This article surveys the methods and tools of quality improvement used today in health care. Spec... more This article surveys the methods and tools of quality improvement used today in health care. Specifically, we describe how clinicians can use these methods to impact the clinical practice of medicine. Improvement teams from a variety of health care organizations have reported the successful use of basic methods such as group work, flowcharting, data collection, and graphical data analysis. In addition to these incremental, problem-solving methods borrowed from the industrial practice of improvement, we have also seen the use of specific process design methods in health care applications such as care path development. The pace of change in health care has also led to the practical development of newer methods for rapid cycle improvement. We will review the basic approach behind these methods and illustrate key elements such as the ideas of change concepts and small-scale tests of change. Unfortunately, whereas these methods have been very successful and highly appealing to improvement practitioners, they may also have inadvertently widened a gulf between these practitioners and traditional health-services and clinical researchers. We offer an assessment of this issue and suggest ways to narrow the communication gap. Measurement has also traditionally been a part of the thinking about quality assurance and improvement in health care. We review the new philosophy of measurement that has emerged from recent improvement thinking and describe the use of control charts in clinical improvement. Benchmarking and multiorganizational collaboratives are more recent innovations in the ways we approach improvement in health care. These efforts go beyond simple measurement and explore the why and how associated with the widespread variation in performance in health care. We explore a variety of health care examples to illustrate these methods and the lessons learned in their use. We conclude the article with an overview of four habits that we believe are essential for health care organizations and individual clinicians to adopt to bring about real improvement in the clinical practice of medicine. These are the habits for: 1) viewing clinical practice as a process; 2) evidence-based practice; 3) collaborative learning; and 4) change. Pediatrics 1999;103:203-214; quality improvement methods, clinical medicine, benchmarking, collaboration, rapid cycle improvement.
Virginia Mason, Lean, and Innovation A Leader in Lean Thinking in Healthcare Lean Thinking Basics... more Virginia Mason, Lean, and Innovation A Leader in Lean Thinking in Healthcare Lean Thinking Basics Creativity and Innovation Basics Virginia Mason's Chair of Innovation The Marriage of Lean and Innovation at Virginia Mason Medical Center Strategy as Innovation, Strategy for Innovation The Challenge of Innovation in Healthcare Seat-of-the-Pants versus Deliberately Planned Innovation Are You Guys Kidding Me? The Patient at the Top of a Pyramid! Four Strategic Pillars Support Pursuit of the Perfect Patient Experience Looking Outside for Insight: The Birth of the Virginia Mason Production System Gaining outside Insight on Innovation Evolution of the Strategic Innovation Plan Listening to the Voice of the Future Stimulating Breakthrough Innovation The Board's Role in Strategy and Innovation: You Have to Be on the Team Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation Strategy Leaders in Other Healthcare Organizations Should Integrating Innovation and Lean in Practice Debunking the Myth Integrating Lean and Innovation: Natural Overlaps in Tools and Methods The Marriage of Lean and Innovation: A Careful Courtship Innovation and Lean in Hospital Design Innovating in Primary Care Busting Assumptions about the Management of Medically Complex Surgical Patients Redesigning Surveillance of Healthcare-Acquired Infections Embedding Innovation Tools into the Structure of Lean Workshops Transforming Healthcare: What Others Can Learn from Virginia Mason's Integration of Lean and Innovation Tools Leaders in Other Healthcare Organizations Should Learning to Be Innovative Learning and Unlearning Key Concepts: Pedagogy, Andragogy, and Reflective Practice Creating a Learning Organization: There Are No Shortcuts A Quick Word about Leaders and Leadership Virginia Mason's Systematic Approach to Skills Development for Leaders Structural Practices that Support Innovative Thinking in Leaders Evolution of Training and Development for Innovation Virginia Mason's Innovation Competencies Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation Leadership Knowledge and Capability Efforts Leaders in Other Healthcare Organizations Should Supportive Culture for Innovation Dimensions of Culture that Support Innovation Innovation Culture Does Not Exist in a Vacuum Examples of the Seven Dimensions of Culture at Virginia Mason Describing Organizational Culture for Innovation: Portal Charts Assessing Organizational Culture for Innovation Virginia Mason's Assessment of the Dimensions of Culture that Support Innovation Innovation Culture Kaizen Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation Culture Efforts Leaders in Other Healthcare Organizations Should Supportive Infrastructure for Innovation Examples of Innovation Infrastructures in Leading Healthcare Institutions Infrastructure Evolves in Context The Kaizen Promotion Office (KPO): Supporting the Implementation of the Virginia Mason Production System Innovation Leadership Team (ILT): Providing Board and Executive Level Guidance for Innovation Center for Innovation: The Small Team behind the Scenes Information Technology Supports for Innovation: Browsing for Knowledge and Ideas Emerging Infrastructures: Innovation Grants and Moonshine Communications Infrastructure: Getting the Word Out about Innovation Center for Health Care Solutions: Catalyzing Breakthrough Innovations in Care by Supporting Uncommon Conversations Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation Infrastructure Efforts Leaders in Other Healthcare Organizations Should Bringing Innovation to Daily Work "I Swore I Was Going to Find a Way to Make That Never Happen Again" "We're Throwing Everything, Including the Kitchen Sink, at You" Bringing Fresh Ideas to the Daily Practice of Surgery KVM Radio "I'm Doing It Today, and Never Again" The Everyday Lean Idea System Making Things Better While the Moon Is Shining Informatics Practitioners: Making Better Use of Information in Daily Clinical Work Innovation Grants Process: Supporting Those with Potential Breakthrough Ideas Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation in Daily Work Efforts Leaders in Other Healthcare Organizations Should Using Patient Experience to Drive Innovation The Customers' Role in Innovation Evolution of the Strategic Focus on Service Imported from the UK: Experience-Based Design Experience-Based Design Meets Standard Work in a Clinic Understanding the Emotional Experience of Surgical Patients and Families You Can See a Lot by Looking I Am Sure That This Is What They Will Want The Roller Coaster of Emotion The Case of the Critical Care Unit Building the Infrastructure to Support Experience-Based Design Team Members Have Emotional Experiences Too! Transforming Healthcare: What Others Can Learn from Virginia Mason's Focus on Patients and Families Leaders in Other Healthcare Organizations Should Looking Ahead: The Future…
The authors have indicated they have no financial relationships relevant to this article to discl... more The authors have indicated they have no financial relationships relevant to this article to disclose.
