Rapid Cycle Improvement

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Rapid Cycle Improvement

• The Fab 4
• Plan-Do-Study-Act (PDSA) cycle
• a trial-and-learning method to test changes
  quickly

Act
Plan
Study
Do
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Principles of PDSA Cycle

• Shorter cycles of changes to accelerate rate of
  improvement
• Create flow of ideas, then emphasize
  implementation
• Adoption of existing knowledge (not more
  research but more application of existing
  knowledge)

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Kaiser Permanente Performance Improvement Model
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First identify ideas (Change Concepts) that
will help you to answer the question What
change will result in improvement?

• Do the changes have well-defined parameters?
• Will the changes improve client care relatively
  quickly?
• Will staff members and leaders be able to live
  with the changes?

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Discussion

• What projects are you currently working on?
• What are you most proud of?
• What will you do differently next time?
• When using the PDSA approach, what do you need
  the most help on?

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Then use the Fab 4 PDSA!
Act
Plan
Study
Do
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Approach

• At the beginning, small-scale, short time frame
• What change could you implement this Friday?
• Begin testing with Volunteers
• Useful, not perfect, data
• Use huddles to report

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Experimentation

• Test on a small scale and build knowledge
  sequentially.

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Ideas for improvement

• Goal The HIM Department will obtain a
  turnaround time of 4 days or less for chart
  completion by 1/31/09
• What changes can we make that will result in an
  improvement?
• Idea Put signs on the nursing units reminding
  physicians to complete charts
• Hunch Visual reminders will help the physicians
  remember
• Test Tomorrow hang signs in Dept 220 and 335 and
  follow up with the physicians to see if the
  signage helped

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Ideas for improvement

• Goal The Dermatology Clinic will increase the
  staff courtesy and helpfulness MPS rating by 1
  by 3/31/09
• What changes can we make that will result in an
  improvement?
• Idea Train one Registration Desk Staff to use
  communication tool or script like Acknowledge,
  Introduce, Duration, Explanation, Thank You
• Hunch Using scripted language helps staff feel
  more comfortable with how to communicate with
  patients
• Test Tomorrow am one receptionist will try this
  with all morning patients and then debrief at
  the before lunch huddle to see if it helped

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Cycle 1 Cycle 2 Cycle 3 Cycle 4
HIM Put signs in 2 nursing units for physicians
to complete charts
Official signs printed to place in all
nursing Units and on call rooms
Expand to 4 nursing units
Place signs in on call rooms
Sterile Processing Test new cardiac inventory
system with one physician .
Expand test to two physicians Monday - Friday
Implement inventory system and educate all
cardiac staff
Run inventory system on weekend
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• The Sterile Processing Department will improve
  the turnover of cardiac instrumentation to 7
  hours or less by 6/30/09.

Implemented new inventory system
25 add ons to schedule
Educated physicians
Hours
Median 14
Sterile processing receives draft OR schedule 2
days in advance
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The Sequence for Improvement
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Ambulation Project Description

• Literature suggests that early ambulation during
  hospitalization leads to the prevention of
  deconditioning in patients, thus contributing to
  a decrease in total length of hospital stay.
  This multidisciplinary pilot project involves all
  non-oncology patients admitted to Dept. 330. A
  mobility assessment is completed on each patient
  to determine their baseline mobility status. A
  mobility criteria checklist determines their
  mobility assistance needed during
  hospitalization. Patients who meet criteria for
  ambulation with assistance will be ambulated
  twice a day.

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Team

• Co-Leads
  
• Kasey Spears, Mobility Manager
• Pauline Nee, RN, MSN, Manager Dept. 330
  
• Team
• Drs. Nguyen, Ahluwalia, Chou, Claudia Carhart, PT
  
  
• Improvement Advisor
• Barbara Liberty, RN, MSN
• Sponsor
• Anne Goldfisher, CNO

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Ambulation Project Goal 1. What are we trying to
accomplish?

• Strategy
• Goal Leading Patient Centered, Efficient Care
  Processes
  
• Driver Optimiziming Throughput
  
  
• Focus Area Reducing Length of stay
• Project Goal
• All non-oncology ambulatory assist patients (as
  determined by the nursing mobility assessment
  checklist) on Medical Oncology department 330
  will be ambulated twice per day by 07/01/2009

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Measures2. How will we know that a change is an
improvement?
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Multiple Ramps of Small Tests of Change3. What
changes can we make that will result in
improvement? Change ConceptsThen, multiple
ramps of small tests of change - Plan, Do, Study,
Act
Create 9 am huddle
Multiple ramps of small tests of change
Nurse write on care board
Identify accuracy of eligible pts
10 am PMT checks list
Expand eligible pt population
my daily routine Ambulation checked on cardboard
PMT data to next shift. Offer help on evening
Separate Self Amb. vs. Mobility Assist
PMT introduces self to pt (discusses POC)
Staff education on proper technique
Mobility list on board in Conf Rm during RN
huddles
Create mobility addendum
Escalation Process
Create mobility binder
Educational tools for pt and family
Create mobility assessment
Script for PMT and Nursing
PMT huddle. Print out 3rd fl assignment
11 am PMT checks list
Algorithm (worksheet) for Nursing
Create daily mobility list
1. Assess patient mobility status
3. Ambulate patients
4. Standardize patient communication
2. Identify eligible patients
5. Standardize staff communication.
6. Next Steps
Change Concepts

Barbara Liberty, RN, MSN, Improvement Advisor
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Reason Codes DataInformed our work
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Q A