Lean Inspires Engagement for Quality

ImprovementWendy Panton

Richmond Hospital Manager Women’s and Children’s Program

Laura SatoCoordinator, Lean Transformation Services

RH Birth Centre

Overview

• Overview of the Project – Dec ‘10 – Feb ‘12

• Lean processes encouraged patient, physician, midwife and staff engagement

RH Birth Centre

About the Richmond Hospital Birth Centre (BC)

• 15 bed SRMC / 6 bed NICU• Ambulatory, Triage, and Inpatient Services• New BC opened in 2009 with updated OR

on the unit– Change in model of care– Increase in activity by 25%

to 1700 births/year – Embed Lean thinking to ensure quality and

efficiency to increase BC OR capacityRH Birth Centre

Patient, Physician, Midwife and Staff Engagement

RH Birth Centre

Quality & Safety Improvement:Increase # of Caesarean Births in BC

Improve response time

• Patient Focused Journey– Value stream map

• Code Pink– Communication logarithm– Standard operational procedures

• Best Practice– Keep mother and baby together

• PDSA (Plan/Do/Study/Act) Cycle

RH Birth Centre

6

Keeping Mom & Baby Together

Next target condition

Recover Mom in

BCSkin to skin in the OR

Mom & Baby are separated for 2 hrs

Ideal State

Mom & Baby

always togetherOverarching

PrincipleMother & baby are safe &

healthy

RH Birth Centre

Improvement Indicators

RH Birth Centre

77% increase in # of cases77% increase in # of cases

57% decrease in BC OR turnaround time

57% decrease in BC OR turnaround time

Code Pink OB Mock Session (Example of multi-disciplinary staff

engagement)Initial Mock Post - Actual Code Pink

Noisy – lots of talking Calm & quiet

Repeating questions multiple times Staff know what to do

Duplicated work- # of people doing the same thing

Roles and responsibility clarity

Lots of double checking Trusting environment

Too many people in the room Roles and responsibility clarity

RH Birth Centre

Code Pink: Standard Work

• IssueIssue: Roles & responsibilities were unclear among team members– Established clear

standard operating procedures for each role

– Tags that reflect the roles

• IssueIssue: Team was not coordinated in work– Mock session to clarify

roles and practice

Captain / 1st RN (In-Charge or PCC)Or Delegate -Phone calls (at night / days?)-Check if BC OR is ready-Safety of other ptn-Limits # of people present if appropriate-Supports family-makes REC-Blood from blood bank-labs-Communicate with OR team when they arrive

OB (co-pilot)-Provides direction to the team-Verbal consent & explanation-Primary RN gives report-Site mark?

RH Birth Centre

Change within Infant Care Centres

RH Birth Centre

Before After

Too much clutter

Can’t find

things

Emergency kit is checked and sealed!

Staff TestimonialsI cannot believe I am getting paid to do this work

Since we started the huddle are

equipment issues are being

addressed in a timely manner

With communication algorithm in place, it has reduced response time

Since standardization with code pink, staff and

physicians indicate the room is quiet and calm

throughout the caesarean birth

This is something I have been wanted to change for the last 3 years and I have been talking to

staff about it. Lean has given me the structure and process to make the change. When I talk to

staff, they love the change.

I am so excited to work on this change because I know what difference it

will make for my colleagues

RH Birth Centre

Sustainment

• Management standard workOn going tracking & improvement cycles– Morning review-people first assessment tool– Daily Huddle– Staff engagement and coaching

RH Birth Centre

Leadership Strategies to Address Intrinsic Motivators for Engagement

RH Birth Centre

Source: “The Engaged Workforce” 2009 by Jo Manion

Cheerlead for progress→Staff and physicians are seeing progress→Project work celebration & recognition

Inspire and focus employees on meaningfulness of work:→Increase dialogue during morning huddles + PDSA cycles creates capacity to do work that is most meaningful→Opportunity to work on initiatives they always wanted to address

Build and encourage healthy relationship:→Multidisciplinary team involvement→Morning check-ins, huddles → agreement strategies for conflict resolution model

Coach for development and competence:→Increased opportunities through Lean methodologies for front line involvement→ Creating more time for coaching→ Supportive of learning

Create choices:→VSM problem solving models, huddles, →increase of awareness of innovation & creativity opportunities, → Clarity of roles and responsibilities

Cultural Shift• Staff and physicians embrace identifying improvement

opportunities and participating in solutions• Multidisciplinary team is impressed with the amazing

progress we have made in the last year• I am excited to come to work because I have organizational

support to create the time to focus on quality and safety improvements which enhances my sense of meaningful work

• Multidisciplinary engagement enhances choices and builds relationships

• Multidisciplinary agreements on best practice standards and development of standard operational procedures enhances everyone’s sense of competence

RH Birth Centre

Accomplishments• Lean engagement processes have

inspired staff involvement in quality and safety improvements

RH Birth Centre