April 20, 2012
“The safety of maternity services is of paramount importance. Maternity teams face many challenges in delivering safe care to mothers, babies and families. The King’s Fund launched an independent inquiry into the safety of maternity services in 2006. The report from that inquiry, Safe Births: Everybody’s business, made a series of recommendations about how the safety of maternity care could be improved.
Building on the recommendations from our inquiry and in partnership with the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the NHS Litigation Authority, Centre for Maternal And Child Enquiries and the National Patient Safety Agency, The King’s Fund launched the Safer Births Improvement Programme, providing customised support to 12 multidisciplinary maternity teams in England. This toolkit shares the experiences and lessons from those teams.
Improving Safety in Maternity Services: a toolkit for teams is organised around five key areas for improvement in maternity care on which the teams focused:
- information and guidance
- staffing and leadership.
Each section begins with a brief explanation on how focusing on improvements in each area can contribute to improved safety. It then highlights some of the experiences of the maternity teams who focused on this issue and their key learning points. There are also short summaries of tools that can be used to improve safety. These provide a brief guide to how to use the tool and signpost further resources. Where available we have included examples or templates that can be used or adapted for local use. Finally, we provide more information about service improvement and the tools and techniques that can be used.”
Posted in READ Portal, Reports & Papers | Tagged with Efficiency, Health care reform, Process improvement, Safety | No Comments
April 19, 2012
“Recent research has demonstrated that an exceptional patient experience correlates with improved clinical quality, reduced readmissions and improved mortality. HCAHPS is a tool that can be used to help organizations improve the patient experience, and may have a related effect on clinical quality. With the implementation of value-based purchasing beginning with October 1, 2012 discharges, HCAHPS performance will also have an impact on financial goals.
This guide describes how HCAHPS data should be used in context with other information about organizational performance. It highlights cultural elements necessary to build a firm foundation for HCAHPS success. Once these foundational elements have been considered, the guide outlines a 5-step approach to using HCAHPS effectively to improve the patient experience, quality and safety:
- Understand HCAHPS data
- Set improvement priorities
- Identify and implement targeted interventions
- Engage the team
- Measure and monitor success
The appendix includes links to white papers and case studies that can help health care leaders better understand the HCAHPS survey and identify and successfully implement strategies for improvement.”
Posted in READ Portal, Reports & Papers | Tagged with Process improvement, Quality improvement | No Comments
March 21, 2012
“This toolkit is designed to help your hospital understand the Quality Indicators (QIs) from AHRQ, and support your use of them to successfully improve quality and patient safety in your hospital. Created by the RAND Corporation and the University HealthSystem Consortium with funding from AHRQ, it is available for all hospitals to use free of charge. The toolkit is a general guide to using improvement methods, with a particular focus on the QIs.
The AHRQ QIs use hospital administrative data to assess the quality of care provided, identify areas of concern in need of further investigation, and monitor progress over time. This toolkit focuses on the 17 Patient Safety Indicators (PSIs) and the 28 Inpatient Quality Indicators (IQIs).”
Posted in Multimedia, READ Portal | Tagged with Indicators, Patient-centered care, Process improvement, Quality improvement, Safety | No Comments
March 13, 2012
“In the health sector, Lean is a patient-focused approach to systematically eliminating waste in health care organizational processes in order to improve quality, productivity and efficiency. In essence, Lean involves mapping out the patient journey from the time they enter the system until they exit the system in order to identify activities that provide value to the patient and eliminate those that add no value (waste). Once wasteful activities are removed, remaining steps are made more efficient and integrated so that services flow smoothly. This means that services are “pulled” only when needed by patients. The final step of Lean is the pursuit of continuous improvement by repeating the cycle to get it more and more streamlined.
In November 2010, Leadership Council1 decided to support the use of Lean within the health authorities as a process redesign tool. One of the strategic actions or Key Result Areas (KRAs) for achieving the Ministry of Health’s Innovation and Change Agenda is concerned with reducing waste and increasing value in the health care sector using Lean methods. A key deliverable for this KRA is an annual report for Leadership Council that outlines how Lean has been used in the province. This report presents seven case studies that have been identified by the health authorities as compelling and successful Lean initiatives.”
