Interprofessional, multitiered daily rounding management in a high-acuity hospital

Abstract

PurposeThe purpose of this explanatory case study is to explain the implementation of interprofessional, multitiered lean daily management (LDM) and to quantitatively report its impact on hospital safety.Design/methodology/approachThis case study explained the framework for LDM implementation and changes in quality metrics associated with the interprofessional, multitiered LDM, implemented at Saint Francis Hospital and Medical Center (SFHMC) at the end of 2018. Concepts from lean, Total Quality Management (TQM) and high reliability science were applied to develop the four tiers and gemba rounding components of LDM. A two-tailed t-test analysis was utilized to determine statistical significance for serious safety events (SSEs) comparing the intervention period (January 2019–December 2019) to the baseline period (calendar years 2017 and 2018). Other quality and efficiency metrics were also tracked.FindingsLDM was associated with decreased SSEs in 2019 compared to 2017 and 2018 (p ≤ 0.01). There were no reportable central line-associated blood stream infection (CLABSI) or catheter-associated urinary tract infection (CAUTI) for first full calendar quarter in the hospital's history. Hospital-acquired pressure injuries were at 0.2 per 1,000 patient days, meeting the annual target of <0.5 per 1,000 patient days. Outcomes for falls with injury, hand hygiene and patient experience also trended toward target. These improvements occurred while also observing a lower observed to expected length of stay (O/E LOS), which is the organizational marker for hospital’s efficiency.Research limitations/implicationsLDM may contribute greatly to improve safety outcomes. This observational study was performed in an urban, high-acuity, low cost hospital which may not be representative of other hospitals. Further study is warranted to determine whether this model can be applied more broadly to other settings.Practical implicationsLDM can be implemented quickly to achieve an improvement in hospital safety and other health-care quality outcomes. This required a redistribution of time for hospital staff but did not require any significant capital or other investment.Social implicationsAs hospital systems move from a volume-based to value-based health-care delivery model, dynamic interventions using LDM can play a pivotal role in helping all patients, particularly in underserved settings where lower cost care is required for sustainability, given limited available resources.Originality/valueWhile many hospital systems promote organizational rounding as a routine quality improvement process, this study shows that a dynamic, intense LDM model can dramatically improve safety within months. This was done in a challenging urban environment for a high-acuity population with limited resources.

Lean Six Sigma in Healthcare: A Systematic Literature Review on Challenges, Organisational Readiness and Critical Success Factors

“…Teamwork in healthcare consists of information sharing, quality programme meetings, employee recognition and results sharing. In addition, empowerment plays a critical role in deploying improvement initiatives, which are in turn associated with job satisfaction, productivity, effectiveness and a lower propensity to leave [2,42,56].…”

“…The unique CSFs of LSS in healthcare compared to the manufacturing and service sector are the involvement and commitment of physicians [40,56], workload management and cross-functional collaboration [2,5]. It is reported that the involvement of physicians is critical, as improvement projects directly impact patient care and related treatments.…”

“…In addition, shifts in the working system create challenges in establishing and executing multidisciplinary teams for operations excellence initiatives. Thus, it is essential to strike a proper balance between workload, shifts and LSS projects among the medical personnel [56]. Moreover, it is observed that healthcare sectors have limited research collaboration with engineering, management and other institutions that practice and promote OPEX methodology for service quality improvement.…”

Decade of Patient Experience Improvement at a Tertiary Care Urban Hospital

“…Before implementing this initiative, unit-based rounding focused on clinical units and occurred on a weekly rotating basis. Over time, SFHMC adopted an LDM strategy whereby senior hospital leaders—including the president, chief nursing officer (CNO), chief medical officer, chief operating officer, chief quality officer, clinical department physician chairs, nursing directors—rounded every day by rotating through all hospital units, clinical and nonclinical, and worked with directors and managers to achieve and maintain their unit-based targets 21. This gave senior leadership an opportunity to discuss the care SFHMC patients were receiving and interact with staff to foster an environment centralized around patient safety and experience.…”

“…Over time, SFHMC adopted an LDM strategy whereby senior hospital leaders-including the president, chief nursing officer (CNO), chief medical officer, chief operating officer, chief quality officer, clinical department physician chairs, nursing directors-rounded every day by rotating through all hospital units, clinical and nonclinical, and worked with directors and managers to achieve and maintain their unit-based targets. 21 This gave senior leadership an opportunity to discuss the care SFHMC patients were receiving and interact with staff to foster an environment centralized around patient safety and experience. The senior leaders also mandated that their work schedule set aside dedicated appointments to engage with patients, verifying firsthand that their care was managed appropriately.…”