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Creating a UBT Culture June 24, 2013. Welcome. Lisa Schilling, Vice President Center for Health Systems Performance. Rancho Cordova Eye Surgery Center Got Errors?. Our Team. Our SMART Goal. - PowerPoint PPT Presentation
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Creating a UBT Culture June 24, 2013
Welcome
Lisa Schilling, Vice President
Center for Health Systems Performance
Rancho Cordova Eye Surgery CenterGot Errors?
Our Team
Name Title/Classification/Union
Dawnell Grant Certified OR Tech, SEIU-UHW, UBT member
Teresa Lee RN, staff nurse III, subject-matter expert
Steve Metzger RN Manager, managementco-lead
Lisa Wilson UBT Co-Lead, Central Processing Tech
Jenee Mateo UBT member, OR Tech
Vicki Green UBT member, Surgery Scheduler
Nit Kharka UBT member, OR Tech
Our SMART Goal
Rancho Cordova Eye Surgery Center will identify, share and evaluate at least five errors per month that could have led to patient harm or injury, by November 30, 2012.
Our Team Culture Was…
• Efficient and safe • Lacked transparency in the department and among
each other• Awareness suffered as a result• In a year period, had one never event and two near
misses
Motivating questions
• How many errors potentially happen daily?
• What do we do to prevent near misses?
• How do we increase staff awareness?
Our Small Tests of Change
Test of Change Results
Created and used the citation form to record errors
In four months, prevented:
•5 potential wrong-site surgeries
•3 patient identity issues
•3 potential medication errors
•1 surgical time-out issue
Challenges
Staff reluctant to use form for various reasons: •“Flavor of the week”•Busy•Why mess with a good thing? •Punitive
• Depersonalized the event • Education• Awareness • Testing “good catch” theme
Overcoming challenges
Our Team Culture Now…
• Increased awareness• Better understanding of the project• Enhanced team work• Better communication• More transparency• Staff feel more empowered
Our Key Learnings
• Teamwork + awareness=safety • Education is key• Trust is essential • Use a safe word or phrase • Always room to improve
Our NQC Experience
• Involvement of entire staff is key to culture change.
• Partnership and standardization plays a leading role in quality and service.
• The everyday work you do has great impact on quality and patient satisfaction
Emergency Department, Sunnyside Medical Center (Northwest)
Our Team
Name Title/Classification/Union
Jay Ravarra Manager
Ally Degatata RN, OFNHP
Our SMART Goal
Kaiser Sunnyside Medical Center Emergency Department will decrease the patient length of stay from a baseline of 2.7 hours to a goal of 1.5 hours by the end of the year (2012) .
Our Team Culture
• High physician and management turnover
• Low morale and low service scores
• Non-functional UBT
Our Small Tests of Change
Test of Change Results
Locate triage area and fast track team together
Adopt
Develop new fast track criteria Adopt
Patients receive focused assessment; brought to X-Ray quickly
Adopt
Patients are only in treatment rooms while being treated
Adopt
Fast track rooms protected for fast track patients only
Adopt
Our Small Tests of Change
Test of Change Results
Trial medical office beds Abandoned – didn’t like the beds
Trial paper rolls to cover beds Abandoned – preferred linen for patient comfort
Fast Track Results
Standardizing Rooms
Sort: Bins for each item, label each item, conduct regular inventory
Set in Order: Establish permanent home for specialty carts, IV cart prototype
Shine/Sweep: Rearrange room set up, develop cart checklist
Standardize: Clear roles for RNs and techs
23
Standardizing Rooms
23
ToFrom
Our Team Culture Now…
• More satisfied patients • More open environment for offering ideas for
improvement, as demonstrated in improved responses to key People Pulse question
• Those initially most resistant to change became the biggest champions of change
Our Key Learnings
• What worked: holding offsite meetings to establish our new vision, hiring new managers, electing new UBT co-leads, redesigning patient rooms and stock rooms
• Early wins are important• Must clarify expectations and roles, have process
owners with clear accountability • Physician engagement is crucial
Voice of the Customer
Staff Perspective
Our NQC Experience
• Working in a unit-based team and becoming high performing is hard work. Once you reach your goal, it isn’t over. You have to continue to work on improvements and re-build when people leave or processes change.
Histology Department
(Northwest)
Our Team
Name Title/Classification/Union
Saundra Ellis Supervisor
Kristen Mose Histology Tech, OFNHP-Technical
Mary Kilo, MD Chief of Pathology
Our SMART Goal
KP Northwest regional histology lab will improve slide turn-around time from a baseline of 68.6 percent in 2011 to a goal of 90.0 percent by the end of 2012.
Our Team Culture Was…
• Plagued by inefficient workflows
• Pathologists did not feel supported by the staff
• Did not focus on quality assurance
• Low People Pulse scores on Work Unit Index measures
Specimen Life-Cycle
Specimen Collection
Transportation
Accessioning
Gross Exam
Processing
Embedding
Microtomy
Staining
Case Match/Case Assembly
Recuts, Specials, Immunohistochemistry
Path Review
Case Sign-out
Storage/Archive
Our Small Tests of Change
Test of Change Results
Visual notification system In progress
Added TAT and quality reports to daily huddles
Adopted
Weekly project team meeting Created engagement with sponsors
Surveys of Pathologists and staff satisfaction
Performed quarterly surveys for 18 months then transitioned to People Pulse and Physician Work-Life Balance surveys
Performance Improvement Tools
Our Team Culture Now…
Measures Results
Turnaround Time (TAT)
Improved from 68.8% to 80.6% April 2013
Staff Satisfaction Average favorable rating increased from 40% on 2011 People Pulse survey work unit index to 70% on 2012 People Pulse survey work unit index
Pathologist Satisfaction
Increased overall satisfaction from 11% on 2010 Pathologist Work life Survey to 58% on 2012 Pathologist Work life Survey
Our Key Learnings
• The UBT identified, planned and executed all PDSAs.• Strengthened alliance between Histology and Pathology, and
the active involvement of Pathologists• Resources (time, money, expertise) vary in supply and pose
barriers• Labor-to-labor communications strengthened engagement and
commitment to the project.• Given adequate information, the UBT knows what
improvements will make a difference.
Our NQC Experience
• Opportunity to learn from other teams• Sharing the journey of our team with others• Recognizing engaged sponsors, physicians and
UBT team members as the key to success
Closing Thoughts
Lisa Schilling, Vice President
Center for Health Systems Performance