Posted in READ Portal, Reports & Papers | Tagged with Canada, Efficiency, Process improvement | No Comments
February 29, 2012
Emergency department (ED) overcrowding has been defined as “a situation where the demand for emergency services exceeds the ability to provide care in a reasonable amount of time.” 1 ED overcrowding is a serious and ongoing issue across Canada; in a 2006 survey of Canadian ED directors, 62% of respondents reported that overcrowding had been a major or severe problem in 2004 and 2005.
Short stay units (SSUs) have emerged as a potentially useful strategy for managing overcrowding in emergency departments. The theoretical benefit of SSUs is to “off-load” stable patients from the acute-care ED and to reduce the number of unnecessary hospital admissions. Typically, SSUs are focused on (1) expected short treatments such as blood transfusions; (2) further diagnostic investigations to finalize a medical diagnosis; and (3) safe discharge into the community, such as by involving a social worker. To prevent such units from being “dumping grounds,” most SSUs have strict inclusion/admission criteria. Part of the difficulty in evaluating the value of SSUs is terminology, since many terms have been used to describe such units (e.g., observation units, assessment units, and clinical decision units). Typically, however, SSUs are some type of extension of the ED whose overarching objective is to improve “the quality of medical care through extended observation and treatment, while reducing inappropriate admissions and healthcare costs.”
Posted in Journal Articles, READ Portal | Tagged with Emergency service, Process improvement | No Comments
February 28, 2012
“Background: There is growing interest in applying lean thinking in healthcare, yet, there is still limited knowledge of how and why lean interventions succeed (or fail). To address this gap, this in-depth case study examines a lean-inspired intervention in a Swedish pediatric Accident and Emergency department.
Methods: We used a mixed methods explanatory single case study design. Hospital performance data were analyzed using analysis of variance (ANOVA) and statistical process control techniques to assess changes in performance one year before and two years after the intervention. We collected qualitative data through non-participant observations, semi-structured interviews, and internal documents to describe the process and content of the lean intervention. We then analyzed empirical findings using four theoretical lean principles (Spear and Bowen 1999) to understand how and why the intervention worked in its local context as well as to identify its strengths and weaknesses.
Results: Improvements in waiting and lead times (19-24%) were achieved and sustained in the two years following lean-inspired changes to employee roles, staffing and scheduling, communication and coordination, expertise, workspace layout, and problem solving. These changes resulted in improvement because they: (a) standardized work and reduced ambiguity, (b) connected people who were dependent on one another, (c) enhanced seamless, uninterrupted flow through the process, and (d) empowered staff to investigate problems and to develop countermeasures using a “scientific method”. Contextual factors that may explain why not even greater improvement was achieved included: a mismatch between job tasks, licensing constraints, and competence; a perception of being monitored, and discomfort with inter-professional collaboration.
Conclusions: Drawing on Spear and Bowen’s theoretical propositions, this study explains how a package of lean-like changes translated into better care process management. It adds new knowledge regarding how lean principles can be beneficially applied in healthcare and identifies changes to professional roles as a potential challenge when introducing lean thinking there. This knowledge may enable health care organizations and managers in other settings to configure their own lean program and to better understand the reasons behind lean’s success (or failure).”
Posted in Journal Articles, READ Portal | Tagged with Benchmarking, Process improvement, Quality improvement | No Comments
February 20, 2012
“An emerging category of hospital quality initiatives, comparable to preventing medical errors and improving quality and patient safety, could be labeled “waste management” or “waste reduction.” “Waste” in this sense refers not to biohazardous substances in need of disposal, but to the overuse of medical resources—such as lab tests and pharmaceuticals—when they are not helpful to a patient’s medical management.”
“If patients are getting CAT scans they don’t really need or an extra day of telemetry because we don’t have criteria for who should be on telemetry, that’s wasteful, it’s costly, and it could be dangerous,” Dr. Wachter explained at the UCSF Management of the Hospitalized Patient meeting last October. “The data are clear that 30% of what we do in American medicine is of no value to patients—and some substantial portion of that is harmful as well. I think we as hospitalists should be identifying what these wasteful things are—and making the hard decisions to stop them.”
Posted in Mass Media Articles, READ Portal | Tagged with Process improvement, Quality improvement | No Comments
February 6, 2012
“Study objective:We examine practical aspects of collecting time-based emergency department (ED) performance measures.
