Improving patient care by making small sustainable changes: a cardiac telemetry unit's experience

IN SEPTEMBER 2004, A 36-BED medical/telemetry unit at Porter Adventist Hospital in Denver, Colorado began learning how to make small improvements in the course of their work using the scientific [...]
* With the introduction of each new drug, technology, and regulation, the processes of care become more complicated, creating an elaborate set of procedures connecting various hospital units and departments. * Using methods of Adaptive Design and the Toyota Production System, a nursing unit redesigned work systems to achieve sustainable improvements in productivity, staff and patient satisfaction, and quality outcomes. * The first hurdle of redesign was identifying problems, to which staff had become so accustomed with various work arounds that they had trouble seeing the process bottlenecks. * Once the staff identified problems, they assumed they could solve the problem because they assumed they knew the causes. * Utilizing root cause analysis, asking, 'why, why, why,' was essential to unearthing the true cause of a problem. * Similarly, identifying solutions that were simple and low cost was an essential step in problem solving. * Adopting new procedures and sustaining the commitment to identify and signal problems was a last and critical step toward realizing improvement, requiring a manager to function as 'teacher/coach' rather than 'fixer/firefighter.'