Notes from My First IHI National Quality Forum (#ihi09)
Today was an exciting day at the Institute for Healthcare Improvement‘s 21st annual National Forum on Healthcare Quality Improvement. It's my first time here, to learn and network. They have over 5,000 attendees who are committed to quality and patient safety improvement. The energy and enthusiasm is contagious (in a good way!).
To read Twitter updates from attendees, search the hashtag #ihi09 during the day on Wednesday, if you like.
I had a chance to briefly meet Dr. Donald Berwick before his keynote address, which Paul Levy summarized here.
Don mentioned Lean and Toyota methods four or five times during his talk and, early on, showed a number of slides with results from organizations like Denver Health and ThedaCare. One major theme of Don's was that the quality movement can't ignore the need for cost reduction, given financial realities. This is a message that ties in well with Lean, that quality improvement leads to cost reductions, in addition to all of the benefits for patients in avoiding harm and providing the best care possible.
He made a provocative statement on “value”:
“Health CARE has no intrinsic value, health DOES.”
He is suggesting that value to the customer (the patients) has more to do with outcomes than it does to activity and effort.
Don also talked about the need for change and how:
“Command and control solutions seem weaker every day.”
One of the breakout sessions that had an impact one me was from Kaiser Permanente and Ascension Health about freeing up time for nurses to spend with patients.
They cited a 2006 study that showed nurses spent only about 30% of their time in patient rooms due to waste of all varieties.
In looking at the factors that impacted nurse productivity, the studies showed that architecture and physical layout was NOT a statistically significant factor. They found high variability across shifts in the same hospital and across different nurses on the same shift.
The productivity was all a matter of personal work style and support process that often don't provide support so nurses can provide the right patient care.
The lack of standardized work is described by the presenter who said:
“Everyone develops their own style.”
“They don't teach you in nursing school how to organize your time.”
That seems like a recipe for inconsistent care and inconsistent quality.
The recommendations for improving productivity and patient care included having supplies and equipment available ON DEMAND at the point of use and the time of need.
That sounds so basic and fundamental, doesn't it? Shocking to those of you from outside of healthcare?
One health system did a study of their “smart pumps” and discovered that, due to a lack of organization and 5S and lack of standard process, that they had overpurchased this one item to the tune of $20 million since the pumps they had often couldn't be found, so additional ones got purchased. What an easily preventable form of waste and overspending.
Nurses often hoard and hide equipment as a workaround to make sure THEY can provide care to THEIR patients. It might seem selfish, but it's well-intended in the short-term, but does nothing to fix the real system. One presenter said the “strangest” place they found a piece of hoarded/hidden equipment was a pulse oximeter found in the CEILING above the tile in a patient room. Nurses and hospital staff shouldn't have to go to such lengths to ensure they have the tools to do their jobs.
One quote given about the lack of support to nurses was:
“It's like they sent me a door but no door frame? What am I supposed to get done with that?”
Whose job is it to make sure people have the right tools, equipment, supplies, and systems? Quoting Dr. Deming, it's top management's job.
The final principle they encouraged was “patient-centered design” of processes and spaces. Again, seems pretty basic to focus on the customer, eh?
One final thought: a presenter opined that for all of the talk about the “hospital of future” (which every hospital thinks they are building, they said), that it doesn't really exist yet. If it did, such a hospital would have 25% to 30% better labor productivity and the presenters said that's not here. My suggestion was that they look at what ThedaCare has delivered through their Collaborative Care model – they have delivered such productivity improvements while also providing better quality. It is possible, now.
Another highlight was being able to meet patient safety advocate Sorrel King in person finally (check out my podcast with her and her recent book, Josie's Story: A Mother's Inspiring Crusade to Make Medical Care Safe. I'm about 80% of the way through her book and I highly recommend it.