OBJECTIVE. To quantify the potential for misidentification among NICU patients resulting from sim... more OBJECTIVE. To quantify the potential for misidentification among NICU patients resulting from similarities in patient names or hospital medical record numbers (MRNs). METHODS. A listing of all patients who received care in 1 NICU during 1 calendar year was obtained from the unit's electronic medical record system. A patient day was considered at risk for misidentification when the index patient shared a surname, similar-sounding surname, or similar MRN with another patient who was cared for in the NICU on that day. RESULTS. During the 1-year study period, 12 186 days of patient care were provided to 1260 patients. The unit's average daily census was 33.4; the maximum census was 48. Not a single day was free of risk for patient misidentification. The mean number of patients who were at risk on any given day was 17 (range: 5-35), representing just over 50% of the average daily census. During the entire calendar year, the risk ranged from 20.6% to a high of 72.9% of the average daily census. The most common causes of misidentification risk were similar-appearing MRNs (44% of patient days). Identical surnames were present in 34% of patient days, and similar-sounding names were present in 9.7% of days. Twins and triplets contributed one third of patient days in the NICU. After these multiple births were excluded from analysis, 26.3% of patient days remained at risk for misidentification. Among singletons, the contribution to misidentification risk of similar-sounding surnames was relatively unchanged (9.1% of patient days), whereas that of similar MRNs and identical surnames decreased (17.6% and 1.0%, respectively). CONCLUSIONS. NICU patients are frequently at risk for misidentification errors as a result of similarities in standard identifiers. This risk persists even after exclusion of multiple births and is substantially higher than has been reported in other hospitalized populations.
The authors have indicated they have no financial relationships relevant to this article to discl... more The authors have indicated they have no financial relationships relevant to this article to disclose.
Problem: Need for improved sedation strategy for adults receiving ventilator support. Design: Obs... more Problem: Need for improved sedation strategy for adults receiving ventilator support. Design: Observational study of effect of introduction of guidelines to improve the doctors' and nurses' performance. The project was a prospective improvement and was part of a national quality improvement collaborative. Background and setting: A general mixed surgical intensive care unit in a university hospital; all doctors and nurses in the unit; all adult patients (.18 years) treated by intermittent positive pressure ventilation for more than 24 hours. Key measures for improvement: Reduction in patients' mean time on a ventilator and length of stay in intensive care over a period of 11 months; anonymous reporting of critical incidents; staff perceptions of ease and of consequences of changes. Strategies for change: Multiple measures (protocol development, educational presentations, written guidelines, posters, flyers, emails, personal discussions, and continuous feedback) were tested, rapidly assessed, and adopted if beneficial. Effects of change: Mean ventilator time decreased by 2.1 days (95% confidence interval 0.7 to 3.6 days) from 7.4 days before intervention to 5.3 days after. Mean stay decreased by 1.0 day (20.9 to 2.9 days) from 9.3 days to 8.3 days. No accidental extubations or other incidents were identified. Lessons learnt: Relatively simple changes in sedation practice had significant effects on length of ventilator support. The change process was well received by the staff and increased their interest in identifying other areas for improvement.
