systems thinking and lean transformation · standard work september 16‐20 ... – handling...

Systems Thinking and Lean Transformation: An Integrative Model for the

Operating Room

3

A Transformational Gift . . .

It is the duty of everyone to do

what is within his power to

alleviate human suffering.

One NemoursAn Integrated System Of Care . . .

• 2 Hospitals• 12 Partner Hospitals• 37 Outpatient

Practices• 6 Urgent Care Centers• 679 Physicians• 215 Researchers• 114 Residents,

Fellows and Students• 6,427 Associates

4

We here today…..• Why the traditional industrial model was inadequate for a pediatric surgical setting

• What was needed to move us forward• How we accomplished the transformation• Our current state and outcomes• Story of our 3‐year lean transformation journey

– Patient safety and patient flow– Pre‐Op through Discharge from PACU– Support Services (EX: SPD, EVS, OR Pharmacy)

Learning Objectives• Understand the components of the Integrated Lean Systems Model and the implementation challenges

• Understand the impact of high‐performance, multidiscipline teams on the ability to sustain improvements in quality, safety, delivery and cost

• Learn the importance of visible senior leadership, a daily management system, and the P‐D‐C‐A problem solving methods to lean transformation

Platform for Change – 2011 Current State

Patient and Family Dissatisfaction

• What we heard from our patients in 2011– “we don’t want to come in several visits prior to surgery; why can’t we do everything the morning of surgery”

– “we don’t want to wait”– “we want to be better informed about delays” – “we want to know our surgery information sooner”– “please listen to our concerns postoperatively

• Variations in how patients flowed through our system (PAT > POH > OR > PACU)

• Scheduled $400,000 expansion plan to add 5 Pre‐Op Holding bays

• State of healthcare and changes

Why Continuous Improvement• Provide the optimal patient/family experience

– Best care and safety – Permanently reduce cost – Embrace patient/family variation and eliminate performance variation

• Improve our competitive position and brand recognition

• Become the “pediatric hospital of choice”

Embarked on a “Traditional CI Journey” with a Fast‐Forward Mentality

Using Traditional Event‐Based Model– Relentless pursuit of waste (non‐value added)– Patient flow as an analogy to assembly line flow – External facilitators, internal CI resources, VSM and Sponsors

– Emphasis on front line involvement with leadership support

– Managed through 30+ metrics and alignment sessions

– Maintained an aggressive redesign and implementation schedule

Event‐Based Model – Traditional Format

3‐Day Assessment and Planning

5‐Day Rapid Process Improvement Workshop

Following Week: Implement ChangesTrack Progress:

Confirmations, Data, Reports

Sustain: 30‐, 60‐, 90‐Day Reports to leadership

14

Sponsors/MGT

Process Owners

Staff

VSMCI

Clinical Educators

Facilitator

Testing The Model – POH Patient Flow: Nov. 2011/Jan. 2012

• Patient registration through in OR – improved flow• Implemented late January 2012• Reduced process steps from 95 to 33• Reduced DOS mean wait time 128 minutes to 78 minutes by April 2013

• Stabilized the process for patients and staff • Waited until February 2013 for next POH event• Eliminated need for $400,000 capital project

Testing The Model – Administrative Function: July/August 2012

• OR Case Scheduling ‐ accuracy of case scheduling on first pass

• Implemented August 2012 • Increased entry accuracy General Surgery and Otolaryngology

• Failed to generalize to other services• Restarted in mid‐2013: failed to gain traction• Restarted in early 2014 (through integrated systems model)

Event‐Based Model Full ImplementationJanuary 2013

2013 Event ScheduleMonth Date Event Type DescriptionJanuary 8‐9 Assessment & Planning PAT Screening

January 21‐25 RPI SPD Case Cart Picking

February 5‐7 Assessment & Planning Equipment Maintenance

February 12‐14 Assessment & Planning OR Set‐Up Wheels‐Out/WheelsIn

February 18‐22 RPI PAT Screening

April 9‐11 Assessment &Planning SPD Decontamination

April 15‐19 RPI Equipment Maintenance

April 25 Mini Alignment session

May 7‐9 Assessment & Planning PAT Standard Work Clinical

May 13‐17 RPI RPI OR Set‐Up Reduction

June 10‐14 RPI SPD Decontamination

July 9‐11 Assessment & Planning SPD Tray Assembly

July 15‐19 Study Trip

2013 Event Schedule (continued)Month Date Event Type Description

July 22‐26 RPI PAT Standard Work Non Clinical

August 6‐8 Assessment & Planning Daily Schedule Accuracy

August 13‐15 Assessment & Planning SPM Clean Up/ InstrumentVolume/ Maintenance

September 10‐12 Assessment & Planning PACU Phase 1/Phase 2 Flow and Standard Work

