New England Baptist Hospital

* New England Baptist Hospital= renowned orthopedic care * Ranks above the 95th percentile in patient satisfaction nationally * Under LEAD, committed to eliminate medication events, surgical site infections and post-operative blood clots within the institution.
Background
* Estimated that 98,000 patients die in the US hospital due to preventable medical errors * There has been slow progress to fix this because it involves changing an organization’s culture and systems of care delivery as well as improving communication and teamwork. * Estimated that medical errors cost the nation as much as 29 billion each year. * Nearly half of annual increase Baptist receives each year is tied to quality metrics (from Blue Cross Blue Shield). * Also Medicare, as of October 2008 has stopped paying hospitals for costs of several hospital acquired conditions (including some types of infections). * As of his 2010 budget plan, Obama has proposed saving Medicare an estimated 26 billion. Hospitals with high rates of readmission within 30 days would be paid less.
Quality Improvement Principles: Looking Beyond Health Care * Baptist looked outside of health care for models. * Looked at aviation and manufacturing models which stress safety, teamwork, communication and root cause analysis. * Baptist were attracted to the Toyota Production System method which is an integrated socio-technical system in order to produce quality products and outcomes efficiently. They focus on eliminating waste, employee participation, systems thinking and accountability. * Baptist looked to Value Capture (well versed in the Toyota Method), to train them in the ways of Toyota, and to develop ways in which Toyota principles could be applied to the units at Baptist. * The principles that guide NEBH organizational transformation include: 1. Simple and direct processes. All pathways, whether it’s delivery of a medicine or manufacturing a car, should be void of loops, forking processes or workarounds. The pathway to deliver a medicine from the time it is ordered to the patient’s mouth included 54 steps when charted out. That has been reduced to six steps on the medical unit, for example. 2. Binary connections are made at key steps in the process. The concept is that all customer-supplier connections are direct, between two people, with a yes-no way to make a request and receive a response. Applied to the medication process, a physician’s medication order for a patient is made directly to a pharmacist stationed on the unit, who ensures the order is clear, complete, correct and can be filled. 3. Each person’s work or activity is highly specified. As a result, the outcome, timing, sequence and content are all expected. No surprises. If something unexpected occurs, people are empowered to “stop the line,” or the process, in order to resolve the issue. 4. All improvement occurs using the scientific method, under the guidance of a teacher, at the level closest to the patient, all toward the characteristics of the ideal process.
The Baptist created three multidisciplinary teams, with all members of each team trained in the Toyota Production System method, to oversee each of its initiatives—eliminating medication events, surgical site infections and post-operative blood clots. These include: * Using the key principles above to design the ideal process; * Creating a help chain to resolve issues that arise—so that issues are addressed as they occur and problem-solving occurs on the frontlines of the organization; * Identifying key metrics to measure success; and * Implementing a comprehensive communication plan so that successes are highlighted.
Striving for Excellence: Yesterday, Today and Tomorrow * Baptist has focused since To Err is Human Report to make patients even safer * Hospital staff designed clinical dashboards so that Baptist officials could set and measure progress on quality and outcome goals * The dashboards gave direction and perspective

Getting to zero
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