1. Becoming a High Reliability Organization EMHC’s model for process improvement has been Deming’s Plan Do Check Act (PDCA). It was once the universal model for all hospitals.

2. Becoming a High Reliability Organization The Joint Commission is now recommending a new model – Robust Process Improvement in order to become a High Reliability Organization. We are developing our skills so that we can use the new model – you will want to use it, too!

3. Becoming a High Reliability Organization WHY CHANGE? US spends more than any other nation per capita for health care,* Almost twice as much per capita as the average of 7 industrialized nations.** *Centers for Medicare & Medicaid Services ** Commonwealth Fund

4. Becoming a High Reliability Organization Hospital care represents about 1/3 of the total cost of healthcare. AND YET, The average life expectancy in the US is lower than many other developed & developing nations,* *Centers for Medicaid & Medicare Services

5. Becoming a High Reliability Organization We don’t have enough RN’s and MD’s to implement the Affordable Care Act,** 1/3 – 1/2 of the money spent on healthcare goes for inefficiencies, unnecessary tests & treatments, fraud & medical errors.* *Association of American Medical Colleges * Performance Improvement in Healthcare, 2012

6. Becoming a High Reliability Organization Of all US hospital admissions: 1 patient in 100 will die as a result of a medical mistake.* 6 patients in 100 will be permanently disabled.** Another 43 in 100 will suffer some form of preventable harm.** *To Err is Human, National Academy Press, 2000. **Institute for Healthcare Improvement

7. Becoming a High Reliability Organization Simply put, PDCA isn’t doing the job. We need a process that: 1. really fixes the root cause instead of a band-aid application, 2. doesn’t fix one problem only to create others, and 3. fixes it permanently.

8. Becoming a High Reliability Organization For our patients and our hospital, we need to become a “High Reliability Organization” through the use of Robust Process Improvement. That is, an organization that takes control of its critical processes to ensure that consumers (and the organization) are SAFE & getting better and better.

9. Becoming a High Reliability Organization Robust Process Improvement uses 3 sets of tools – “Lean,” “Six Sigma,” and “change management” to analyze and develop improvement plans, then to put those plans into practice & finally to ensure that changes actually result in lasting improvement.

10. Becoming a High Reliability Organization The Six Sigma model is DMAIC:  Define the Problem  Measure the Problem  Analyze the Root Causes of the Problem  Improve the Process  Control the Process

11. SIX SIGMA EXAMPLE Define the Problem Start with a serious problem - patient falls are increasing. Our goal? ZERO patient falls at EMHC.

12. SIX SIGMA EXAMPLE Measure the Problem WHO has falls? Are patients falling during a particular activity, or time of day, or on a particular surface? Are we correctly identifying them with our risk assessment? What are we doing to prevent them from falling now?

13. SIX SIGMA EXAMPLE Analyze the Root Causes With the data we collect about falls, we learn: patients who are older than 50 years fall more often than expected. patients with cognitive impairments and ambulation challenges fall more frequently than other patients.

14. SIX SIGMA EXAMPLE Analyze the Root Causes We know from our Pareto chart that 80% of the problem comes from 20% of the cases, so we can make a BIG difference by concentrating on these groups of patients who fall. We decide to focus attention on reducing falls for these groups.

15. SIX SIGMA EXAMPLE Analyze the Root Causes

16. SIX SIGMA EXAMPLE Improve the Process Based on our analysis, we change our risk assessment to include age. We experiment with Nursing Home aids such as alarm mats by the bedside. We use the aids for 3 months, and then we evaluate how they work for us. We do not stop experimenting until we are doing much better.

17. SIX SIGMA EXAMPLE Control the Process We institute on-going checks of the changes, and we keep our eye on the data we collect on falls, to see if the numbers are continuing to go down. EVERYONE is involved in preventing falls, watching the data, suggesting more improvements.

18. SIX SIGMA EXAMPLE Control the Process

19. Robust Process Improvement using LEAN “LEAN” analyses are used to speed up processes – such as getting supplies faster. The goal is to speed up the process WITHOUT making anyone work faster/harder.

20. LEAN EXAMPLE One way to do this to make a diagram map of the process steps, then get data on how much time passes BETWEEN each step. Then find out WHY there is time between the steps, and FINALLY finding ways to reduce that “down time.”

21. LEAN EXAMPLE “Load leveling” is a LEAN tool for situations like improving scheduling so that the complicated, long appointments are spread out over the week or month. That way, all the other appointments don’t get backed up, cancelled, delayed. Load leveling might allow only 2 new patients per week, to reduce the wait time for on-going patients.

22. LEAN EXAMPLE “Constraints management” is another LEAN tool which searches for bottlenecks, then finds out how the bottlenecks can be widened or otherwise worked around.

23. Robust Process Improvement using Change Management Change Management is a set of tools for implementing change, once it has been planned. Steps include: 1) Addressing the human side of change – identifying the rewards of change, involving everyone in preparations, being clear about the goal and the process.

24. Robust Process Improvement using Change Management 2) Start at the top, ensuring leadership is on board with the change. 3) Involve every layer, identifying leaders throughout the hospital.

25. Robust Process Improvement using Change Management 4) Make the formal case. Describe current reality, demonstrate the viability of improvement. 5) Create ownership by leaders throughout the organization.

26. Robust Process Improvement using Change Management 6) Communicate the message. 7) Assess the cultural landscape (must be taken into account for change to succeed).

27. Robust Process Improvement using Change Management 8) Address culture explicitly (model and reward the behaviors that will help make change). 9) Prepare for the unexpected – continuous reassessment of the impact of change.

28. Robust Process Improvement using Change Management 10) Speak to the individual – throughout the process, touch base with workers at all levels.

29. Robust Process Improvement Why are we changing our Performance Improvement Model? Sharing our vision, EMHC is on a journey of hope healing growth choice change!

30. Robust Process Improvement Safe Healthcare is such a critical baseline that we must embrace a goal of ZERO Errors. Everyone contributes to identifying and meeting our challenges until we are failure-free.

31. Robust Process Improvement Questions? Suggestions? Barriers?