Objective. To describe the timing of initial surfactant treatment for high-risk preterm infants i... more Objective. To describe the timing of initial surfactant treatment for high-risk preterm infants in routine practice and compare these findings with evidence from randomized trials and published guidelines.Methods. Data from the Vermont Oxford Network Database for infants who were born from 1998 to 2000 and had birth weights 401 to 1500 g and gestational ages of 23 to 29 weeks were analyzed to determine the time after birth at which the initial dose of surfactant was administered. Multivariate models adjusting for clustering of cases within hospitals identified factors associated with surfactant administration and its timing. Evidence on surfactant timing from systematic reviews of randomized trials and from published guidelines was reviewed.Results. A total of 47 608 eligible infants were cared for at 341 hospitals in North America that participated in the Vermont Oxford Network Database from 1998 to 2000. Seventy-nine percent of infants received surfactant treatment (77.6% in 1998, 79.4% in 1999, and 79.6% in 2000). Factors that increased the likelihood of surfactant treatment were outborn birth, lower gestational age, lower 1-minute Apgar score, male gender, white race, cesarean delivery, multiple birth, or birth later in the study period. The first dose of surfactant was administered at a median time after birth of 50 minutes (60 minutes in 1998, 51 minutes in 1999, and 42 minutes in 2000). Over the 3-year study period, inborn infants received their initial dose of surfactant earlier than outborn infants (median time: 43 minutes vs 79 minutes). Other factors associated with earlier administration of the initial surfactant dose were gestational age, lower 1-minute Apgar score, cesarean delivery, antenatal steroid treatment, multiple birth, and small size for gestational age. In 2000, 27% of infants received surfactant in the delivery room. There was wide variation among hospitals in the proportion of infants who received surfactant treatment in the delivery room (interquartile range: 0%–75%), in the median time of the initial surfactant dose (interquartile range: 20-90 minutes), and in the proportion of infants who received the first dose >2 hours after birth (interquartile range: 7%–34%). Six systematic reviews of randomized trials of surfactant timing were identified. No national guidelines addressing the timing of surfactant therapy were found.Conclusion. Although the time after birth at which the first dose of surfactant is administered to infants 23 to 29 weeks’ gestation decreased from 1998 to 2000, in 2000 many infants still received delayed treatment, and delivery room surfactant administration was not routinely practiced at most units. We conclude that there is a gap between evidence from randomized controlled trials that supports prophylactic or early surfactant administration and what is actually done in routine practice at many units.
Several benefits of multi-institutional specialty-based voluntary reporting systems such as the V... more Several benefits of multi-institutional specialty-based voluntary reporting systems such as the Vermont Oxford Network system are evident. They can identify errors that are rare in individual institutions but occur in multiple institutions. For example, on www.nicq.org, there were several reports of intravenous infusion of solutions intended for enteral use-a systems problem that can be prevented by designing enteral tubing and syringes that cannot be connected to intravenous tubing (a so-called "physical constraint").
... Creativity, innovation, and quality. Post a Comment. CONTRIBUTORS: Author: Plsek, Paul E. PUB... more ... Creativity, innovation, and quality. Post a Comment. CONTRIBUTORS: Author: Plsek, Paul E. PUBLISHER: ASQ Quality Press (Milwaukee, Wis.). SERIES TITLE: YEAR: 1997. PUB TYPE: Book (ISBN 0873894049 ). VOLUME/EDITION: PAGES (INTRO/BODY): xi, 316 p. ...
Virginia Mason, Lean, and Innovation A Leader in Lean Thinking in Healthcare Lean Thinking Basics... more Virginia Mason, Lean, and Innovation A Leader in Lean Thinking in Healthcare Lean Thinking Basics Creativity and Innovation Basics Virginia Mason's Chair of Innovation The Marriage of Lean and Innovation at Virginia Mason Medical Center Strategy as Innovation, Strategy for Innovation The Challenge of Innovation in Healthcare Seat-of-the-Pants versus Deliberately Planned Innovation Are You Guys Kidding Me? The Patient at the Top of a Pyramid! Four Strategic Pillars Support Pursuit of the Perfect Patient Experience Looking Outside for Insight: The Birth of the Virginia Mason Production System Gaining outside Insight on Innovation Evolution of the Strategic Innovation Plan Listening to the Voice of the Future Stimulating Breakthrough Innovation The Board's Role in Strategy and Innovation: You Have to Be on the Team Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation Strategy Leaders in Other Healthcare Organizations Should Integrating Innovation and Lean in Practice Debunking the Myth Integrating Lean and Innovation: Natural Overlaps in Tools and Methods The Marriage of Lean and Innovation: A Careful Courtship Innovation and Lean in Hospital Design Innovating in Primary Care Busting Assumptions about the Management of Medically Complex Surgical Patients Redesigning Surveillance of Healthcare-Acquired Infections Embedding Innovation Tools into the Structure of Lean Workshops Transforming Healthcare: What Others Can Learn from Virginia Mason's Integration of Lean and Innovation Tools Leaders in Other Healthcare Organizations Should Learning to Be Innovative Learning and Unlearning Key Concepts: Pedagogy, Andragogy, and Reflective Practice Creating a Learning Organization: There Are No Shortcuts A Quick Word about Leaders and Leadership Virginia Mason's Systematic Approach to Skills Development for Leaders Structural Practices that Support Innovative Thinking in Leaders Evolution of Training and Development for Innovation Virginia Mason's Innovation Competencies Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation Leadership Knowledge and Capability Efforts Leaders in Other Healthcare Organizations Should Supportive