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TRANSCRIPT
Improving Our Capacity to Improve Quality:Development and Approval Process for
Regional Pre-Printed Orders and Prescriber Guidelines
Joanne Solmundson, Janet Joy, & Carmen Dyck
Vancouver Coastal Health
Why did we focus on the development and approval
process of clinical guidelines?
We asked stakeholders at VCH,
“What are the key bottlenecks you face in the introduction of regionalclinical practice standards for QI?”
They pointed to long delays associated with approvals for pre-printed orders (PPOs) as their single greatest challenge.
We used Lean tools to tackle the challenge.
What is the process we sought to improve?
Medication related pre-printed orders and prescriber guidelines
•Scope of review:
…And all of the steps in between!
Background
• Standardized order sets have been used for many years.
• The goal of having these order sets standardized across the entire health authority is relatively recent.
• A review of 2 major processes revealed:
PPO Reviewed
Value Added Time
Non Value Added Time
Total Cycle Time as of January
2011
COPD 10 months 12 months 22 months
VTE 10 months 13 months 24 months
Initiation of Lean ReviewGoal:
Establish a standard process for
development and approval of documents, including target timelines for each phase
A process that will support the introduction of new regional standard order sets and support the implementation of best practice standards regionally
Supporters of the Initiative
Regional Programs and Councils
Regional Pharmacy & Therapeutics
Professional Practice
Quality & Patient Safety
Clinical Guidelines Initiative
Each of these groups “owned” a different component of the pathway.
Departmental Silos
• Each entity was operating with little knowledge of the others roles
• Process breakdown between departments was very common
Process breakdown
& delays at each
hand off
Key Themes
Prior to the Review
Post Implementation Goals
No clearly defined process
Defined process including way-finding, tools & templates
Varying support for documents
Process is “owned” by a Regional Council and support is confirmed (regionally) prior to development
Keys to Success: Defined Stakeholder Roles
and Process
The First Step is Standard Work
Source: Toyota Kata by Mike Rother, Ch 5, Page 113
StandardTarget Performance level
Actual Performance level
A “standard” = how a process should operate. The pre-specified, intended, normal pattern.
“Standardized work” = the process is actually operating as specified by the standard. It is a condition.
Standards vs. Standardized WorkStandards can be Target Conditions
Actual
Where are we now…
An Ever Changing Environment
• Technological advancements will impact this process
• Having a defined (standard) process will help us to adjust and accommodate those technological advancements
• There’s always room for improvement!
Lean Methods Can Be Used for Very Different Types of Process
E.g, decluttering
work spaces
E.g, patient transfers,or lab orders
E.g, a clinical pathway for stroke patients
Where we worked
there’s all this prep work,
then the baby is born,
and no one tells you
about the sleepless nights
that come after.“
“It’s like having a baby…