September 16‐20 RPI SPD Instrument Tray Assembly

October 7‐11 RPI Daily Schedule Accuracy

October 21 Alignment Session 2

OctoberNovember

28‐1 RPI SPM Clean/Up Instrument Volume/Maintenance

November 11‐15 RPI PACU Phase 1/Phase 2 Flow &Standard Work

December 3‐5 Assessment & Planning OR Preference Cards Standardization

December 17‐19 Assessment & Planning Pharmacy Delivery Accuracy

And Then…July 2013 We Called A Timeout• Event and change fatigue • Data indicated process changes were not stabilizing – variation

• Patient/family satisfaction feedback showed minimal improvement

The Turning Point: Team Study Trip

Failure Analysis #1: Integration of Existing Values

• Created contradictions– “Relentless pursuit of waste vs. “whatever it takes” – “Independent thinking and freedom to practice” vs. “reliable methods and standard work”

• Failed to adequately prepare staff – Absence of buy‐in among operating room staff – “we don’t make cars; patients don’t move along an assembly line”

– Lean concepts “foreign” to healthcare providers – Flow? Level Loading?

– Belief that lean transformation is “only about the money”

• Expected a “magical” change in perspective– Absence of a business perspective and failure to accept the financial state of the healthcare industry

– Approach process improvements from the customer’s perspective

– “Patients/families aren’t our customers…we provide care and safety”

Outcome? Non‐Adopters; Withdrawal; Obstruction

Failure Analysis #2: Event‐Based vs. Systems Approach

• Rigid redesign and implementation model– Only one tactic for every problem– Only focusing on waste reduction…failure to address gaps

• Continuously destabilized processes– Aggressive schedule had to be maintained

• Embracing teams and sub‐optimizing with silos• Taking a “shoulda’, oughta’, wanna’ approach to reliable methods and standard work– Trained and implemented without a performance management system

– Process destabilization rooted in performance variation

• Failing to manage on a daily basis– Casual daily oversight– Weekly MGT meetings– 30, 60, 90 day reports by Process Owners

• Functioning from a tactical rather than strategic vantage point– Tracking an array of discrete process metrics from isolated events

– Absence of cascading goals strategic metrics and cascading events

Outcome?Fragmentation, Whack‐a‐Mole, Collateral Damage

Solution: Integrated Systems Model

High Performing Multidiscipline Team Development

• Who:– Perioperative Services, Surgical Services, Anesthesiology, Sterile Processing, Environmental Services, Materials Management, Bio‐Med, Facilities, OR Pharmacy, Quality, Financial Services, Human Resources, Legal and Risk Management, Continuous Improvement

– Feeder Lines: Emergency Department, Inpatient Units, Intensive Care Units, Surgical Clinics

• What:– Enterprise‐wide guiding principles:

• eliminate contradictions; everyone on the same page– Education

• why we need to transform our processes• eliminate knowledge gaps

– Engagement and Empowerment:• authors/designers of “how”• equal membership; online andons and stoppage rights

– Leveraged Visible Leadership: • consistent messaging, firm expectations, guiding principles, patient/family experience, and our customer

Profile: High Performance Multidiscipline Team

• Collaborative relationship between all stakeholders– Partners beyond the operating room (POH, PACU, EVS, SPD)– Stakeholders outside Perioperative Services– Family Advisory Committee

• Sharing responsibility and accountability• Owning each others goals and success• Challenging and escalating as a value• Embracing the ultimate focus….”what is best for the patient”

Strategic Vantage Point: Creating Alignment

• Enterprise True North Mission– Patient/Family Experience and Satisfaction– Quality, Safety, Delivery, Cost

• Moved from “I think to I Know”– Financials; business plan; competitive benchmarking– Operation metrics: Quality, Safety, Delivery– Voice of the customer, leadership and staff– Current state of the Value Stream

Cascading Enterprise True North to Strategic Initiatives

• Likelihood To Recommend – Top Box Goal• Surgical Site Infection – “0”• First Case Starts – 75% On Time• OR Case Turnover – Reduce Wheels Out to Wheels In Time

