Accountability is one of those words many people in healthcare throw around.

We all want it for ourselves and we especially want our employees to have it.  Few leaders know how to get it or how to give it.  Timothy Porter-O’Grady defines accountability as “A willingness to invest in decision-making and express ownership in those decisions.”  As such, accountability is a core component of Shared Governance.

You may be asking yourself, “Who cares, isn’t this site about Lean Healthcare?”

Exactly!  A mature lean healthcare organization is based on respect for people.  This concept includes moving decision-making to the highest level of expertise, which often is the lowest level of authority or title.  Systems and structures are necessary to support good decision making.  Following is a simple example that demonstrates these principles:

Vail Valley Medical Center is a 50-bed private community-based hospital which began implementing lean healthcare principles two-and-a-half years ago.  As part of their journey they have placed a heavy emphasis on A3 Problem Solving and have trained approximately 25 percent of their staff in this Lean Healthcare tool.  Recent training on lean management systems allowed charge nurses on a med-surg unit to apply their knowledge of Visual Management and A3 Problem Solving.

In developing their unit’s Visual Management, charge nurses Alissa Saari and Tania Boyd were coached by their CNO to align key areas of focus for the unit with overall organizational goals.  As with every patient care unit, expenses were of course among the top three focus areas.  Data for labor and non-labor expenses was provided to the charge nurses from the Director and was displayed on a bulletin board in the staff lounge.

This prompted conversations with staff on how the non-labor expenses could be decreased.  One observed issue was the disposal of non-used patient hygiene items at discharge.  By analyzing this issue, they realized nursing staff routinely brought these items to a room when a patient was admitted, whether or not a patient wanted or needed them.  The staff also knew that a second area of focus was patient satisfaction, especially improving scores around involving patients and families in decisions regarding their care.

After discussing the issue with Unit Healthcare Assistants a plan was developed to start the morning shift by rounding on patients, introducing themselves, and providing the patient with a list of hygiene items they might want.  Patients checked the items needed and those items were brought to the room.  Initial tests of this process included feedback from patients and staff which was overwhelmingly positive.  Unit Healthcare Assistants were thrilled that someone finally asked them what they could do to decrease expenses.

While the final data is being counted in terms of the impact this made on unit expenses and patient satisfaction, the charge nurses used a simple method of measurement by collecting the wash basins that were disposed of at discharge.  The before and after pictures of the wash basins were posted on the same unit bulletin board.  The sense of accountability and pride in the results is clearly evident in these pictures.

Imagine if 25 percent of your staff were accountable to implement small solutions to decrease expenses–what could happen in your organization?


Today’s blog was written by Maureen Sullivan, a senior associate at HPP.

Maureen has over 28 years of healthcare experience in clinical nursing, management and quality leadership to Healthcare Performance Partners.  As a registered nurse, Maureen’s clinical experience is in medical surgical nursing with progressive responsibilities in nursing management at the front line, middle management, and administrative levels.

Maureen has an associate degree in Nursing from Joliet Junior College and a bachelor of science in nursing with an emphasis in healthcare management from Metropolitan State College in Denver, Colorado. Maureen achieved certification from the National Association for Healthcare Quality, certified professional in healthcare quality (CPHQ), Colorado State University in process mapping, and University of Michigan in Lean Healthcare.

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