Methods: Seven measures were implemented in 6 hospitals during 1 year. Structured interviews were used to assess the benefits and burdens of reporting. In 2 hospitals, Centers for Medicare & Medicaid Services (CMS) sample size requirements for 3 measures were compared to a reasonable sample size estimate (in which 95% of samples fell within 15 minutes of the population median).
Results: ED performance data on 29,587 admitted patients and 127,467 discharged patients were reported. Median throughput time for admitted patients ranged from 327 to 663 minutes and for discharged patients ranged from 143 to 311 minutes. Other performance measures varied similarly (2- to 3-fold between hospitals). In general, ED throughput was longer at academic sites and those with higher volume. Several benefits of reporting were identified, including promoting ED quality improvement, accountability, and practice standardization. The burdens included having to access multiple information technology systems and difficulties setting up the data collection. Most respondents found great value in the throughput measures and time to pain medication but less value in time to chest radiograph. The human capital required to implement measures varied by hospital and staff demonstrated a learning curve. Our empirically derived minimum reliable sample sizes were different from CMS recommendations.
Conclusion: There is great variation in performance between EDs in time-based ED measures. There are multiple reporting benefits. Reporting burdens seemed to lessen after data systems were established. The CMS sample size requirements for throughput measures may not be optimal compared with actual ED throughput data.”
Posted in Journal Articles, READ Portal | Tagged with Efficiency, Process improvement, Quality control | No Comments
December 2, 2011
“Change Foundation CEO Cathy Fooks says integrated healthcare is the key to better patient experiences, improved access to quality, safe services, and a stronger, sustainable healthcare system. But she says integrated healthcare is not yet possible in Ontario given the arrangements currently in place, adding that we need to create the winning conditions to yield a patient-centred system that provides value for our healthcare investments.
“The province is working on several fronts to improve healthcare quality, better serve patients and use resources more strategically. But we’re missing a game-changing shift,” says Fooks. “As long as the levers of healthcare change are grinding against each other, real progress will be slow. We need to embrace team-based care. We need to strengthen regional planning bodies by giving them the scope, support, and structure to do their job; and we need to ensure professional interests don’t trump big-picture decision-making and the voice of patients and caregivers.”
Winning Conditions recommends 24 interconnected actions to improve care, governance, funding, performance, and information flow, outlining where we stand now, and where we need to go to improve the patient and caregiver experience.
Winning Conditions is The Change Foundation’s best advice on how Ontario can move closer to an integrated health system and improve the experience of patients and their caregivers. It’s based on work conducted and commissioned by the Foundation and published research. It draws on what we’ve learned from other jurisdictions, and is informed by discussions with government, policy experts, regional planners, and most importantly, the people who use Ontario’s healthcare system.”
Click here to read the full article
Posted in READ Portal, Reports & Papers | Tagged with Forecasting, Process improvement, Quality improvement | No Comments
November 30, 2011
“Background: In health care, many organizations are working on quality improvement and/ or innovation of their care practices. Although the effectiveness of improvement processes has been studied extensively, little attention has been given to sustainability of the changed work practices after implementation. The objective of this study is to develop a theoretical framework and measurement instrument for sustainability. To this end sustainability is conceptualized with two dimensions: routinization and institutionalization.
Methods: The exploratory methodological design consisted of three phases: a) framework development; b) instrument development; and c) field testing in former improvement teams in a quality improvement program for health care (N teams = 63, N individual =112). Data were collected not until at least one year had passed after implementation. Underlying constructs and their interrelations were explored using Structural Equation Modeling and Principal Component Analyses. Internal consistency was computed with Cronbach’s alpha coefficient. A long and a short version of the instrument are proposed.
Conclusions: The theoretical framework offers a valuable starting point for the analysis of sustainability on the level of actual changed work practices. Even though the two dimensions routinization and institutionalization are related, they are clearly distinguishable and each has distinct value in the discussion of sustainability. Finally, the sub scales conformed to psychometric properties defined in literature. The instrument can be used in the evaluation of improvement projects.”
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Posted in Journal Articles, READ Portal | Tagged with Process improvement, Quality assessment, Quality improvement | No Comments