• Cost Per Case – Lap Appy and T & A

Daily Management System and Visible Leadership

• Tiered daily huddles• Standard structure to maintain consistency

– DMS boards– Handling abnormalities (on‐line and off‐line)– Escalation system

• Cascaded metrics – Quality, Safety, Delivery, Cost

Cause Frequency Tracker Month of __August 2014Freq

uency (dates of o

ccurrence in each cell)

25

20

15

10

5

Causes of Issues

Note: Causes of Issues should be written across the bottom. As causes repeat, additional dates should be written above the cause to show ascending frequency

05

101520253035404550

1. Sup

plies m

issing/

listed on

PL

2. Sup

plies

missing/no

t listed

on

PL

3. Instrumen

t missing

or broken from

tray

4. Case Cart not

available on

time

5. Breech in sterility of

packaged

item

Operating Room Andons 2014

Jan‐14

Feb‐14

Mar‐14

Apr‐14

May‐14

Jun‐14

Jul‐14

Aug‐04

Sep‐14

Oct‐14

0

5

10

15

20

25

6. Non

‐sterile room

supp

lies m

issing

7. Sterile supp

lies

missing/exhausted

8. Sterile glove supp

lyexhausted

9. Sterile gown supp

lyexhausted

10. Position

ing aids

not a

vail

11. Shared eq

uipm

ent

not a

vail


Jan‐14

Feb‐14

Mar‐14

Apr‐14

May‐14

Jun‐14

Jul‐14

Aug‐14

Sep‐14

Oct‐14

0

5

10

15

20

25

12. N

o Surgeo

n in OR

hudd

le

13. EVS

respon

se <

requ

ested

14. Com

puter C

OW

issue

s in OR

15. Pharm

acy Issue in

OR

16. Con

sent Issue in

OR

17. Problem

w/ O

Rph

one


14‐Jan

Feb‐14

Mar‐14

Apr‐14

May‐14

Jun‐14

Jul‐14

Aug‐14

Sep‐14

Oct‐14

05

101520253035404550

18. Problem

w/ O

Rmon

itors or cam

eras

19. OR Nurse neede

d as

escort to

PAC

U

20. Procedu

re add

ed to

or changed

during

hudd

le

21. R

oom re

ady at or

before 0740 hu

ddle late

22. Issue

s cop

ied for

Anesthesia fo

llow‐up

23. Incorrect item

picked

for case cart

24. Pho

ne Hud

dle


14‐Jan

Feb‐14

Mar‐14

Apr‐14

May‐14

Jun‐14

Jul‐14

Aug‐14

Sep‐14

Oct‐14

OR Room

Service Coordinators

Charge RN

OR Assistant Nurse Managers OR Manager OR Model Line

Sponsors

Chief Nurse Exectutive

Medical DirectorAnesthesia Director

Chief Operating Officer

VP Chief Medical Officer

Cheif Exec DE Operations

Sandy Cheezum

Chris Harris

Janice Gannon

Lani Heyman

Charge RN

10 60

Janice Simmons

Margaret Souder

Sharon Udy‐Janczuk

Bob Redlinger (Nursing)

Al Dorsey (Anesthesia)

Kirk Reichard (Surgeon)

Jane Mericle

Tetsu “Butch” Uejima

(Anesthesia)

Stephen Dunn(Surgeon)

Will Mackenzie(Orthopedics)

Paul Kempinski

Brent King

Roy Proujansky

2

Other Andons

10

Patient Safety

2

10

5

20

30

90

60

180

Your Daily Management System

Other AndonsPatient Safety

• Tiered daily huddles• Standard structure to maintain consistency

– DMS boards– Handling abnormalities (on‐line and off‐line)– Escalation system

• Cascaded metrics – Quality, Safety, Delivery, Cost

• Gemba ….”Go to the workplace”– “Real time” observation and problem solving

• Visible Leadership– Gemba walks– Tri‐folds and confirmations (spot checks)– Just‐in‐time solutions

• Plan‐Do‐Check‐Act Cycle

WHO Checklist - OR Coordinator/Charge

COMPLETE TASK ACTIONS & FOLLOW-UPValidate Cir RN goes to bedside and

visualizes patient id band and confirms with Anesthesia

Validate Cir RN reads consent audiblyValidate Cir RN completes sign in

documentationValidate Time out is initiated by surgeon

Validate elements of the time out: -Correct Patient, Procedure to be

performed (laterality), Site marking, prophylactic antibiotic, fire safety, equip

settings, imaging, blood products, concerns, team intro

Validate Time out occurs prior to procedure start

Validate if everyone is participating and paying attention (no competing

conversation or movement is occuring)Validate Cir RN Completes time out

documentationValidate sign out occurs after critical events of the procedure are performed and before the attending surgeon leaves the ORValidate the following:- Proc performed, Wound Class, Specific Concerns, Concerns for disp/recovery, Equip problems, Specimen confValidate no competing conversations occur during sign out

