Hospitals need “SWAGGER”

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Did you know that Hospital Value-Based Purchasing (VBP) is part of the Centers for Medicare & Medicaid Services’ (CMS’) long-standing effort to link Medicare’s payment system to a value-based system to improve healthcare quality, including the quality of care provided in the inpatient hospital setting?

Also the program attaches value-based purchasing to the payment system that accounts for the largest share of Medicare spending, affecting payment for inpatient stays in over 3,500 hospitals across the country.

Basically participating hospitals are paid for inpatient acute care services based on the, “QAULITY” of care, not just, “QUANITY” of the services they provide. To make this simple the government has asked hospitals to perform on certain processes with flawless execution. Hospitals that do not perform will not receive reimbursement. Understand some of  these processes if not done correctly can harm or kill a patient.

These processes all start with the first step and end with the last step. The definition of the word SWAGGER is as follows, “walk with confidence”. If hospitals want to regain or create SWAGGER in regards to patient care they must start by walking in confidence as how to execute on processes.

Here are some high level steps to begin your SWAGGER journey:

  • Empower frontline employees i.e. nurses, housekeeping etc..to express how they can improve processes.
  • Explain to physicians, surgeons’ administrators, and hospitalist, and all staff that if we are not at 100% for all VBP criteria we have to change. Start the political dialogue to come to a bi-partisan agreement.
  • Incorporate the use of a Lean / Six Sigma tools known as GEMBA, Cause and Effect, Measurement System Analysis, etc…to determine root cause for none optimal performance
  • Educate and socialize to all staff the latest VBP score so that they understand how they truly play a role in the care of the patient. I don’t feel that everyone understands what VBP is or how they play a role in the success.

If you’re a hospital employee and you know you’re not 100% successful on your VBP contact  us we want to help you help your patients.

How Lean can create a safe Operating Room (OR)

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What is if you or your love one were having open heart surgery, and the surgical instruments were dirty? What if the anesthesiologist had to keep you unconscious longer than expected because the instruments that were needed to complete your surgery had to be cleaned for an additional hour or there were not enough instruments in the building?  There is a machine known as an Autoclave, it uses high temperature, steam and pressure to clean medical instruments and to perform sterilization. When the Autoclave is used it is known as Flash Sterilization.  The worst case Surgical instruments can be cleaned at (132 C, 270 F for a max of 30 minutes). The goal for all hospitals should be for ( 0%-.5% ) of surgical instruments go through flashing, I have seen some hospitals at ( 4% – 6.6%) !  The dangers that this can cause could result in death. Surgical instruments are sent to what is known as SPD (Sterile Processing Departments) In an SPD, the purpose of the department is designed for one thing: the preparation, assembly, and sterilization of instruments for surgery. This process is human manual. It reminds you of washing very complex dishes and assembling very complex puzzles. Thus, the staff has to be very knowledgeable of cleaning and assembly. Also with access to the autoclaves only a few SPD staff have this privilege. The autoclave zone is not visited by staff who have patient contact. This minimizes the potential for contamination. How can Lean help reduce or eliminate this situation? Here are a few high level steps that have been personally proven.

  • Complete an analysis on the top 5 types of surgeries per surgeon
  • Determine the volume per surgery type per surgeon
  • From the volume and, on an as needed frequency you can create a stock replenishment schedule for instruments
  • Using a Lean tool known as 5S complete an inventory assessment of current instruments per surgery type per surgeon. These instruments will be neatly stored in visible sterile packages
  • Using a Lean tool known as Kanban create a visual signal to show when and instrument needs to be replenished
  • Using a Lean tool known as standard work, train the SPD staff as to how to clean the instruments repeatedly the right way every time
  • Monitor the Autoclave usage and complete a needs request form before and after the use of the Autoclave for flashing. You need to know why there is an unplanned need to have the instrument cleaned                                                                                                                                                                                                                                                                                                                                                                      If your Operating Room is Flashing more than .5% please contact us !

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Physicians need to be involved in your Kaizens

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Physicians love Kaizens

Kaizen is a Japanese for “improvement.” When used in the business sense and applied to healthcare, Kaizen refers to activities that continuously improve all functions and involve all employees from the CEO to the house keepers. For what ever reason front-line employees in healthcare are a bit apprehensive to approach physicians. No one wants to tell a physician about process improvement, safety, or efficiency. Kaizen is another Lean tool that is created to take a part a process and improve it for the good. This is accomplished by involving everyone.

Here are some proven suggestions:

  • Make sure the event truly impacts to the patient…no pet peeve initiatives.
  • Make sure during your Kaizen the use of tools such as 5Y, process maps, value stream maps, and baseline statistical data is being shared and reviewed.
  • Truly define the problem with real data no anecdotal information, but rather data that you have gathered and processes that you have seen.
  • Make sure the physicians understand the impact that your making for them and the patient .be strong and committed to your cause. Demand respect at all time because your there for the patient at the end of the day.
  • Listen to the physician’s points of view from end to end of the process, let them explain their normal process. Be leave it or not, not all physicians understand Lean. Listen to their voice. The bible says be quick to listen. I call physicians,” competitive scientists”.  Invoke some competition.
  • Ask the physician for their help as a team member to solve the problem, you want them as a part of the campaign, not as a walk bye expert.
  • Be honest and brave, stop thinking that physicians are the, “devil’, they really do care!

 

 

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The 5y’s of perfect patient care

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The 5 Y’s for perfect patient care.

On of the greatest common sense tools of Lean is the (5Y) analysis.  This tool simply ask’s Y (why)  5 times. The following is a result of me asking for the 5Y’s for perfect patient care .

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Reduce 30 day Readmission for Congestive Heart Failure

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Reduce 30 day readmission for Congestive Heart Failure (CHF), once the patient leaves the hospital the 6SigmaTek way.

The following steps are what I personally used to reduce my father’s 30-day readmission rate for CHF. My father has CHF, diabetes, high blood pressure, he has to take two types of dialysis six days a week, he has two Ziploc bags of meds that he has to take daily, he weighs 98 lds., and I thank God for him every day. But he will eat a bag of hot skins and drink a beer to watch football (Roll tide)! Here is what I did (to) him to keep him from returning to the hospital in 30 days or less.  Home health, and the physician must discuss with the caregiver and the patient about the process and the importance of being compliant prior to these steps. I feel that the patient truly needs to understand they have a responsibility also or they will feel the consequence.

 

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Decrease ER wait times – admit the 6SigmaTek way.

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How to decrease wait times from your Emergency Department to patient discharge or admit the 6SigmaTek way.

If your hospital is experiencing long length of stay, patients leaving without being seen, patients leaving against medical advise? Here is our high level approach.

1. Provide 6sigmaTek with one year of ED data from your EMR.

2. From your data 6sigmaTek will create an electronic model and analyze the busiest day, time of day, volume of patients ,and acuity of patients.

3. From the data the busiest day and time will be chosen. Then the 6SigmaTek CEO will dress up as a secret patient and present himself with a severe stomach ache. He will have no i.d., no insurance , but will have a cell phone with a Value Stream Map app and will be timing how long each process takes to complete.

 

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Time of Reflection

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Every year during the holidays I become sad due to the fact my only brother passed away 17 years ago. His passing is what ignited me to start 6SigmaTek www.6sigmatek.com. My brother died of CLABSI , which still infuriates me. I use this tragedy to fuel my companies passion toward perfect healthcare outcomes. Have a happy holiday and be safe to all.