Original Publish Date: April 7, 2020
Patient safety is a top health care priority, but determining how to consistently ensure highest quality can be a complex process that doesn’t always provide a clear path toward action.
Confronting safety concerns—and preventing patient harm, delays, and errors in care—can be even more challenging in larger organizations in which support from executives, clinical and quality leaders, and IT and data scientists is necessary for large-scale change.
Overcoming safety challenges will require your organization to make a firm commitment to continuous improvement. While quick fixes can immediately address simple problems, a lean approach to health care works to focus on process and behavior improvements that promote alignment, engagement, and sustained success well into the future.
Below, we explore how applying lean tools in the health care setting can help combat a major common concern for health care organizations—sepsis.
How Can Lean Improve Health Care?
Lean methodology is a performance improvement approach that originated in the manufacturing industry and subsequently revolutionized a range of industries, including health care. The concept rests on two pillars—continuous improvement and respect for people.
Lean can help your teams:
With discipline and structure, a lean management system—which uses leader standard work, daily management, visual control, and daily accountability—can unleash the potential of your best resource: the frontline employees and providers who deliver care.
When lean is applied to common challenges within care settings—from hospitals and clinics to long-term care and skilled nursing facilities—your organization can increase patient care, safety, and knowledge-sharing among employees and providers.
This is especially true in fighting sepsis, which is often called a stealth disease because it’s present throughout the care continuum and impacts patients in every setting.
The Sepsis Epidemic
Sepsis is the body’s potentially fatal response to infection. It’s the third highest cause of death in the United States—with 270,000 deaths annually—and present in 54% of patients who die in hospitals. Patients initially admitted for sepsis also have a more than one in six chance for readmission within 30 days.
Sepsis can arrive through patients in the emergency department and quickly enter the bloodstream through common infections such as pneumonia, UTIs, or surgical or gastrointestinal infections.
Sepsis is often the result of preventable issues. By working toward clinical quality and safety improvements, your organization can address specific concerns like sepsis while also identifying unexpected errors throughout the care continuum.
How Lean Helps Address Safety Issues
To start fixing a specific problem, a lean approach typically follows these steps.
1. Visit the places work is done to determine your starting point.
Finding problems starts by bringing your organization’s leaders to the gemba, or the place where work is done, such as the emergency room or hospital floor where patients with sepsis frequently present.
By observing your current processes and procedures in person, team members can:
Sometimes staff recognize problems, but don’t understand the reasons for delays and defects in delivering appropriate care consistently. That may be because multiple sources or systemic defects are hidden within an organization’s complex infrastructure, and multidisciplinary collaboration is needed.
With complex care processes like sepsis, it’s essential to conduct a root cause analysis while on the gemba. For example, a health system working to reduce sepsis made great strides in safety improvements within care processes, but didn’t see patient outcomes improve.
A root cause analysis revealed that, despite having made progress, administrative documentation and coding errors skewed outcomes in reporting sepsis cases, so teams weren’t seeing further improvements.
This discovery allowed the organization to chart a clear course to address defects tied to coding and documentation.
To read more case studies about going to gemba, please see Rethink Lean Internal Auditing: Lower Health Care Costs with Lean Consulting.
2. Use critical thinking to create and test an improvement plan.
Apply disciplined critical thinking approaches to understand what you saw, learned, and tracked on the gemba. This problem-solving approach will help enable you to create an improvement plan derived from your findings.
Employing A3 thinking—named for the paper size used in the documentation process—executive leaders and high-performing staff members can then apply disciplined problem-solving and critical thinking approaches to the issues you observe. This can help your teams:
Through Plan-Do-Check-Act (PDCA) testing cycles, teams can propose countermeasures to their problems, with each new cycle uncovering essential information for next steps.
When confronting sepsis, an organization may focus on a common culprit, clinical variation, which creates delays in diagnosis and timely antibiotics administration. Hesitation to call a patient’s condition sepsis and coordinate appropriate, evidence-based interventions can contribute to higher mortality rates.
3. Implement a daily management system.
In addition to scrutinizing adverse events when they happen, organizations should also prioritize safety as part of everyday work.
Implementing a daily management system can help your organization:
As part of the management system, staff huddles held at the beginning of shifts can address daily readiness assessments and improvements. Sharing metrics—and prominently displaying them on visibility boards—can help align the team around goals, targets, and objectives, and keep them top of mind.
By focusing on targeted improvements, you’ll be able to recognize, report, and learn from missed opportunities. When problems are immediately addressed, you can create and sustain improvement plans and easily communicate those results.
Daily management is an outstanding approach to identifying, managing, and reducing defects that lead to safety errors and issues like sepsis. Huddles and visibility boards can help teams:
4. Embrace a culture of improvement.
By upholding respect for the people doing the work, lean values the agency, knowledge, and skill of each employee. Implementing these values in your organization can empower your teams to be transparent when surfacing problems and bold in finding and testing solutions.
As part of this ethos, lean organizations learn to employ a stop-the-line approach to their processes. This approach allows every employee to identify and immediately correct problems in a process so the problems don’t continue on to the next stage.
Stop-the-line methods help build, integrate, and sustain a reporting and resolutions program that every team member will learn to uphold. Having a reliable patient safety reporting and response system—and obtaining information about other safety concerns raised by staff—promotes organizational safety culture overall.
Proper documentation of near misses, actual incidents, and timely follow-up actions allows your leaders to:
With your staff empowered to adopt a safety mindset, everyone can serve as a safety expert. They’ll have the tools needed to recognize, report, and facilitate steps to reduce and ultimately prevent issues that can cause sepsis and other problems such as:
Implementing lean in health care requires a deep knowledge of specific tools and techniques. It’s important to work with an advisory team that’s both certified in its methodologies and coaching and versed in the unique demands and pressures across the care continuum. Defects and errors in practice are often deeply rooted in an organization, so the outside eyes of lean advisors can provide fresh perspectives that help with process improvement.
With lean methodologies in place, your organization can begin to operate in a holistic manner and embrace a culture of safety daily—from root cause analysis to problem-solving and critical thinking.
Whether you’re addressing improvements in sepsis care or tackling other delays or defects that may impact patient safety, lean can equip your staff to design and implement new processes and act on them effectively.
Dahlia has been in the health care industry for over 20 years, focusing on lean health care since 2002. At Moss Adams, she guides health care systems with her expertise in quality and patient safety, process improvement, and strategic planning. She can be reached at (206) 302-6888 or firstname.lastname@example.org.
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