Achieving Excellence in Patient Care: Empowering the Front Line Maureen Broms, MS, RN Vice President Health Care Quality and Patient Safety New England Baptist Hospital June 23, 2009

Our Journey Toward Excellence Our Vision Our Vision Where We Were Where We Were The Zero Challenge The Zero Challenge Empowering the Front Line Empowering the Front Line Results Results

What Drives Us? Our Vision New England Baptist Hospital will be known as a premier Orthopedic Center of Excellence, providing the highest quality medical and surgical care.

How were we doing? Superior performance in surgical site infection elimination Superior performance in surgical site infection elimination Nationally 94 – 98% compliance with SCIP Nationally 94 – 98% compliance with SCIP SSI rate – 0.51* vs NNIS database rate 1.5 SSI rate – 0.51* vs NNIS database rate 1.5 Patient Fall Rate and Hospital Acquired Skin Breakdown less than the national average Patient Fall Rate and Hospital Acquired Skin Breakdown less than the national average Superior patient satisfaction results Superior patient satisfaction results * All SSIs

The “Zero” Challenge The Board of Trustees challenged us to do better The Board of Trustees challenged us to do better Our staff felt agreed improvement was possible Our staff felt agreed improvement was possible Ultimate goal – avoid preventable harm Ultimate goal – avoid preventable harm Areas to explore, assess, and monitor included: Areas to explore, assess, and monitor included: –Reducing HAIs –Reducing medication events –Eliminating post-operative DVT and PEs

What Would It Take? Required out-of-the-box thinking and a new philosophical approach Required out-of-the-box thinking and a new philosophical approach Front-line empowerment Front-line empowerment Eliminate: Eliminate: –lack true ownership by front-line staff –natural tendency to slide back to old habits –Hawthorne effect

Great Companies For great companies – “There was no miracle moment. Instead, a down-to-earth, pragmatic, committed-to- excellence process -- a framework -- kept each company, its leaders, and its people on track for the long haul.” Jim Collins For great companies – “There was no miracle moment. Instead, a down-to-earth, pragmatic, committed-to- excellence process -- a framework -- kept each company, its leaders, and its people on track for the long haul.” Jim Collins

Our Approach Develop a new framework and stick to it Develop a new framework and stick to it –TPS LEAN –Focused approach – med events Develop a mechanism for staff and physicians to call out problems as they occurred Develop a mechanism for staff and physicians to call out problems as they occurred Implement real-time problem-solving Implement real-time problem-solving Ensure improvements happen at the level closest to the patient, i.e. Out of the conference room Ensure improvements happen at the level closest to the patient, i.e. Out of the conference room

Framework Agreed upon principles applied carefully and consistently: Agreed upon principles applied carefully and consistently: –To each and every phase of medication pathway redesign –To real-time problem-solving

Real-time Problem- solving Implemented mechanisms to call out problems as the occurred Implemented mechanisms to call out problems as the occurred –Help Chain –Problem log Improvements occur at the level closest to the patient and toward the characteristics of an ideal process Improvements occur at the level closest to the patient and toward the characteristics of an ideal process –With front-line staff leading the improvement (those who do the work) –In the work area (allows for observations)

Help Chain Mechanism by which problems are addressed Mechanism by which problems are addressed Begins at level closest to patient and moves toward CEO Begins at level closest to patient and moves toward CEO Creates safety by requiring cross level communication, i.e. manager to manager or director to director Creates safety by requiring cross level communication, i.e. manager to manager or director to director

Patient Staff (Ordering Practitioner, RN, RPH Secretary) Clinical Resource Nurse Problem New England Baptist Real-Time Root Cause Problem Solving Help Chain Clinical Manager Director of Patient Care Services SVP of Patient Care Services CEO Dept. Chief

Problem Log Benefits Makes problems visible Makes problems visible Creates “pull” from leadership vs. “push” Creates “pull” from leadership vs. “push” Allows others to learn from solutions and key points Allows others to learn from solutions and key points

Surgical Site Infection Prevention FY06-FY09 Results: FY06 46 orthopedic SSI in 9027 cases (0.51%) FY06 46 orthopedic SSI in 9027 cases (0.51%) FY07 39 orthopedic SSI in 9027 cases (0.43%) FY07 39 orthopedic SSI in 9027 cases (0.43%) FY08 37 orthopedic SSI in 8884 cases (0.42%) FY08 37 orthopedic SSI in 8884 cases (0.42%) FY09* 9 orthopedic SSI in 3620 cases (0.21%) FY09* 9 orthopedic SSI in 3620 cases (0.21%) (*Oct-Feb 2009) (*Oct-Feb 2009)

Results National NationalBenchmarks NEBH FY07 NEBH FY08 NEBH NEBH FY09 YTD PulmonaryEmboli3.7% 2.3 % (9) 0.8% (3) 0 Deep Vein Deep VeinThrombosis12% 4% (16) 00

NEB Medication Pathway Redesign CHART NURSE PATIENT ORDERING PRACTITIONER PHARMACIST UNIT SECRETARY

PACU Results

Hospital-wide Outcomes – Patient Satisfaction Audacious Goal Kick-off

One of our Proud Moments! 2008 recipient of the Press Ganey Summit Award 2008 recipient of the Press Ganey Summit Award –Three consecutive years above the 95 th percentile or greater (nationally) –First Hospital in Massachusetts to receive the award for inpatient satisfaction

Questions?