Culture for Innovation Dimensions of Culture that Support Innovation Innovation Culture Does Not Exist in a Vacuum Examples of the Seven Dimensions of Culture at Virginia Mason Describing Organizational Culture for Innovation: Portal Charts Assessing Organizational Culture for Innovation Virginia Mason's Assessment of the Dimensions of Culture that Support Innovation Innovation Culture Kaizen Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation Culture Efforts Leaders in Other Healthcare Organizations Should Supportive Infrastructure for Innovation Examples of Innovation Infrastructures in Leading Healthcare Institutions Infrastructure Evolves in Context The Kaizen Promotion Office (KPO): Supporting the Implementation of the Virginia Mason Production System Innovation Leadership Team (ILT): Providing Board and Executive Level Guidance for Innovation Center for Innovation: The Small Team behind the Scenes Information Technology Supports for Innovation: Browsing for Knowledge and Ideas Emerging Infrastructures: Innovation Grants and Moonshine Communications Infrastructure: Getting the Word Out about Innovation Center for Health Care Solutions: Catalyzing Breakthrough Innovations in Care by Supporting Uncommon Conversations Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation Infrastructure Efforts Leaders in Other Healthcare Organizations Should Bringing Innovation to Daily Work "I Swore I Was Going to Find a Way to Make That Never Happen Again" "We're Throwing Everything, Including the Kitchen Sink, at You" Bringing Fresh Ideas to the Daily Practice of Surgery KVM Radio "I'm Doing It Today, and Never Again" The Everyday Lean Idea System Making Things Better While the Moon Is Shining Informatics Practitioners: Making Better Use of Information in Daily Clinical Work Innovation Grants Process: Supporting Those with Potential Breakthrough Ideas Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation in Daily Work Efforts Leaders in Other Healthcare Organizations Should Using Patient Experience to Drive Innovation The Customers' Role in Innovation Evolution of the Strategic Focus on Service Imported from the UK: Experience-Based Design Experience-Based Design Meets Standard Work in a Clinic Understanding the Emotional Experience of Surgical Patients and Families You Can See a Lot by Looking I Am Sure That This Is What They Will Want The Roller Coaster of Emotion The Case of the Critical Care Unit Building the Infrastructure to Support Experience-Based Design Team Members Have Emotional Experiences Too! Transforming Healthcare: What Others Can Learn from Virginia Mason's Focus on Patients and Families Leaders in Other Healthcare Organizations Should Looking Ahead: The Future…
Quality improvement collaboratives are increasinglybeing used in many countries to achieve rapidi... more Quality improvement collaboratives are increasinglybeing used in many countries to achieve rapidimprovements in health care. However, there is littleindependent evidence that they are more cost effectivethan other methods, and little knowledge about howthey could be made more effective. A number ofsystematic evaluations are being performed byresearchers in North America, the UK, and Sweden.This paper presents the shared ideas from two meetingsof these researchers. The evidence to date is that somecollaboratives have stimulated improvements in patientcare and organisational performance, but there aresignificant differences between collaboratives andteams. The researchers agreed on the possible reasonswhy some were less successful than others, andidentified 10 challenges which organisers and teamsneed to address to achieve improvement. In the absenceof more conclusive evidence, these guidelines are likelyto be useful for collaborative organisers, teams and theirmanagers and may also contribute to further researchinto collaboratives and the spread of innovations inhealth care.
Part II of this three-part tutorial focuses on the logistics of data collection. The author prese... more Part II of this three-part tutorial focuses on the logistics of data collection. The author presents a checklist of things to consider when planning the details of a data collection effort; touches on the topics of bias and stratification; discusses examples of popular data collection methods; and points out some common pitfalls in data collection, offering practical tips on how to avoid them.
A “system” can be defined by the coming together of parts, interconnections, and purpose (see, fo... more A “system” can be defined by the coming together of parts, interconnections, and purpose (see, for example, definitions proposed by von Bertalanffy [1968] and Capra [1996]). While systems can be broken down into parts which are interesting in and of themselves, the real power lies in the way the parts come together and are interconnected to fulfill some purpose. The health care system of the United States consists of various parts (e.g., clinics, hospitals, pharmacies, laboratories) that are interconnected (via flows of patients and information) to fulfill a purpose (e.g., maintaining and improving health). Similarly, a thermostat and fan are a “system.” Both parts can be understood independently, but when they are interconnected, they fulfill the purpose of maintaining a comfortable temperature in a given space. The intuitive notion of various system “levels,” such as the microsystem and macrosystem, has to do with the number and strength of interconnections between the elements of...
Variation in outcome is a natural result from any complex biological or production process. Unfor... more Variation in outcome is a natural result from any complex biological or production process. Unfortunately, this variation can cloud our decision making and lead us to take inappropriate action. The control chart is a basic quality maangement tool that helps managers and clinicians make statistically sound decisions when analyzing outcome data from processes. In this tutorial, we will illustrate the problems inherent in taking action based on data that displays variation. We will then develop the statistical foundation for control charts and show an example of its use to analyze data from a pharmacy process.
