It was only a few years ago that there were no red lines on the wall behind the beds in CCU –anyone providing patient care could only guess at what 30 degrees looked like. What was a Bundle? We couldn’t go for months without a Ventilator Associated Pneumonia (VAP). When I reflect on it now, it almost seems we planned care knowing that assisted breathing was inevitably, or at least understandably, going to be accompanied by pneumonia. It was hardly imaginable that we could go months without a VAP. Now VAPs and many other serious hospital-associated infections/complications are rare because of the innovative work of our staff. When I was initially trained as a nurse – not the formal school-based training but the ward/unit training which was something different altogether – I was taught that our 'rapid response,' commonly known as a Code Blue, was a team of highly skilled clinicians that rushed to a patient in need of respiratory or cardiac rescue/resuscitation. Today we have rapid response teams (Medical Emergency Teams, RRTs, etc.) that quickly bring additional needed assessment and care to patients when they first exhibit signs that may signal a dangerous decline in health – in most cases before a Code Blue.
Thankfully, things are changing here and everywhere. I find strength and inspiration in the stories from the bedside of those who are committed to improving health care. We are increasingly recognizing and embracing the fact that the use of improvement science does improve health and does so in dramatic and revolutionary ways. Our monthly Rapid Improvements Events are example of the ongoing improvement work in our delivery system.
As promised, here are the slides from last week’s Rapid Improvement Event (Kaizen) on the medication refill process. Many thanks to the staff from the front line and Patient and Family Partners who are working hard to improve our system for everyone. Your efforts are greatly appreciated. I also want to thank our team members who came out to support these teams. Improvement is hard work and your support is crucial.
Refusing to Settle
In spite of all the results seen here and around the world, why is it that improvement, led by front line staff, patients and family members continues to feel as though it is regarded as a "soft" or support activity? Improvement is about the work of saving lives.
We must be committed to driving defects and non-value-added activity out of what we do. I will stand with all of you, who are dedicated to serving our community and improving our system, to continue to focus on and pursue our mission.
George Halvorson in his book Health Care Will Not Reform Itself, states "the alternative to courage and focused action is a continuation and probably a worsening of the status quo." Many will agree that it takes acceptance, willingness, courage, caring and honest exchange to engage in a change effort. It also takes constancy of purpose and discipline.
There are many distractions along the path to an improved and sustainable system. The inertia of the status quo and pervasive nature of the health care industry's hierarchical culture can seem impossibly strong. Many have mastered the current state; their power, position and self-image may be derived from that mastery. Many believe that more of the same is good enough. I believe that to seek a new order, to resist the urge to 'settle,' to stand up and lead a transformation effort, is indeed the work of the courageous. It is our work. It is work we must do together. However, the first step is to change ourselves - which may be the most difficult step of all. Many will settle, taking refuge in the status quo. I will not.
What will you do?
More very soon,