Navigating Changes to Transform Care

Tuesday, 19 November 2013: 10:00 AM

Caryn Douma, RN, MSN
Women's and Children's, Children'sMemorial Hermann Hospital, Houston, TX

Changing healthcare delivery models to align with future organizational needs requires visionary leadership and an innovative strategy that incorporates both lean processes and clinical practice quality improvement techniques designed to deliver high value, high quality patient and family centered care. Combining change management methodologies utilizing the IHI Perinatal Community collaborative framework and a clinical microsystem assessment process, an interdisciplinary team was formed and performed an intensive assessment including systems mapping and data collection. Process maps for each process were created, enlarged with data and displayed in a central location. Staff and physicians validated the findings and assisted with project prioritization and strategic plan development ultimately aligning with organizational priorities.

A selection of prioritized clinical improvement and process flow projects were divided into three phases: quick wins, rapid improvement projects including Kaizen’s and Plan Do Study Act cycles, and longer term strategic plans. Process changes included improving discharge processes, improving flow through labor and delivery, decreasing triage wait time and processes. Frontline staff and physicians participated in quality improvement training and were an invaluable source of information and enthusiasm. Dashboards were put in place to monitor progress and sustain gains.

 A new interdisciplinary model of care with the primary focus on mothers, babies and families was implemented and sustained including targeted clinical practice changes such as implementation of an Oxytocin Bundle, Hemorrhage Protocol, Safety Rounds and Shift Huddles. The improvement processes were designed to provide safe, effective care and decrease cost, increase efficiency and improve patient and family satisfaction. The journey continues to be a work in progress with internal and external forces creating challenges and opportunities while adapting to a constantly changing healthcare environment.