This article surveys the methods and tools of quality improvement used today in health care. Spec... more This article surveys the methods and tools of quality improvement used today in health care. Specifically, we describe how clinicians can use these methods to impact the clinical practice of medicine. Improvement teams from a variety of health care organizations have reported the successful use of basic methods such as group work, flowcharting, data collection, and graphical data analysis. In addition to these incremental, problem-solving methods borrowed from the industrial practice of improvement, we have also seen the use of specific process design methods in health care applications such as care path development. The pace of change in health care has also led to the practical development of newer methods for rapid cycle improvement. We will review the basic approach behind these methods and illustrate key elements such as the ideas of change concepts and small-scale tests of change. Unfortunately, whereas these methods have been very successful and highly appealing to improvement practitioners, they may also have inadvertently widened a gulf between these practitioners and traditional health-services and clinical researchers. We offer an assessment of this issue and suggest ways to narrow the communication gap. Measurement has also traditionally been a part of the thinking about quality assurance and improvement in health care. We review the new philosophy of measurement that has emerged from recent improvement thinking and describe the use of control charts in clinical improvement. Benchmarking and multiorganizational collaboratives are more recent innovations in the ways we approach improvement in health care. These efforts go beyond simple measurement and explore the why and how associated with the widespread variation in performance in health care. We explore a variety of health care examples to illustrate these methods and the lessons learned in their use. We conclude the article with an overview of four habits that we believe are essential for health care organizations and individual clinicians to adopt to bring about real improvement in the clinical practice of medicine. These are the habits for: 1) viewing clinical practice as a process; 2) evidence-based practice; 3) collaborative learning; and 4) change. Pediatrics 1999;103:203-214; quality improvement methods, clinical medicine, benchmarking, collaboration, rapid cycle improvement.
Virginia Mason, Lean, and Innovation A Leader in Lean Thinking in Healthcare Lean Thinking Basics... more Virginia Mason, Lean, and Innovation A Leader in Lean Thinking in Healthcare Lean Thinking Basics Creativity and Innovation Basics Virginia Mason's Chair of Innovation The Marriage of Lean and Innovation at Virginia Mason Medical Center Strategy as Innovation, Strategy for Innovation The Challenge of Innovation in Healthcare Seat-of-the-Pants versus Deliberately Planned Innovation Are You Guys Kidding Me? The Patient at the Top of a Pyramid! Four Strategic Pillars Support Pursuit of the Perfect Patient Experience Looking Outside for Insight: The Birth of the Virginia Mason Production System Gaining outside Insight on Innovation Evolution of the Strategic Innovation Plan Listening to the Voice of the Future Stimulating Breakthrough Innovation The Board's Role in Strategy and Innovation: You Have to Be on the Team Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation Strategy Leaders in Other Healthcare Organizations Should Integrating Innovation and Lean in Practice Debunking the Myth Integrating Lean and Innovation: Natural Overlaps in Tools and Methods The Marriage of Lean and Innovation: A Careful Courtship Innovation and Lean in Hospital Design Innovating in Primary Care Busting Assumptions about the Management of Medically Complex Surgical Patients Redesigning Surveillance of Healthcare-Acquired Infections Embedding Innovation Tools into the Structure of Lean Workshops Transforming Healthcare: What Others Can Learn from Virginia Mason's Integration of Lean and Innovation Tools Leaders in Other Healthcare Organizations Should Learning to Be Innovative Learning and Unlearning Key Concepts: Pedagogy, Andragogy, and Reflective Practice Creating a Learning Organization: There Are No Shortcuts A Quick Word about Leaders and Leadership Virginia Mason's Systematic Approach to Skills Development for Leaders Structural Practices that Support Innovative Thinking in Leaders Evolution of Training and Development for Innovation Virginia Mason's Innovation Competencies Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation Leadership Knowledge and Capability Efforts Leaders in Other Healthcare Organizations Should Supportive Culture for Innovation Dimensions of Culture that Support Innovation Innovation Culture Does Not Exist in a Vacuum Examples of the Seven Dimensions of Culture at Virginia Mason Describing Organizational Culture for Innovation: Portal Charts Assessing Organizational Culture for Innovation Virginia Mason's Assessment of the Dimensions of Culture that Support Innovation Innovation Culture Kaizen Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation Culture Efforts Leaders in Other Healthcare Organizations Should Supportive Infrastructure for Innovation Examples of Innovation Infrastructures in Leading Healthcare Institutions Infrastructure Evolves in Context The Kaizen Promotion Office (KPO): Supporting the Implementation of the Virginia Mason Production System Innovation Leadership Team (ILT): Providing Board and Executive Level Guidance for Innovation Center for Innovation: The Small Team behind the Scenes Information Technology Supports for Innovation: Browsing for Knowledge and Ideas Emerging Infrastructures: Innovation Grants and Moonshine Communications Infrastructure: Getting the Word Out about Innovation Center for Health Care Solutions: Catalyzing Breakthrough Innovations in Care by Supporting Uncommon Conversations Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation Infrastructure Efforts Leaders in Other Healthcare Organizations Should Bringing Innovation to Daily Work "I Swore I Was Going to Find a Way to Make That Never Happen Again" "We're Throwing Everything, Including the Kitchen Sink, at You" Bringing Fresh Ideas to the Daily Practice of Surgery KVM Radio "I'm Doing It Today, and Never Again" The Everyday Lean Idea System Making Things Better While the Moon Is Shining Informatics Practitioners: Making Better Use of Information in Daily Clinical Work Innovation Grants Process: Supporting Those with Potential Breakthrough Ideas Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation in Daily Work Efforts Leaders in Other Healthcare Organizations Should Using Patient Experience to Drive Innovation The Customers' Role in Innovation Evolution of the Strategic Focus on Service Imported from the UK: Experience-Based Design Experience-Based Design Meets Standard Work in a Clinic Understanding the Emotional Experience of Surgical Patients and Families You Can See a Lot by Looking I Am Sure That This Is What They Will Want The Roller Coaster of Emotion The Case of the Critical Care Unit Building the Infrastructure to Support Experience-Based Design Team Members Have Emotional Experiences Too! Transforming Healthcare: What Others Can Learn from Virginia Mason's Focus on Patients and Families Leaders in Other Healthcare Organizations Should Looking Ahead: The Future…
The authors have indicated they have no financial relationships relevant to this article to discl... more The authors have indicated they have no financial relationships relevant to this article to disclose.