Date:

P‐D‐C‐A and Practical Problem Solving

P‐D‐C‐A and Practical Problem Solving

I think its they don’t care

Go to the evidence

Which inpatient units

Deep‐dive w/ cross‐

functional team

Applying P‐D‐C‐A and Practical Problem Solving

So what?

“I think this happens because….”

The evidence says….

Where?

Direct causes: process design;conditions; equipment; methods; individual performance

Solutions

Tracking outcomes

Responding to the data

Performance Management Component

Expectations

Train

Observation & Feedback

Consistency

Confirmations & Refinements

55

Performance Targets

ReliableMethods

Coaching

Alignment

Sustaining

Continuous Cycle

Confirming Standard Work –Performance Feedback

Effective Feedback• Immediately after completing the observation • Specific vs. general or ambiguous

– “You completed the counts” vs. “you did a good job counting”• Objective based on real‐time observation of actions/behaviors listed on the confirmation card

• Personal and Sincere to the observer and the staff member– “I noticed that you reviewed the preference card….”

• Positive/Maintain and Constructive/Redirect

A Slight CI Paradigm Shift…Adding Not Always Subtracting

58

Event‐Based Model – Traditional Format

3‐Day Assessment and Planning

5‐Day Rapid Process Improvement Workshop

Following Week: Implement ChangesTrack Progress:

Confirmations, Data, Reports

Sustain: 30‐, 60‐, 90‐Day Reports to leadership

59

60

Systems‐ Based Flexible Event Model

Systems Thinking and Acting:Key Lessons Learned

• Everything is linked in some way• A slight tweak “here” may cause a collision “there”…collateral damage

• Solving “my” problem may create a new problem….whack‐a‐mole

• Solution:– Have all stakeholders represented including patients/families

– Make strategic decisions on who to include (champions, adopters, SMEs)

– Never move forward with changes before confirming feasibility (cost, technology)

– Never move forward without confirming changes do not conflict with established policies, procedures and regulations….compliance check

– Always ask: “how might this change impact……..

Current State and Outcomes

Understanding the Value of Health Care Delivery

• Goal: To improve the value delivered to patients and their families

• Equation: Value in health care is measured in terms of the patient outcomes achieved per dollar expended

• Outcomes:measured along several dimensions, including survival, ability to function, duration of care, discomfort and complications, and the sustainability of recovery

• Costs: all resources including clinical and admin personnel, drugs, supplies, devices, space and equipment during a patient’s full cycle of care for a specific medical condition

Objectives and Opportunities to Improve Value

• Eliminate unnecessary processes and process variations that don’t add value

• Improve resource capacity utilization• Deliver the right processes at the right locations• Optimize over the full cycle of care• Capture the payoffs• Reexamine reimbursement• Be better leveraged when engaging with managed care companies

Outcomes

• Process Improvements• Financial Savings• Patient and Family Experience/Satisfaction• Beyond The Process Metrics

Process Improvements

• OR Room Turnover (Wheels Out to Wheels In)• OR Room Utilization• First Case Starts• SPD Decontamination, Tray Assembly and Case Cart Picking

• Patient Flow – In Surgical Services through In O.R.

Wheels Out To Wheels In – Moving Parts

• Patient flow through POH– On‐time arrival, registration, POH check‐in, H & P, labs/x‐rays, site marking, consents, pre‐meds

• Environmental Services– Case cart removed and delivered to dirty lift; call SPD– Trash removed and room cleaned

• Sterile Processing– Correct case carts staged in core 1 hour prior to case start time

• OR room ready– Opening, inspecting/flushing and staging instrumentation– Receiving handoff– Room ready 5 minutes prior to scheduled start time

• Surgical team ready– Team huddle completed 10 minutes prior to scheduled First Case Start

• Anesthesia pulling patient to OR• Case scheduling accuracy

Surgical Case Timeline: First Case Starts

For 7:45 start• POH check‐in complete within 15 minutes of arrival• Site marking, consents and pre‐med by 7:30• In‐room huddle completed by 7:35• Handoff completed by 7:40• Room ready light turned green by 7:40• Patient in the OR by 7:45

