In Lean Healthcare we are frequently tasked with achieving a specific target. We have all seen successful improvement efforts which moved the needle and achieved planned targets and goals. However, how often do you hear of teams that have documented significant efforts and gains well beyond the original project goals?
Recently, I worked with a health system that was experiencing continued high numbers of central line infections. The improvement team studied their current process and determined that they were not following their documented standard work for managing the central line and line dressing, nor were they following their line flush protocol. Solutions were identified and implemented that resulted in an outcome of zero central line- or dressing-associated infections. I have experienced many cases in which the team and organization would implement a sustainment plan and celebrate their successful elimination of infections. That would be the end of it. Not this organization—they continued to try to improve:
Before the project work, nurses were changing central line dressings every seven days, regardless of the integrity of the dressing. After the improvement event they instituted a dressing change protocol in which a dressing change was required within one hour of any dressing breach. As a result, dressings were instead being changed every two to three days on average and nurse effort to maintain an intact dressing more than tripled.
This was only the beginning of the improvement effort. Through additional process walks and staff discussions, they found a high dressing breach incidence rate with specific Mediport needles, with specific placement of internal jugular central lines and with specific patient types. They also had doubts about the adhesive nature of their standard dressing product. They decided to evaluate new dressing products from several suppliers which resulted in a new dressing kit design with several new features. It increased dressing integrity, realizing an improvement to changing every five days on average. It also identified better techniques for the preparation of the line insertion site.
The Lean Healthcare concepts of going to the gemba to see the issues and involving the front line staff in the improvement process delivered project results well beyond the elimination of central line infections. During project deployment and also into the sustaining period, the health system deployed a Lean management system to measure, manage to the measure and have leaders conduct Gemba walks with front line nurses to discuss their work and targets achieved.
So, the next time you see a project complete, ask what else may have been affected by the changes implemented, allowing identification of additional opportunities.
Today’s blog was written by Rick Beaver a director with HPP.
Rick has more than 25 years of experience leading process improvement and change management in the healthcare, manufacturing, insurance and pharmaceutical sectors. He has previously served as senior leader and vice president of performance improvement and support operations for a two-hospital, 550-bed health system. Additionally, he has served as an examiner for both the Pennsylvania and U.S. Malcolm Baldrige Board of Examiners.
Rick earned a degree in Chemistry from the University of Pittsburgh.