OBJECTIVE. To quantify the potential for misidentification among NICU patients resulting from sim... more OBJECTIVE. To quantify the potential for misidentification among NICU patients resulting from similarities in patient names or hospital medical record numbers (MRNs). METHODS. A listing of all patients who received care in 1 NICU during 1 calendar year was obtained from the unit's electronic medical record system. A patient day was considered at risk for misidentification when the index patient shared a surname, similar-sounding surname, or similar MRN with another patient who was cared for in the NICU on that day. RESULTS. During the 1-year study period, 12 186 days of patient care were provided to 1260 patients. The unit's average daily census was 33.4; the maximum census was 48. Not a single day was free of risk for patient misidentification. The mean number of patients who were at risk on any given day was 17 (range: 5-35), representing just over 50% of the average daily census. During the entire calendar year, the risk ranged from 20.6% to a high of 72.9% of the average daily census. The most common causes of misidentification risk were similar-appearing MRNs (44% of patient days). Identical surnames were present in 34% of patient days, and similar-sounding names were present in 9.7% of days. Twins and triplets contributed one third of patient days in the NICU. After these multiple births were excluded from analysis, 26.3% of patient days remained at risk for misidentification. Among singletons, the contribution to misidentification risk of similar-sounding surnames was relatively unchanged (9.1% of patient days), whereas that of similar MRNs and identical surnames decreased (17.6% and 1.0%, respectively). CONCLUSIONS. NICU patients are frequently at risk for misidentification errors as a result of similarities in standard identifiers. This risk persists even after exclusion of multiple births and is substantially higher than has been reported in other hospitalized populations.
The authors have indicated they have no financial relationships relevant to this article to discl... more The authors have indicated they have no financial relationships relevant to this article to disclose.
Problem: Need for improved sedation strategy for adults receiving ventilator support. Design: Obs... more Problem: Need for improved sedation strategy for adults receiving ventilator support. Design: Observational study of effect of introduction of guidelines to improve the doctors' and nurses' performance. The project was a prospective improvement and was part of a national quality improvement collaborative. Background and setting: A general mixed surgical intensive care unit in a university hospital; all doctors and nurses in the unit; all adult patients (.18 years) treated by intermittent positive pressure ventilation for more than 24 hours. Key measures for improvement: Reduction in patients' mean time on a ventilator and length of stay in intensive care over a period of 11 months; anonymous reporting of critical incidents; staff perceptions of ease and of consequences of changes. Strategies for change: Multiple measures (protocol development, educational presentations, written guidelines, posters, flyers, emails, personal discussions, and continuous feedback) were tested, rapidly assessed, and adopted if beneficial. Effects of change: Mean ventilator time decreased by 2.1 days (95% confidence interval 0.7 to 3.6 days) from 7.4 days before intervention to 5.3 days after. Mean stay decreased by 1.0 day (20.9 to 2.9 days) from 9.3 days to 8.3 days. No accidental extubations or other incidents were identified. Lessons learnt: Relatively simple changes in sedation practice had significant effects on length of ventilator support. The change process was well received by the staff and increased their interest in identifying other areas for improvement.
