-What factor(s) trigged the initiation of CCHMC’s continuous improvement program? Cincinnati Children’s Hospital Medical Center” (CCHMC) details how one institution has implemented its own version of health-care reform, taking overall performance levels from well below average to the top 10 percent in the industry. The leadership of CCHMC did a great job of tackling important problems and engaging people throughout the organization in solving them. One of the key players is Dr. Uma Kotagal, a neonatologist with a deep-seated passion for improving the quality of care at CCHMC.
In 1996, when Jim Anderson is named CEO, he convinces Kotagal to lead the hospital’s improvement efforts as senior vice president of quality and transformation. Anderson, a practicing attorney with expertise in the quality improvement methods used by manufacturing firms, is joined by Chairman of the Board Lee Carter, who articulates his vision for the hospital as, “We will be the best at getting better. ” The complexity of patient care and the prevalence of system failures created opportunities to improve the reliability and efficiency of the systems through which care was delivered.
The improvement effort at CCHMC gains real traction in 2002 with the award of a $1. 9 million Pursuing Perfection grant from the Robert Wood Johnson Foundation. In addition to funding an improvement-science training program, the grant requires that the hospital undertake improvement projects. Hence, Kotagal develops hospital-wide protocols with proven efficacy—for example, implementing a “forcing function” into the operating room process that keeps patients out of the OR until they’ve received antibiotics, thus reducing surgical site infections.
For another project, she selects the hospital’s Cystic Fibrosis (CF) Clinic, in part because its head physician was the only division leader who showed any interest in participating in improvement initiatives. These factors along with the change in the vision and new leadership triggered the initiation of CCHMC’s continuous improvement program. -Which factors were the most critical for CCHMC to establish a successful continuous improvement program?
a)One of the crucial factors which CCHMC had to take into consideration for successful continuous improvement program was an internal assessment. Because grant guidelines required CCHMC to disclose its performance, however, the CF Clinic’s participation resulted in some serious soul-searching.
Founded in 1883 as an academic medical center, CCHMC had considered itself to be among the best hospitals in the country, even though it had scant evidence to benchmark its performance against others. But data co-collected by the Cystic Fibrosis Foundation instead showed that the outcome for the clinic’s juvenile patients measured at the 20th percentile.
So hospital staff tackled the situation head-on, finding that the data galvanized families rather than angering them. The clinic went on to change its processes and communications based on input from seventeen patient-parent team members. Six years later, CF patient outcomes had risen to the 90th percentile. b)Another key factor was the leadership inside the organization. Anderson really stepped up for this. Instead of setting typical financial goals such as growing revenues by 15%, the new strategic plan called for a dramatic improvement in the delivery of care.
It is really crucial to have a management which comes from a such a background where they not only promote something but believe in it strongly. c)Another important factor was Kotagal’s efforts to create a culture of improvement throughout the hospital. Her strategy included the use of employees who serve as internal quality improvement consultants, as well as an in-house education program on improvement science that emphasizes rapid cycles of small-scale change. All these played a crucial part in the success of the improvement plan.
d)When we look at the case, we also see that transparency and acceptance helped a lot in the implementation of the program. Sharing the data and results with the patients and their family really helped in getting them motivated rather than making them skeptical. This was taken really positively and helped in making a great deal of success. e)Collaboration between units and medical specialties played a large role in the hospital’s approach to improving patient outcomes. The hospital tried to align incentives to facilitate collaboration.
For example, they streamlined the flow of patients through the hospital was enabled by rewarding overall hospital performance rather the performance of individual departments. f)Training and development is always essential although is ignored by most of the large organizations. CCHMC’s in-house education program I2S2. I2S2 emphasized rapid cycles of small-scale tests of change, which enabled quick learning and avoided resistance to larger scale. -Which techniques from class did CCHMC use in their continuous improvement program and how were they used?
A lot of concepts and techniques used by CCHMC are ones which we already covered in the class. I have tried to capture the most relevant ones – a)In our first class we covered the various steps to close the gap in healthcare spending and we touched upon points like customization based on patient needs and values and using the patient as a source of control. CCHMC does implement this for their CF center and makes parents as CF improvement team member. b)One of the other topics which we talked about how sharing information among hospitals and different units can benefit all.
We can see examples of implementation of this throughout the case when the CCHMC physicians and medical groups go down to the other top hospitals to learn process improvements from them.
Also, collaboration is promoted and fostered by the new leadership by rewarding overall hospital performance rather than the performance of individual departments. c)One of the important topics we discussed in class was the importance of matching supply with demand. The CCHMC hospital tried to get patients for the right period of time and worked on decreasing infections and hence reducing the patient’s length of stay.
This altogether resulted in meeting the unmet demand of their services. d)As we stressed upon the importance of data, similarly in the case the hospital gets the data for all its services and benchmarks it’s against all the other hospitals and is shocked to see the results. Being transparent was a part of the process. But this led the doctors and physicians to believe that what they were doing was not good enough and they had to change the process and do much more. Seeing the result of the surveys and data collected from the past really helped in motivating the whole system.
e)Intermediate Improvement Science Series taught Pareto Principle to the participants. Histograms were used to plot the frequency of each problem class in descending order. For example, they used a histogram to track adverse events in pediatric cardiac surgery. This helped in prioritizing their improvement efforts as we discussed in the class. f)Importance of critical patients first. Trying to deal with Level 1 kids before the other patients. This is something we covered in class under priority and sequencing rules.
g)CF clinic created a check sheet to ensure the patients didn’t leave the clinic until all required caregivers had met with the patient. This was something which we discussed in class under Patient Acuity systems where we tend to focus more on patients who needed more care. h)Other important techniques included engaging the lower levels of the medical divisions, quality improvement consultants, implementing change by testing small groups and taking small steps rather than large.