A Toolkit for Redesign in Health Care: Final Report

Strategies for Translating Information Into Proposed Projects for Implementation

The lessons learned from external and internal data gathering were focused on three components of the system:

• People.
• Processes.
• Communication and culture.

Therefore, the redesign projects and the system transformation which emerged from this extensive planning effort focus on these three areas.  A strategy was developed for the approach to implementation of system-wide transformation through this information.  The following describes the proposed projects for the subsequent implementation phase.

People

• Lesson learned: The right person must be in the right role.
  • Planned response:  Talent profiling.
• Lesson learned: People should function at the highest level of their knowledge and skill.
  • Planned response: Increase role of nurses, nurse practitioners, and physician assistants. Expand ability of non-physician professionals in writing orders.
• Lesson learned: Create champions.
  • Planned response: Establish cadre of employees with unique skills—the experts in Lean.
• Lesson learned: Health care workers need new tools to allow them to redesign processes.
  • Planned response: Training in Lean, adoption of Clinical Microsystem concept for work groups, and talent profiling.

Processes

• Lesson learned: Efficient, effective, timely, and accurate process flow requires use of real-time data on products and people.
  • Planned response: Develop mini command center for movement of materials and supplies and pilot test the use of radio frequency identification for one type of equipment.
• Lesson learned:Match work teams with work demands.
  • Planned response: Change shift times and geographic distribution of workers for certain processes.
• Lesson learned: System transformation is best accomplished through a balance of many, well chosen rapid-cycle projects and system projects. Core process redesign is best accomplished by those engaged in the process.
  • Planned response: The 25 trained "Black Belts" will conduct 50 rapid-cycle projects per year. Their process improvements projects will be focused on processes in their assigned and familiar areas of work responsibility.  A small number of system-wide projects of high strategic value will be undertaken.

Criteria were also developed to help select both system and small rapid cycle projects.  These selection criteria are expected to help guide those trained in Lean tools in identifying projects and increasing the probability that these projects would be successful.Project selection will focus on those with:

• High strategic value.
• Substantial inefficiencies.
• Identified champions.
• A team that is ready for the task.
• Good (albeit not assured) chance of success.
• Institutional resources to bring project to completion.
• Measurable outcomes.

Communication and Culture

• Lesson learned:  Effective communication must be timely, complete, accurate, and come to closure. Communication can be synchronous or asynchronous.The former is necessary in health care, but the latter is more efficient.
  • Planned response: Develop multiple types of structured communication for synchronous communication, including:
    • Situation-Background-Assessment-Recommendation (SBAR) for nurse-physician communication.
    • Defined escalation processes for clinical circumstances.
    • Multidisciplinary rounds with daily care plans.
    • Huddles/time outs.
    • Use of wireless devices.
    Institute multiple approaches for asynchronous communication, including:
    • Text paging.
    • Secure E-mail.
    • Computerized provider order entry.
    • Picture archiving and communication system.
    • Feasibility assessment of single integrated (across all disciplines) electronic record on a clinical service.
• Lesson learned: Create a culture of accountability and continuous improvement.
  • Planned response: Develop with employees a set of expected and preferred behaviors.
• Lesson learned: Immediate rewards are important as incentives for improvement and alignment of corporate and employee goals.
  • Planned response: New employee bonus/rewards program.
• Lesson learned: Corporate and employee goals must be aligned.
  • Planned response: New bonus/rewards program.

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