Objective. To describe the timing of initial surfactant treatment for high-risk preterm infants i... more Objective. To describe the timing of initial surfactant treatment for high-risk preterm infants in routine practice and compare these findings with evidence from randomized trials and published guidelines.Methods. Data from the Vermont Oxford Network Database for infants who were born from 1998 to 2000 and had birth weights 401 to 1500 g and gestational ages of 23 to 29 weeks were analyzed to determine the time after birth at which the initial dose of surfactant was administered. Multivariate models adjusting for clustering of cases within hospitals identified factors associated with surfactant administration and its timing. Evidence on surfactant timing from systematic reviews of randomized trials and from published guidelines was reviewed.Results. A total of 47 608 eligible infants were cared for at 341 hospitals in North America that participated in the Vermont Oxford Network Database from 1998 to 2000. Seventy-nine percent of infants received surfactant treatment (77.6% in 1998, 79.4% in 1999, and 79.6% in 2000). Factors that increased the likelihood of surfactant treatment were outborn birth, lower gestational age, lower 1-minute Apgar score, male gender, white race, cesarean delivery, multiple birth, or birth later in the study period. The first dose of surfactant was administered at a median time after birth of 50 minutes (60 minutes in 1998, 51 minutes in 1999, and 42 minutes in 2000). Over the 3-year study period, inborn infants received their initial dose of surfactant earlier than outborn infants (median time: 43 minutes vs 79 minutes). Other factors associated with earlier administration of the initial surfactant dose were gestational age, lower 1-minute Apgar score, cesarean delivery, antenatal steroid treatment, multiple birth, and small size for gestational age. In 2000, 27% of infants received surfactant in the delivery room. There was wide variation among hospitals in the proportion of infants who received surfactant treatment in the delivery room (interquartile range: 0%–75%), in the median time of the initial surfactant dose (interquartile range: 20-90 minutes), and in the proportion of infants who received the first dose >2 hours after birth (interquartile range: 7%–34%). Six systematic reviews of randomized trials of surfactant timing were identified. No national guidelines addressing the timing of surfactant therapy were found.Conclusion. Although the time after birth at which the first dose of surfactant is administered to infants 23 to 29 weeks’ gestation decreased from 1998 to 2000, in 2000 many infants still received delayed treatment, and delivery room surfactant administration was not routinely practiced at most units. We conclude that there is a gap between evidence from randomized controlled trials that supports prophylactic or early surfactant administration and what is actually done in routine practice at many units.
Several benefits of multi-institutional specialty-based voluntary reporting systems such as the V... more Several benefits of multi-institutional specialty-based voluntary reporting systems such as the Vermont Oxford Network system are evident. They can identify errors that are rare in individual institutions but occur in multiple institutions. For example, on www.nicq.org, there were several reports of intravenous infusion of solutions intended for enteral use-a systems problem that can be prevented by designing enteral tubing and syringes that cannot be connected to intravenous tubing (a so-called "physical constraint").
... Creativity, innovation, and quality. Post a Comment. CONTRIBUTORS: Author: Plsek, Paul E. PUB... more ... Creativity, innovation, and quality. Post a Comment. CONTRIBUTORS: Author: Plsek, Paul E. PUBLISHER: ASQ Quality Press (Milwaukee, Wis.). SERIES TITLE: YEAR: 1997. PUB TYPE: Book (ISBN 0873894049 ). VOLUME/EDITION: PAGES (INTRO/BODY): xi, 316 p. ...
Virginia Mason, Lean, and Innovation A Leader in Lean Thinking in Healthcare Lean Thinking Basics... more Virginia Mason, Lean, and Innovation A Leader in Lean Thinking in Healthcare Lean Thinking Basics Creativity and Innovation Basics Virginia Mason's Chair of Innovation The Marriage of Lean and Innovation at Virginia Mason Medical Center Strategy as Innovation, Strategy for Innovation The Challenge of Innovation in Healthcare Seat-of-the-Pants versus Deliberately Planned Innovation Are You Guys Kidding Me? The Patient at the Top of a Pyramid! Four Strategic Pillars Support Pursuit of the Perfect Patient Experience Looking Outside for Insight: The Birth of the Virginia Mason Production System Gaining outside Insight on Innovation Evolution of the Strategic Innovation Plan Listening to the Voice of the Future Stimulating Breakthrough Innovation The Board's Role in Strategy and Innovation: You Have to Be on the Team Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation Strategy Leaders in Other Healthcare Organizations Should Integrating Innovation and Lean in Practice Debunking the Myth Integrating Lean and Innovation: Natural Overlaps in Tools and Methods The Marriage of Lean and Innovation: A Careful Courtship Innovation and Lean in Hospital Design Innovating in Primary Care Busting Assumptions about the Management of Medically Complex Surgical Patients Redesigning Surveillance of Healthcare-Acquired Infections Embedding Innovation Tools into the Structure of Lean Workshops Transforming Healthcare: What Others Can Learn from Virginia Mason's Integration of Lean and Innovation Tools Leaders in Other Healthcare Organizations Should Learning to Be Innovative Learning and Unlearning Key Concepts: Pedagogy, Andragogy, and Reflective Practice Creating a Learning Organization: There Are No Shortcuts A Quick Word about Leaders and Leadership Virginia Mason's Systematic Approach to Skills Development for Leaders Structural Practices that Support Innovative Thinking in Leaders Evolution of Training and Development for Innovation Virginia Mason's Innovation Competencies Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation Leadership Knowledge and Capability Efforts Leaders in Other Healthcare Organizations Should Supportive Culture for Innovation Dimensions