For 9:00 Start• POH check‐in complete within 15 minutes of arrival• Site marking, consents and pre‐med by 8:45• In‐room huddle completed by 8:50• Handoff completed by 8:55• Room ready light turned green by 8:55• Patient in the OR by 9:00

0

10

20

30

40

50

60

70

80

Average Minutes

Turnover By Service

October 2014

November 2014

December 201421

40

22

32

16

32

252327

Environmental Services Turnover

0.0

2.0

4.0

6.0

8.0

10.0

12.0

ORTHO GENERAL ENT EYES UROLOGY NEURO PLASTIC DENTAL CARDIO

11.1

8.2

5.6

10.0

8.2

0.0

8.8

8.0

0.0

Tracking and Problem Solving Room Ready

79

6/9/14 Monday

OR Provider

Set‐up Complete

On‐time/Late

Set‐up Complete (Includes Huddle)

Gap (min)

Patient out of POH

Gap (min)

Patient in OR

In OROn‐Time/

LateGap (min)

Procedure Start

Total Delay (min)

1 Reichard On‐time 7:31 AM 0:027:33 AM 0:02

7:35 AM On‐time 0:22

7:57 AM 0:26

2

3 Piatt Late 7:44 AM 0:057:49 AM 0:02

7:51 AM Late 0:32

8:23 AM 0:39

4 Nardone Late 7:45 AM 0:037:48 AM 0:03

7:51 AM Late 0:11

8:02 AM 0:17

5 Salvin On‐time 7:24 AM 0:147:38 AM 0:04


7:48 AM 0:24

6 Powell Late 7:43 AM 0:047:47 AM 0:01


7:55 AM 0:12

7 BaniHani On‐time 7:37 AM 0:187:55 AM 0:02

7:57 AM Late 0:31

8:28 AM 0:51

8 Bowen On‐time 7:34 AM 0:067:40 AM 0:03


8:01 AM 0:27

9 Mackenzie On‐time 8:44 AM 0:349:18 AM 0:04

9:22 AM Late 1:18

10:40 AM 1:56

10 Gabos Late 7:45 AM 0:057:50 AM 0:01

7:51 AM Late 1:20

9:11 AM 1:26

11 O'Reilly On‐time 7:20 AM 0:237:43 AM 0:01


7:50 AM 0:30

SPR 1 U. Shah On‐time 7:34 AM 0:097:43 AM 0:00


7:48 AM 0:14

SPR 2 0:00 0:00 0:00 0:00

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%1‐De

c2‐De

c3‐De

c4‐De

c5‐De

c8‐De

c9‐De

c10

‐Dec

11‐Dec

12‐Dec

15‐Dec

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24‐Dec

26‐Dec

29‐Dec

30‐Dec

31‐Dec

2‐Jan

5‐Jan

6‐Jan

7‐Jan

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9‐Jan

12‐Jan

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16‐Jan

19‐ Jan

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30‐Jan

Utilization

Room Utilization ‐ Combined Graph

Goal

Actual DOS Summary

Projected Daily

Baseline

0

10

20

30

40

50

60

70

80Pe

rcen

t On Time

First Case Starts ‐Monthly

2013

2014

Goal = 75%

0%5%10%15%20%25%30%35%40%

Associate

Readiness =

46

Patie

ntRe

adiness =

29

Equip/Ro

omRe

ady = 24

Metho

ds = 24

Capacity = 5

Reasons for First Case Delays by Categories 11/7/14 through 12/18/14

0%10%20%30%40%50%60%70%80%90%100%

0

5

10

15

20

25

Late First Case Starts Delay Reasons: 11/7/14 through 12/18/14 (301 Cases; 128 Late)

Associate Readiness 11/7/14 through 12/18/14: 128 Late Cases; 46 Associate Readiness = 36%

Surgeon late to POH

Anesthesiologist late to POH

Consent issues

Surgeon Late to Huddle

Procedure add/change in POH

POH Check‐In Late

Surgeon Late to Huddle 11/7/14 through 12/18/14:

13 Surgeon Late = 10%

Physician Late to POH 11/7/14 through 12/18/14: 128 Late

Cases; 20 Physician Late = 16%

Patient Readiness 11/7/14 through 12/18/14: 128 Late Cases; 29 Patient Readiness = 27%

Inpatient sent for late

Inpatient late into POH

Outpatient late into POH

Labs, Xrays needed

Insurance Issue

0.00%

0.20%

0.40%

0.60%

0.80%

1.00%

1.20%

0

1000

2000

3000

4000

5000

6000

7000

8000

Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.

