45.  
  • 46. Summary
    • We used facility design as a catalyst for organizational culture change
    • St. Joseph’s Community Hospital has used a new approach to create a replacement facility aimed at reducing errors and promoting patient safety and satisfaction through design
    • We are now working on process design/redesign using a combined methodology approach of Lean Six Sigma and Human Factors.
    • Six Sigma has been applied to healthcare for several years, but not with the concept of a “core team”.
  • 47. Summary Keys for Success
    • Clear vision
    • Pioneering spirit
    • Intestinal fortitude (medication doesn’t hurt!)
    • Unwavering commitment
    • Executive champion
  • 48. Summary Keys for Success
    • Find the right partner for expertise and support
    • Careful selection of core team members
    • Investment in education, training
    • Cultivate relationship of core team and department directors
    • Medical staff buy-in
  • 49. Summary Keys for Success
    • Recognize impact of culture
      • “ Culture eats strategy for breakfast every day!”
    • 10 C’s:
      • Communicate, communicate and then communicate.
    • Celebrate
    • Daily recommitment
  • 50. Questions? kbruegman@stjosephswb.com 262-306-7760 or synergyhealth.org.