Leaning together in North Carolina

Here's a heartening story from Alexandra Wilson Picci at HealthLeaders Media, entitled "NC Rural Hospitals Lean Together to Zap Waste."  An excerpt:

With the help of the North Carolina Hospital Association, a consulting firm, and a grant from the Duke Endowment, Caldwell Memorial Hospital teamed with four other hospitals to learn how to apply lean management principles. The hospitals shared ideas and resources, including funding and consulting services, and attended each other's learning events.

This is a great way to mitigate the expenses of a Lean program and share the enthusiasm.  As you have seen in examples on this blog, a portion of the Lean approach consists of rapid improvement events.  These focus on specific value streams within the organization, mapping out the entire work flow, identifying areas of waste, and experimenting with a new process. Here's a wonderful quote about how this kind of employee engagement works:

"It's remarkable to watch employees sit down and map out issues and discover possible solutions in a team environment and then have the wherewithal and the authority to implement these changes and see if they work," said Edgar Haywood III, president and CEO at Dosher Memorial Hospital, which is part of the new Eastern North Carolina Rural Hospital Lean Collaborative.  

Caldwell Memorial CEO Laura Easton added a key point:

"This is not something that you can delegate to one of your executives," she said. "I think Lean is only really appropriate if the CEO is committed to changing the way they operate the organization, and learning too, and being part of running their organization in a new and different way."

She is right, of course. As I have noted, like physical systems in which entropy takes over, consistently applied energy is necessary to maintain the process improvement system that we call Lean.  Without commitment from the top, the process will wither.  Congratulations to this group of CEOs for walking the walk.

Peter Pronovost is a liar. He must be. Isn't he?

Peter Pronovost and his subversive friends are at it again.  Imagine, first they assert that implementation of a standard protocol and checklist could reduce the rate of central line associated bloodstream infections.

"It wouldn't work here.  Our patients are sicker."

Then, to make matters worse, they go and contend that reducing the rate of central line infections saves money.  Here's the abstract from the American Journal of Medical Quality:

This study calculates the costs and benefits of a patient safety program in intensive care units in 6 hospitals that were part of the Michigan Keystone ICU Patient Safety Program. On average, 29.9 catheter-related bloodstream infections and 18.0 cases of ventilator-associated pneumonia were averted per hospital on an annual basis. The average cost of the intervention is $3375 per infection averted, measured in 2007 dollars. The cost of the intervention is substantially less than estimates of the additional health care costs associated with these infections, which range from $12,208 to $56,167 per infection episode. These results do not take into account the additional effect of the Michigan Keystone program in terms of reducing cases of sepsis or its effects in terms of preventing mortality, improving teamwork, and reducing nurse turnover. 

"No, it can't work that way unless we get rid of fee-for-service payments and go to capitation.  We all know that nobody will act to reduce infections because they will get paid less."

And then he has the nerve to tell us that reporting of central line infections is highly variable across the United States.  Here's the abstract from that study, again from the AJMQ:

The authors searched state health department Web sites for publicly available CLABSI data. Fourteen states, all with mandatory CLABSI monitoring laws, had publicly available data. The authors identified significant variation in the presentation of infection rates, methods of risk adjustment, locations and care settings reported, time span of data collection, and time lag to reporting. The wide variation in availability and content of information illustrates the need for standardized CLABSI monitoring and reporting mechanisms.

"We'll publish our numbers in a real-time, standard way when we are good and ready, but our numbers are better than their numbers."

MHA does CLABSI right

Here's a great step forward by the Massachusetts Hospital Association, a public presentation  of current data on the rate of central line associated bloodstream infections among its participating members. Here's the current chart:

Let's talk about what's good about this. First, the data are quite current, just a few months old.  Next, the monthly figures, which are subject to minor variations, are smoothed out with a three-month moving average, so you can see the trend.  Third, there are no punches pulled.  When the rate goes up, they say it.

Since each hospital knows it own rate, it can easily compare its progress to others in the state.  N0t for the sake of trying to attract more patients or for other kinds of marketing, but to act as a form of creative tension within the organization to do better. Now, that's the right kind of competition.