Tray Volum

e

2012 2013 2014 Error Rate 2014 Error Rate Target = 0.79% 2014 YTD Error Rate = .71%

Sterile Processing Tray VolumeAnd Error Rate

Patient Flow:PAT Through In OR

• DOS Case Cancellation Rate– Reduced from 6.0% in 2012 to 2.8% YTD 2014

• POH Patient Preparation – Patient arrival time decreased from 90 to 120 minutes in 2011 to 45 to 60 minutes in 2014

– Total time POH preparation reduced from a median of 101 minutes in 2011 to 88 minutes YTD 2014 for a 13% reduction

– In Surgical Services to In POH (patient registration) reduced from a median of 54 minutes in 2011 to 20 minutes YTD 2014 for a 63% reduction

– In POH to In OR increased from a median of 47 minutes in 2011 to 61 minutes YTD 2014 for a 30% increase

89

A Slight CI Paradigm Shift…Adding Not Always Subtracting

Financial Gains

• Total financial gains to date– $1.7 million savings in labor and materials

• Total of 6.5 FTEs eliminated from Perioperative Services in 2014 and 2.5 FTEs in 2015.

– $400,000 capital expenditure

– Reduction in cost per case• Lap Appy decreased from $1355 in 2011 to $672 YTD 2014 for a 50% reduction

FTE Impacts

• PAT Clinical Workflow – Process redesign yielded an FTE reduction in 2014– DOS H & Ps increased from 34% 2013 to 88% YTD 2014

– The most medically complex patients became the focus of the clinic

– Feedback from patients and families is consistently high praise for the change

• Position Reallocation– In 2015 2.5 vacant FTEs were reallocated to other departments

Staff Reduction and Positive Reassignment

• Nemours’ Continuous Improvement HR Policy– Guarantees all staff displaced by position reductions will not lose their employment

• RNs and other associates had the option to interview for open positions– These staff members were given “first consideration” – RN’s transferred to employee Health and outpatient clinics closer to home

• Vacant positions were re‐allocated to support– Materials Management, ECMO, Physician Practices, Lactation Education, and Kids Health Program

– The role of Perioperative Services Improvement Specialist

Patient Safety: Process Improvements and Andons

• Process Improvements– Eliminated 6 handoffs during the PAT – POH – OR Flow– Increased Sage Cloth compliance – Decreased instrument processing errors– Created reliable methods to performance variation– Enhanced instrument inspection and flushing in the OR– Reduced instances of flash sterilization

• Process Improvements– Implemented screening of all surgical patients by Advanced Practice Nurse 2 weeks prior to surgery

– Created no‐reply information and education email sent to surgical patients 3 days prior to surgery

– Moved information/education call to all patients 2 days prior to DOS

• On‐Line Andons, Staff Engagement and Empowerment

Patient and Family Experience

• Initial flow mapping included parents • Family Advisory Committee involved with CI events• PACU postoperative calls:

– 99% satisfaction; 98% connect rate

101

Ambulatory SurgeryNemours/duPont Hosp. for Children

Question - Likelihood of recommending center

102


Question - Information about delays

103


Question - Response to concerns/complaints

104

Ambulatory Surgery

Nemours/duPont Hosp. for Children

Question - Overall rating of care

Going Beyond the Metrics• Education for patients/families 48 hour call, emails, on‐line video, DOS booklet

• Enhanced teamwork RN and APN In POH• Staff cross‐trained to work in PACU and SPRs• PACU staff pull patients from inpatient units to POH• Decontamination beginning in the OR• Multidiscipline high performing teams are real• Coordinated care among all disciplines eliminating redundancies and decreasing rework

Our Path Forward?

Continue To….

• Work our strategic plan focusing on 5 key metrics• Direct energy toward reducing performance variation• Pursue technology improvements and data access• Enhance our Daily Management System• Expand employee engagement and empowerment

Continue To….• Always ask:

– “What (not who) caused this to happen” – “How will this proposed change impact…”

• Always view: – “Patients and their families as our customers”

• Always lead with:– “What is best for the patient (not what is best for me)”

systems thinking and lean transformation · standard work september 16‐20 ... – handling...

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