The Problem:
The staff on a busy nursing unit complained about frequent stock outs of supply items. We observed delays in patient care and wasted staff time as the nurses and techs hunted for supplies. Stock outs spread as nurses horded supplies and borrowed from other departments. Aware of the stock out problem, the materials department overfilled bins attempting to stock for a 2 week average, adding to inventory costs, confusion and demand for more storage areas.
How we helped:
First, we noticed that materials only filled supplies 3 times a week which meant that they were unable to adjust quickly to the spikes in demand that caused stock outs. Stocking infrequently also meant that each time materials stocked there were many more supplies to count and deliver which caused the suppliers to estimate par levels, leading to more errors and more emergent calls from nurses to materials. We worked with the materials and nursing staff to do two things which solved the problem: first, the materials staff started stocking every day and second the nursing staff used a card system to signal items that needed to be restocked. By stocking every day the materials staff was better able to match supply with demand and by the nursing staff signaling when supplies were running low the job of restocking was made easier for materials.
Results:
Inventory reduced by 21%. Staff now refer to their supply system as the "never out" system because stock outs were nearly eliminated. Materials productivity levels at a system-wide high because their stocking time cut in half.
The Problem:
Three years ago, after many years as a successful tech, Cindy became manager of a radiology department. Her performance since then has been lackluster: staff and doctors occasionally gripe about Cindy to leaders, Cindy is constantly behind schedule on tasks big and small, managers of other units roll their eyes at Cindy in meetings because she's gotten the rep for being "all talk", CT down times have increased over the last few months cutting into volume. The radiology department, however, is still reasonably sound financially and Cindy occasionally shows the brilliance she did as a tech. In addition, despite the rep of being "all talk," Cindy is likeable and a great cultural fit in the organization. Cindy's boss John isn't sure what to do.
How we helped:
We gave John, director of radiology and Cindy's boss, a framework with which to work with Cindy for two hours per week for six weeks to diagnose and treat what was ailing her. While this initially seemed like a big time committement, John realized he was spending more time dealing with problems and issues caused by Cindy and if this time could prevent those problems it was worth the investment. Through their working together John discovered specific problems that Cindy was struggling with: she needed remediation on budgeting and staffing activities, she was frustrated that staff weren't solving unit operational problems, she was spread too thin on committees that didn't directly impact her department.
Results:
Rather than seeing Cindy as "all talk" or as a troubled manager, John was able to help Cindy on specific areas in which she needed to improve. In turn, Cindy improved CT second next-available time, staff and doctor engagement scores increased and volume increased through productivity improvement (no new costs.) All of this was the result of focused practice and coaching on Cindy's weaknesses.
The problem:
The nurse manager in a 36-bed medical unit is continually urged by the Quality staff to get her pneumonia vaccine number up. The unit had been consistently performing at about or below 70% for both the pneumonococcal and flu vaccine screening and administration as indicated. The Quality Director was feeling the pressure from management due to public reporting requirements and pay for performance.
How we helped:
The unit’s manager and charge nurses were beginning to learn about problems by observing. They observed their existing pneumonia vaccine process and we helped them prototype and redesign their process. They moved the assessment from discharge to admission and developed the new process in a day. However, when a night nurse used the new form she was confused and reported the problem at shift change the next morning. The manager redesigned the form to be less confusing. The next day another nurse reported a problem. Again the form was re-designed. The unit proceeded to test and redesign their prototype as nurses indicated confusion or problems. The prototype went through almost 20 small redesigns as the process went from unit to unit in the hospital. They prototyped the process with paper and then knew what they needed to build into their clinical documentation system to meet patient needs consistently.
Results:
Pneumonia vaccine assessment went from < 70% to > 97%. Staff learned about how to improve the prototype to fit their work. At one point, a staff RN told the quality director that although a proposed redesign seemed logical, she was unlikely to do it consistently because it did not fit how she worked. She and the quality director redesigned that version of the prototype together. Another nurse told the quality director that she would have never thought of one of the problems they encountered until it happened with one of her patients that day. They then solved that problem together and the prototype was redesigned.
Doing the prototyping in the course of the nurses’ work helped the nurses learn and resulted in a better service for patients. The manager reported that they gave 155 flu shots to patients that year and the year prior they had only given 13.
The problem:
The flagship hospital in a 12-hospital system completes its preparations and goes live on a new clinical information system. Staff complain about the new system. Docs refuse to use the CPOE functionality. Productivity drops. And a few safety and privacy problems occur as a direct result of the system and its implementation. The corporation decides to delay the upcoming implementation at two large community hospitals.
How we helped:
We observed the current state of training and preparation. Preparation was too focused on "system functionality," rather than being connected to real work. We trained a group of superusers to do three critical things: lead improved standard training activities; lead groups of associates to improve their work--in a way that optimized the benefits of the CIS; and provide post go-live support and training to users, focused on optimizing work practice and system function.
Results:
Post go-live special support reduced to 2 weeks--as opposed to the unsatisfactory 9 weeks for the previous implementation. Productivity "dip" after go-live reduced to 7 weeks from 14 months. CEO sends email to all associates asking, "how can we build on the momentum?"
The Problem:
An offsite laboratory had been seeing steady growth in busness. As they add staff and equipment to meet increasing demand their turn around time (T.A.T.) increased, which threatened continued growth.
How we helped:
Because the laboratory expected continued growth once the T.A.T. times improved as well as frequent changes in laboratory technology, we worked with their staff to give them a problem solving platform from which they could tackle this and future issues. Instead of simply analyzing their processes, identifying bottlenecks and giving recommendations for improvement, we engaged the frontline staff and had them identify barriers to their work. In addition, we worked with the team leads teaching them process improvement methods.
Results:
The line was reconfigured based on staff suggestions and our guidance. T.A.T. improved by 200% and continues to improve. Many team leads involved in the process have become successful managers or joined the process improvement department.
