One at a Time

1. One at a Time Real Time Non-Clinical Problem-solving

2. Objectives • Discuss the impact of complex processes on staff and patients. • Describe how breaking down silos between departments impacts relationships. • Explain how real time problem-solving supports reliable results • Identify when problems become interdepartmental.

3. IV Pump ManagementIowa Lutheran Campus Marilyn Harden, Nurse Manager 2 North Corey Martin, IH-DM Logistics Manager

5. Signal: Ideally my patient would have had an IV pump in the room when admitted from PACU. In this case there was no pump. Background 5

6. Current Condition • Current state has IV pumps located throughout the hospital with no standards. Central Supply maintains the pumps in their area, and delivers pumps upon a call from the floor. This leads to large delays, given that the supply tech in CS may not be in their area, or that there may not be any pumps available. In the event there are no pumps available the tech will have to search room by room to find an unused pump to take to the requesting floor. This can be a substantial wait for the patient.

7. Root Cause Analysis/Problem My patient did not have an IV pump when they needed one • Why: There was not IV pump in the room • Why: The IV pump was removed from the room • Why: The IV pump was needed in another location/patient • Why: There was no IV pump available for the other location/patient • Why: There is a resource allocation issue around this problem

8. Target Condition • There is an IV pump available for the patient at the point of entry and that pump stays with the patient until discharge. That way there is no delay in care and the patient receives the treatment they need.

9. Countermeasures • Based on the recommendations of the ISU Engineering Students a team of nursing leaders as well as Integrated Services personnel will be put together to examine the “par level” concept they presented for the IMMC campus, and how it can be implemented at ILH. • The correct “par” quantities will be decided upon by the team allowing for the right number of pumps to be kept on the units for direct admits, and additional meds that may be needed. • Facilities, Nursing, and Central Supply will assure adequate storage and signage referencing the number of pumps needed on a unit is available in the proper store rooms.

10. Countermeasures Cont. • Central Supply will allocate the pumps to the store rooms the evening prior to the start date of the new model. • EVS will clean all pumps upon discharge assuring the every pump not in use is clean are ready to use • Central Supply will make three passes a day (7:00 a.m. – 2:00 p.m. – 7:00 p.m.) to redistribute extra pumps from discharged patients to assure the “par numbers” are being kept

11. Department Specific Orientation Compliance Trinity Regional Health-Quad Cities Elizabeth Schwarz Annette Sherbeyn

13. Signal • Completion of Department Specific Orientation Checklist for New Hire/Transferred employees did not meet Joint Commission Compliance requirements. • Completion/Compliance rate as of 12/2010: 43% • TARGET: 90%

14. Barriers • No specific incident/signal identified. • Signal received 30-60+ days following initial presentation of new employee in department – not “real time” • Difficult to conduct observations

15. Over Coming the Barriers • Produced list of Employees/Managers non-compliant • Identified a mix of different department managers to meet for ‘Observation’ • Met with Managers and asked “Tell me about your process”

16. Background Ideally, Education/HR would receive completed Department Specific Orientation forms within three (3) weeks of start date, but, in this case Education/HR did not.

17. Problem StatementAs of 1/19/2011, Education/HR had not received the Dept. Specific Orientation on new employee KV (DOH 11/30/2010) Why: Manager maintained the Dept Specific Orientation in the Manager’s ee working file. Why: Manager not aware that it needed to go anywhere else/feared it would get lost. Why: Manager reported not given clear direction regarding the process for the form/many documents lost when sent thru office mail. Why: Manager orientation is not complete, simple, or direct.

18. Counter Measures/Specific Work • Orientation Policy updated to reflect more reasonable timeframe to return Checklist for Complaince • From 3 weeks to 60 Days • Audit all New Hires versus small sample size to attain 90% complaince rate • Notification Process to Managers through Outlook Tasks implemented to facilitate increased compliance beginning February 2011

19. Counter Measures/Specific WorkNotification Process

20. Self-Pay Radiology Process The Finley Hospital Jan Hirsch, Director of Radiology Shellie Thalacker, Director of Registration

21. Ideal Statement Ideally, all self-pay patients have been made aware and understand their payment obligations and options prior to service being performed, but in this instance, the patient missed process checkpoints

22. 5 Whys Problem statement: Patient had MRI procedure without making planned payment Why: X-ray front desk staff did not ask for payment receipt Why: X-ray front desk staff did not know that they were supposed to ask for receipt Why: X-ray front desk staff did not know patient was self-pay Why: Patient was not identified as self-pay at registration Why: There was an active account available Why: Patient was registered as standard out-patient Why: Because there is no standardized registration process for self-pay patients

23. Countermeasures Created self-pay patient identification and payment procedure Education for staff on new procedure Initiated new communication process between Finley Liaison and Registrar Created a red face sheet to alert staff to self-pay status Patient obtains receipt upon payment at Cashier Patient presents receipt to initiate service in Radiology 23

25. Signal Question Did a self-pay patient have a radiology procedure without payment? Next Steps Wait for self-pay patient to trial new process

26. St. Lukes Cedar Rapids Environmental Services Heather Sylvia, Zone Supervisor Connie Demuth, Patient Flow Coordinator 5E

28. Signal • Delay in getting patient admitted to med/surg from the ED

29. Root Cause • The EVS evening and night shift housekeepers (suppliers) had no way of knowing how to prioritize the needs of their customers (units that are running out of clean rooms)

30. Countermeasure • Direct connection between House Supervisor/Bed Placement and EVS evening and night supervisor every day at start of shift so EVS knows where to prioritize room cleaning

31. Results • “The inpatient areas almost never tell us that we have to wait for a room to be cleaned anymore”, ED staff • “The housekeepers are so much happier! They aren’t getting near as many 911 calls, they know where they’re needed, and they’re getting their breaks” EVS Manager

32. Questions? Thank you for your attention