of Culture that Support Innovation Innovation Culture Does Not Exist in a Vacuum Examples of the Seven Dimensions of Culture at Virginia Mason Describing Organizational Culture for Innovation: Portal Charts Assessing Organizational Culture for Innovation Virginia Mason's Assessment of the Dimensions of Culture that Support Innovation Innovation Culture Kaizen Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation Culture Efforts Leaders in Other Healthcare Organizations Should Supportive Infrastructure for Innovation Examples of Innovation Infrastructures in Leading Healthcare Institutions Infrastructure Evolves in Context The Kaizen Promotion Office (KPO): Supporting the Implementation of the Virginia Mason Production System Innovation Leadership Team (ILT): Providing Board and Executive Level Guidance for Innovation Center for Innovation: The Small Team behind the Scenes Information Technology Supports for Innovation: Browsing for Knowledge and Ideas Emerging Infrastructures: Innovation Grants and Moonshine Communications Infrastructure: Getting the Word Out about Innovation Center for Health Care Solutions: Catalyzing Breakthrough Innovations in Care by Supporting Uncommon Conversations Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation Infrastructure Efforts Leaders in Other Healthcare Organizations Should Bringing Innovation to Daily Work "I Swore I Was Going to Find a Way to Make That Never Happen Again" "We're Throwing Everything, Including the Kitchen Sink, at You" Bringing Fresh Ideas to the Daily Practice of Surgery KVM Radio "I'm Doing It Today, and Never Again" The Everyday Lean Idea System Making Things Better While the Moon Is Shining Informatics Practitioners: Making Better Use of Information in Daily Clinical Work Innovation Grants Process: Supporting Those with Potential Breakthrough Ideas Transforming Healthcare: What Others Can Learn from Virginia Mason's Innovation in Daily Work Efforts Leaders in Other Healthcare Organizations Should Using Patient Experience to Drive Innovation The Customers' Role in Innovation Evolution of the Strategic Focus on Service Imported from the UK: Experience-Based Design Experience-Based Design Meets Standard Work in a Clinic Understanding the Emotional Experience of Surgical Patients and Families You Can See a Lot by Looking I Am Sure That This Is What They Will Want The Roller Coaster of Emotion The Case of the Critical Care Unit Building the Infrastructure to Support Experience-Based Design Team Members Have Emotional Experiences Too! Transforming Healthcare: What Others Can Learn from Virginia Mason's Focus on Patients and Families Leaders in Other Healthcare Organizations Should Looking Ahead: The Future…
Quality improvement collaboratives are increasinglybeing used in many countries to achieve rapidi... more Quality improvement collaboratives are increasinglybeing used in many countries to achieve rapidimprovements in health care. However, there is littleindependent evidence that they are more cost effectivethan other methods, and little knowledge about howthey could be made more effective. A number ofsystematic evaluations are being performed byresearchers in North America, the UK, and Sweden.This paper presents the shared ideas from two meetingsof these researchers. The evidence to date is that somecollaboratives have stimulated improvements in patientcare and organisational performance, but there aresignificant differences between collaboratives andteams. The researchers agreed on the possible reasonswhy some were less successful than others, andidentified 10 challenges which organisers and teamsneed to address to achieve improvement. In the absenceof more conclusive evidence, these guidelines are likelyto be useful for collaborative organisers, teams and theirmanagers and may also contribute to further researchinto collaboratives and the spread of innovations inhealth care.
Part II of this three-part tutorial focuses on the logistics of data collection. The author prese... more Part II of this three-part tutorial focuses on the logistics of data collection. The author presents a checklist of things to consider when planning the details of a data collection effort; touches on the topics of bias and stratification; discusses examples of popular data collection methods; and points out some common pitfalls in data collection, offering practical tips on how to avoid them.
A “system” can be defined by the coming together of parts, interconnections, and purpose (see, fo... more A “system” can be defined by the coming together of parts, interconnections, and purpose (see, for example, definitions proposed by von Bertalanffy [1968] and Capra [1996]). While systems can be broken down into parts which are interesting in and of themselves, the real power lies in the way the parts come together and are interconnected to fulfill some purpose. The health care system of the United States consists of various parts (e.g., clinics, hospitals, pharmacies, laboratories) that are interconnected (via flows of patients and information) to fulfill a purpose (e.g., maintaining and improving health). Similarly, a thermostat and fan are a “system.” Both parts can be understood independently, but when they are interconnected, they fulfill the purpose of maintaining a comfortable temperature in a given space. The intuitive notion of various system “levels,” such as the microsystem and macrosystem, has to do with the number and strength of interconnections between the elements of...
Variation in outcome is a natural result from any complex biological or production process. Unfor... more Variation in outcome is a natural result from any complex biological or production process. Unfortunately, this variation can cloud our decision making and lead us to take inappropriate action. The control chart is a basic quality maangement tool that helps managers and clinicians make statistically sound decisions when analyzing outcome data from processes. In this tutorial, we will illustrate the problems inherent in taking action based on data that displays variation. We will then develop the statistical foundation for control charts and show an example of its use to analyze data from a pharmacy process.
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