Many thanks to Kandy Heinen and Michael Roetzer for providing an overview of the Perinatal Improvement Events.
When the Perinatal Value Stream Map was developed several months ago, the complex process that includes Pregnancy through Post Partum was divided into segments for opportunities for Rapid Improvement Events or Kaizens.
Kaizen #1, November 29-December 3 included Post C-Section/Newborn
Kaizen #2, January 31-February 4 included Post Partum Inpatient (Including Tubals)
Kaizen #3, February 28-March 4 included C-Section and Induction (Scheduled Deliveries)
As with all Rapid Improvement Events, each one builds on the successes of the previous Kaizens and Kaizen #3 was no exception.
The team that assembled on Monday included a Pediatrician, Doctors from the Perinatal Services and the clinics and a cross section of Nurses and other staff from Perinatal to the Operating Room. This was a relatively small but high power team of nine members that was able to focus on Scheduled Deliveries from the patient’s perspective from the clinic through birth, including processes around the Operating Rooms. The Executive Sponsors for this team, Dr. David Goldstein and Jaspreet Benepal were active and engaged throughout the process and met almost daily to assess progress, provide encouragement, and offer suggestions for areas to analyze.
The A3, the tool used to provide structure to the problem solution process, identified non-value added time as a problem for patients, before and after scheduled C-Sections. The goal, as defined in the Target Statement, was to “Reduce the wait time for new patients so that they are seen when they want to be/need to be seen.”
Upon analyzing the work, three teams were established to go to the various work places and assess how the work is being performed. These teams visited clinics, the Perinatal unit and Surgery and also contacted other Departments within CCRMC to gain insights into how processes now work and where streamlining might occur.
The team quickly identified two issues with lead time. First, there was a significant issue with the time between arrivals to incision times for C-Section patients and second, about 7% of induction patients were sent home without being induced because the gestational dating was not correct.
In early discussions, team members knew there were delays for scheduled C-Section patients and based on their experience, believed the delays might have been an hour or slightly more. After review of records, it became clear that the average delay in approximately two thirds of our cases was around three hours.
The team efforts, reported out on Friday, March 4 were impressive.
Here are some highlights:
• A new form that will be used by doctors to standardize gestational dating information, and assess the patient for readiness for delivery. This should ensure that patients who arrive at the Perinatal Unit are ready and will not be sent home.
• Education for doctors and nurses on the standard work developed by the Kaizen team to externalize some of the work to cut lead time and ensure patients are ready to deliver.
• Educate O.R. staff on a new process to ensure on time starts.
• Standard work to level load C-Section and Induction patients to spread scheduled cases across available times.
• Do patient education on topics such as skin-to-skin and breast feeding while the patient is in a prenatal visit and prior to admission whenever possible and in a private room otherwise.
• Test a process to pre-register to speed up registration and to have labels and other things delivered before the patient comes in.
• Enhancing patient privacy through the use of private rooms rather than the multi-bed triage room.
The success of this and previous Kaizens is in the work done during the Kaizen week followed by relentless follow up. The Process Owners, Dr. Judy Bliss and Margee Dean will continue to meet to review progress and to ensure that testing is carried out and appropriate adjustments are made.
This Kaizen was led by two of our 2010/2011 Change Agent Fellows, Kandy Heinen and Michael Roetzer. The Fellows, in addition to Kandy and Mike, include Miles Kotchevar, Wendy Katchmar, and Vernita Travis. These Fellows will be leading Kaizens 4, 5 and 6 which are scheduled over the next three months.