C4 Diane Bissenden - Medical Staff Engagement & Lean Management


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  • Why did we want to focus? How do we build our capacity to focus?
  • Identified our most significant issues and improvement opportunities that we wanted to work on together
  • Know that we could not do this alone … work together with everyone who ‘touches’ cares for the people we serve
  • Ministry directive for Code Pink by March 31 st , 2012 Collective passion as an area to improve
  • Before Issue : Roles & responsibilities were unclear among team members Established clear standard operating procedures for each role Tags that reflect the roles Issue : Team was not coordinated in work Mock session to clarify roles and practice
  • Recover c-births – 23% to target
  • C4 Diane Bissenden - Medical Staff Engagement & Lean Management

    1. 1. Medical Staff Engagement & Lean Management Diane Bissenden Director, Population and Family Health Vancouver Coastal Health – Richmond Dr. Brenda Wagner Chair, Richmond Medical Advisory Committee Clinical Associate Professor, Obstetrics & Gynaecology University of British Columbia Laura Sato Coordinator, Lean Transformation Services Vancouver Coastal Health February 28th, 2013
    2. 2. Burning PlatformHow do you engage medical staff in yetanother administrative process to drivepatient safety and quality improvement?How do you ensure sustained medicalstaff engagement in system redesign thatis based on Lean principles?
    3. 3. Medical Staff Engagement: Current StateInitial State: State Feedback from Medical• Medical staff disengagement Staff as have lived through • “There is lack of multiple administrative physician engagement” change efforts • “Management should• Improvements have been make the changes and ‘tried before’ and not leave us alone” sustainable • “Everyone else around• Long standing issues that the table is paid for being have not been resolved and here except for people didn’t believe the physicians” issues could be changed
    4. 4. Medical Staff Engagement: Ideal StateIdeal State: State Target State:• Medical staff engagement in • One medical staff Lean as a unique and member from each successful change relevant discipline will management process engage in the process i.e.• Improvements are family practice, midwifery, sustainable obstetrics, paediatrics,• Long standing issues are and anaesthesia resolved and medical staff • Process inspires ongoing believe they are part of the engagement change
    5. 5. Birth Centre Initiative:Goals and Area of Focus
    6. 6. Birth Centre Initiative: Deliverables• Increase capacity to do Caesarean Births and recovery in the Birth Centre• Build processes to manage surges• Provide timely outpatient services – Triage, assessment, non-stress tests & inductions of labour, etc.• Standardize processes from decision to Caesarean Birth
    7. 7. Birth Centre Initiative: Engagement of People• Medical Staff • Allied Health Staff – Obstetricians – Respiratory – Family Physicians Therapists, Social – Paediatricians Work, Laboratory – Midwives Services – Anaesthesiologists • Support Services• Nursing Staff – Housekeeping, Unit – OR/ PACU/ Birth Aides, Sterile Centre/ NICU/ Staff Processing Aides, Unit Support Coordinators Clerks, Medical Office Assistants
    8. 8. Medical Staff Engagement Strategies• Physician co-sponsor on the team• Funding for medical staff time spent in Lean initiatives• Off site obstetrician & anaesthesiologist meeting on Code Pink & Skin to Skin in Operating Room• Ad-hoc meetings during down times with on-call medical staff (end of the day)• Hallway conversations (1:1)• Feedback obtained during observations (1:1)
    9. 9. Medical Staff Engagement Strategies• Arrange Working Group Meetings around medical staff schedules: – Lunch times & end of the day – Organize meeting agendas so physicians can attend at times when their key issues will be highlighted • Mixture of 2 hour, full day & ½ day workshops• Piggyback on existing medical staff meetings• Provide ample notice for meeting invitations• Invite medical staff in person• Invite on-call medical staff
    10. 10. Medical Staff Engagement in Lean Management• Process improvements occurring in tandem with Lean Management – Using Lean Management approach based on ThedaCare Model – Three physicians attended Lean Management education • Applying Lean principles to clinical office setting • Organization investing in physician education in order to support improved patient care • Physicians feel part of the team
    11. 11. Lean in Action:What is Code Pink ?
    12. 12. Code Pink: Standard Work
    13. 13. Birth Centre Initiative: Code Pink Mock SessionInitial Mock Post - Actual Code PinkNoisy – lots of talking Calm & quietRepeating questions multiple times Staff know what to doDuplicated work- # of people doing the Roles and responsibility claritysame thingLots of double checking Trusting environmentToo many people in the room
    14. 14. Medical Staff Testimonials Keeping mothers and babies together after birth encouraged me to participate Best thing was seeing the capacity we have within our frontline staff to make changes Doctors see thehappen. This is the power I see Lean harnessing satisfaction their patients that I have never seen harnessed before. and babies are kept together. This satisfaction is encouraging the doctors. “…..If you want to show us this isdifferent, fix the problem no one has Sessional been able to fix in 20 years - payments are I have been emergency caesareans”. This helpful and “blown away” physician now states with meaningful by the enthusiasm that LEAN is making a improvements big difference and we are being during the past successful. year
    15. 15. Birth Centre Outcomes Indicator Baseline % Target ∆ Outcome ∆Reduce the Birth Centre 3:30 h ↓ by 50% 1:30 hOR Turnaround time (138%↓)% of Caesarean Births 27% ↑ by 50% 75%done in BC OR (185%↑)Code Pink Response 30~ minutes 18 minutes*Time (Decision to Baby (↓ 40%)born)Medical Staff 4 per ↑by 200% 400%Engagement engagement opportunity *30 day data
    16. 16. Reasons for Success• Strong physician, director & manager leadership• Strong relationship between medical staff and clinical resource nurse (over 20 yrs)• Operational and medical staff leadership “Walk the Talk”• Engaged and stable team (low turnover)• Project leadership share successes• Organizational commitment in form of individuals with expertise in lean thinking
    17. 17. Operational Sponsor’s Experience• Setting the stage at the beginning of every session, no matter where you are in the process• Simple is usually complex• Don’t get discouraged when things get “messy” – trust the process• Medical staff participation in all aspects of the Birth Centre quality improvement initiative adds value and strengthens team relationships• Deeper level of engagement and pride in the change, through doing together• Continuous improvement is embedded in the culture of the Birth Centre
    18. 18. Physician Sponsor’s Experience• Be flexible with meeting times• Invite people personally• Sometimes a different venue can overcome obstacles• Projects identified by frontline staff as “unfixable” will convert the hard of heart• Practice, Practice, Practice…embed, embed, embed