Lean in Orthopedics

This Week’s Guest Writer- Tina Cecil, PT

 Tina Cecil is a Licensed Physical Therapist and Director of the Rehab Department at Clark Memorial Hospital. As a member of the Orthopedic Growth Team and Strategic Planning Committee she became involved with the Rapid Recovery Process which focuses on growing and improving the quality of care of joint replacement patients. She is going to share her personal insights regarding her process improvement involvement.

 The Goal

 Our long awaited endeavor to brandish the title of Center of Excellence in Orthopedics has finally and officially begun. Discussions, huddles, meetings of plans to come have been going on for almost a year now. With the assistance of our Biomet Rapid Recovery Team and a dedicated cross-functional team from Clark Memorial Hospital, we are stepping into new territory. Some of the exciting and scary challenges we face:

 Coordination and synchronization of rounding, group therapy, anesthesia, and pre-op teaching just to name a few.

• Changes at the departmental level that include workflow, protocols and integrating best practices.
• Understanding and improving the patient experience from the office practice to the time they are healing at home is very complex.

 Coordination of the multiple disciplines involved is the most challenging and important aspect of this program.  It is very easy for us to get tunnel vision and focus only on our own departmental changes. Adding the complexity of trying to work around other department schedules is very difficult.

 Tools for Success

 Fortunately about a year ago, Clark Memorial Hospital initiated a push for process improvement in all departments of the hospital. We learned to map out current processes, analyze the problems, plan the new process, and start collecting data to determine if this new plan is effective. This approach will be utilized in our Orthopedic Unit to produce the desired outcomes. This comes with much anxiety as we trudge into this new territory of process improvement. Although I am confident that we have the tools we need to successfully work through it.

 I remind myself constantly that it is ok to initiate a new plan without the assurance of a positive end result. We have learned this through our process improvement coaching and creating a safe environment to come up with new ideas and develop best practices. Some key take-aways I have from the work we have done:

• Improvements happen in small increments and over time
• People don’t like change because it forces people into unfamiliar territory
• Learning and knowing how to map processes has helped our organization make many needed changes. 

 Going through a process improvement event has helped settle a few butterflies in my stomach as I work toward assisting the Rehab Department with the many changes we are facing.  I am much more looking forward to the constant changing steps we will take as we are heading toward the title of Center of Excellence for Orthopedics at Clark Memorial Hospital.

 Tina Cecil PT

Director Rehab Services

How to Manage Change

 “If we are reluctant to change from the beginning, it is a guarantee that improvement will never take place.”  ~Shigeo Shingo

 Clark Memorial Hospital is a busy and demanding place to work. Giving great patient care is never easy. Whenever we ask people to look for ways to change to become the best community hospital, improve processes or patient care, we need to realize we are asking for a lot! We are asking them to interrupt their normal work patterns, do something different and manage all the difficulties that result from the change. It is no wonder innovation is hard to foster and develop.

 As you lead or participate in change, keep in mind these four basic rules to promote innovation and change.

 Rule #1: No Criticism

How to make sure Clark Memorial Hospital is NEVER the best

Sometimes the best way to reach your goals is to have a better understanding of how your goals could be stopped. How could we ensure we don’t improve? I want to examine a few of those ways as they relate to a process improvement team working on medication ordering.

The Background

When a provider orders a medication to be given in the hospital, the order must go through a very complex process. A small group of CMH team members came together to look at how to make the process easier for our patients. This process improvement team wanted to make sure their patients get the medications they need when they need them. The team also wanted to improve the process for the providers, nurses, ancillary team members and pharmacy. When this cross functional team mapped out the process, it was very revealing. Here is summation of what they found:

1. The process had 10 steps from the order of the medication to its arrival on the floor.
2. It involved 6 different pieces of technology, including different programs, software and systems.
3. The team found 48 possible wastes, rework or defects that could happen during this process……48! for one medication!
4. The team then calculated the chance when a medication was ordered that everything would go correctly the first time with no defects, no waiting and no errors. They calculated a 5% chance of a mistake-free order.  

So if 200 medications are ordered in a day:

1. There will be 9,600 possible wastes or defects that will involve time and energy from every area involved.
2. Out of the 200 orders, only 10 medications will be delivered on time, without errors or extra phone calls.

As you can imagine, this was a little overwhelming to the team. Even though they are just beginning to address this process, they have already learned a lot. I want to share some of the insights through  comments made by Judy Brohm, RN, CCRN, Director of Critical Care Services.

Understanding the Current State

“Those who are unaware of history are destined to repeat it,” George Santayana once stated. Many times in healthcare, we engage in process improvement events for the same problem year after year. Certain issues never go away, partly because we don’t fix them correctly the first time. By having a better understanding of our current state, we can tackle these issues so they don’t keep coming up.

When we have an issue in our work, we have an urge to fix something. We do this without taking the time to understand exactly what is going on.

Here are some healthcare examples from other systems:

Innovation

 

“There’s a way to do it better—find it.”    ~ Thomas Edison

How do you become the best community hospital in the nation? My thoughts…one step at a time by focusing on the patient, delivering a compelling strategy, continuously improving processes and removing waste in the system.  This requires us to exercise many skills, and one of the most important is innovation. Webster defines innovation as “to introduce something new; to make changes in anything established.” Every time we try to improve processes and make things better for our customers, it requires innovation.

Why can’t I just go home!!

While I was collecting data and observing the discharge process, an elderly patient looked at me. Tired of waiting and not understanding the delay, he asked, “Why can’t I just go home? The doctor said I could leave this morning. Why can’t I leave?”

We Are Not Alone!

Process improvement in healthcare is hard work. Often we can feel we are on this journey secluded and alone. Here are a few notes of encouragement from colleagues across the nation.

From Seattle, Washington

To our friends in health care transformation at Clark Memorial Hospital:

Seeking perfection in health care has been the brass ring that had eluded us all, until recently. You are beginning a journey that will lead you to achieve the perfect patient experience. This remains the road less travelled for many in our industry and yet, one road so worth traveling! This journey requires insistence and persistence. Insistence that defects are preventable and persistence to see great thinking through to complete implementation. Patients are counting on you! Your greatest assets lie within you, and it is the wisdom you will gain in declaring a lean management system that unlocks the future you seek.