Tuesday, February 16, 2010

The Model for Improvement, Lean and CCRMC: Much more than rubbish

A couple of weeks ago I was speaking at the Improvement Academy and there was a comment from one of our nurses, Grace, who said "While you all talk about all this statistics, I want to tell you about my week with the garbage." After the laughter subsided Grace went on to tell us about the PDSA she and others had conducted in the prior week. The group wanted to identify and standardize optimal placement of common items (in this example it was the waste bins) in a patient room to decrease clutter. The project was part of efforts to eliminate falls on the unit.
I'm sharing the PDSA below because it involves the use of The Model for Improvement and Lean(5S). My aim is to illustrate that these approaches (Model for Improvement and Lean) are not competing science, but in fact complimentary. We can and are using both the MFI and Lean together to facilitate changes that lead to improvements.

You can imagine the fun we all had talking about a PDSA that focused on the ideal placement of rubbish! In all seriousness, the staff tested their way into standard work. Does this sound familiar? This is an application of The Model for Improvement and Lean Methods, set in the context of our unique culture.

Much more than rubbish, this is a wonderful example of how we are using science, action and us to transform our system.


Here is the PDSA.

What is this PDSA aligned with? Why do this?:
Reducing harm - this test is connected to the aim to eliminate falls at CCRMC by June 2010.

This cycle is being used to, test a change?

What question(s) do we want to answer on this PDSA cycle?

AIM of this PDSA: Can we accomplish the following(?):

1. Decrease clutter in a patient room
2. Eliminate / remove cables when not in use
3. Make it easy for everyone to place items in the correct location

Plan to answer questions: Who, What, When, Where

Who's involved in this testing cycle?
Patient, Nurse, Charge Nurse, Housekeeper, PT/OT, RT and Dietary

What are they going to try and do?
Standardize placement of key items in patient room to minimize clutter and facilitate safe mobility in room.

Provide feedback on ease of furniture arrangement

Primary nurse:
Detach cables when not in use/ untether them from potential clutter
Monitor of furniture / equipment arrangement

Night shift nurse:
to clear overhead table before breakfast

Charge Nurse:
Label where equipment/furniture to be arranged in room

Environmental Services:
Keep / return equipment and furniture to designated area
Feedback on ease/feasibility of furniture and equipment arrangement

Feedback on arrangement of furniture/equipment

Feedback on location of their equipment.

Nutrition Services:
Will not place meal tray in room if overhead table is cluttered. This will need alternative.

When will this happen?:
• Will begin on 1/20/2010 for one week
• Assessment at end of every shift (except Sat and Sun)
• Make appropriate changes based on feedback.

Where is this going to happen?

3E -02 [IMCU]

Plan for collection of data: Who, What, When, Where (Yes we have to collect data)

Charge Nurse and Relief Charge Nurse to survey patient and staff with regards to new room arrangement.

What do we think is going to happen? Predictions (for questions above based on plan):

1. Easier to locate / predict where furniture/equipment are
2. Open space for patient to get in and out of bed
3. Room appears organized

Carry out the test this week; Collect data and begin analysis.
1. One unit, one room with multiple staff.
2. Survey questionnaire.
3. Label and place garbage can in one spot (red, blue and plain)
4. Stepping stool placed at designated area out of patient way, at bedside cabinet below monitor.

Study/what happened?
Complete analysis of data.

YES, the predictions were accurate.
-Everyone liked knowing where things go
-New lesson learned with regards to configuration of patient’s bed.

Act- so now what?

Are we ready to make a change...plan for the next cycle?

We think we are ready to try this on a bigger scale.

Nurse Program Manager to send an email to dietary manager to not place meal tray over the sink if overhead table is cluttered.

Charge nurse to present findings at next CCRMC Improvement Academy.

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