But take a look anyway, if you have an interest in process improvement in hospitals. This is a collection of my best posts on this topic.

Thursday, December 4, 2008

This time, it's about us!

A message I just sent out to people in our hospital. Thanks to Paul O'Neill, former CEO of Alcoa, for his advice and inspiration on this front. If this can be done in a mining and manufacturing environment, we surely should be able to do it in a hospital.


We have now been engaged in BIDMC SPIRIT for over six months, and we have accomplished a lot. But, we have also learned a lot about how to make it work better. I’ll talk about that below, but first this.

When I first introduced SPIRIT to you, I emphasized how we wanted to reduce hunting and fetching and improve the work environment in that way.

Now, we need a new focus.

It’s time to crank things up, but in a new direction.

Last year, there were 891 on-the-job injuries of BIDMC staff members – more than two a day! Almost one hundred of our colleagues were injured to the extent that they were unable to work for five or more work days.

You probably know that we have set ourselves a goal of eliminating preventable harm to our patients. It is time to do the same for us!

I have told our vice presidents that I personally want to receive a report of every employee injury in the hospital within 48 hours of its occurrence. I want a description of the injury, what caused it, and what we are going to do to help avoid that kind of injury in the future. Over time, we will uncover patterns and trends and make this a safer place to work.

We will soon have a running total of staff injuries on our portal. We will have a graphic showing how long it has been since the last injury. Right now, that is measured in hours. We’d like to change the interval to days, weeks, and eventually months. Whether slips and falls, exposures to blood and body fluids, injuries from patient handling, our goal is to drive the number of cases down to zero.

I need your help, though. There is something you can do right now to help jumpstart our safety efforts: Do a SPIRIT call-out.

1. Identify safety hazards or near misses you have experienced or look around your work place to identify potential harm.
2. Call out the problem to your manager/shift leader.
3. Work together to identify the root cause of the problem immediately and solve it as soon as possible.
4. If you and your manager can’t solve it locally, your manager can use the Help Chain to reach beyond your unit/department.

Remember: Call-outs that point to a bigger, medical center-wide problem will go up the Help Chain to the leaders of BIDMC.

We have seen some incredible successes with SPIRIT, but we have also learned from you comments and suggestions that there were some problems with our initial approach. Through it all, we have confirmed that the basic principle of SPIRIT is strong – the people closest to the work are the best problem-solvers.

Your feedback told us:
• There is uncertainty about what to use SPIRIT for – hunting and fetching? Patient care problems only? Big problems? Little problems?
• It was unclear when to do a call-out instead of a regular operational response to a problem, like calling Service Response.
• Using the SPIRIT log was frustrating and it was unclear whom on the help chain to contact. Entries were often made – sometimes anonymously – without a constructive way to act on them.
• There is confusion about how SPIRIT, Lean and other quality improvement efforts are related. The short answer is that they are all different ways of solving problems and improving quality – SPIRIT through staff call-outs; Lean through a trained team of specialists that works side-by-side with staff; and Healthcare Quality and other staff through a wide range of activities, from incident reporting to Joint Commission preparation.
• You need more resources to understand and use the SPIRIT principles – and more practice.

When we started SPIRIT, we expected that our first try would probably need some improvement. We fully intended to improve SPIRIT itself over time, just as we are trying to improve our work environment.

So here's what will change:
• As noted above, the second year of SPIRIT is beginning with a focus on a specific topic – safety in the work place.
• We will more actively use our formal patient and staff incident reporting systems to identify problems.
• More training and coaching through actual problem solving efforts – for all staff, managers and physicians – in person and through easier access to materials and tools.

Here’s what will remain:
• Those of you who are engaged and using SPIRIT principles are encouraged to keep it up and let us know about your work.
• We will continue to share with you stories about how SPIRIT, Lean and quality improvement projects are working.



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