Perinatal Kaizen Overview Monday March 28th at 11:00 AM

“Whatever you do, or dream you can, begin it. Boldness has genius and power and magic in it.”
-Johann Wolfgang von Goethe

The Perinatal Rapid Improvement Event (Kaizen) #4 begins Monday, March 28th at 11:00 AM at CCRMC Building One, Conference Room One. The overview session which is open to all is 11:00 AM - 1:00 PM.

CCRMC Noon Conference/ Improvement Academy welcomes Thomas Burke, MD, FACEP

Photo source: http://fojailnohel.wordpress.com/2009/04/26/global-health/

Please join me at CCRMC's Noon Conference/Improvement Academy
Restructuring Health Care in Southern Sudan

Presented by:
Thomas Burke, MD, FACEP,
Chief, Division of Global Health and Human Rights
Department of Emergency Medicine, Massachusetts General Hospital
Associate Professor, Department of Surgery, Harvard Medical School

Thursday, March 24, 2011
12:15 - 1:00 pm
CCRMC, Building One, Conference Room One

National Quality Strategy

I will certainly write more on this very soon!

From Healthcare.Gov:
HHS released it's Report to Congress: National Strategy for Quality Improvement in Health Care

The National Quality Strategy will pursue three broad aims that will be used to guide and assess local, State, and national efforts to improve health and the health care delivery system.

•Better Care: Improve the overall quality, by making health care more patient-centered, accessible, and safe.
•Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and, environmental determinants of health in addition to delivering higher-quality care.
•Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.

Find the full report here.

Team Stats

For my husband on his birthday...

It begins with a story I have posted before. I have only changed one word. Instead of "eight" years, today marks "ten."

Even though today marks ten years, I can remember it so clearly. It was just a few hours before the clock struck twelve and it would be my husband’s birthday. He loves presents, but always makes it difficult for me to get the right thing. He acts as if his birthday doesn’t matter to him, but I do think he likes a bit of a fuss.

The message on my phone wasn't very clear. There was a great deal of background noise. I could hardly hear him say, “Call me now, it’s an emergency!” I tried calling several times, but he wasn’t answering. Finally, I called my father-in-law and I could have never predicted what would come next. His voice was different; it was slow and soft as he calmly explained to me that my husband’s brother had just killed himself. He was 26 years old. It was incomprehensible. I couldn't make sense of it. Even after years of working in mental health, I could not even begin to grasp what I was hearing.

There isn’t a day that goes by that I don’t think of him. He and my husband were best friends. Al was always there. He did everything with us. I remember he would come out on the boat with us. He never got out on the ski or wake board. He never drove either. He just liked to come along for the ride. He liked to spend time with his brother. The feeling was mutual. They were very close. Where you found one, you would very likely find the other.

It only takes a momentary glance to see the sadness in my husband’s eyes. I have come to know this silent sorrow all too well, because it dwells in our family. I have experienced other family members dying. I have talked about my father's death, which had a profound effect on me but this is different; there is a silence that accompanies suicide. The silence is deafening. Each December we are quiet, our conversation subdued, as his birthday passes and the holidays come and go. Then there is today’s date, and even though we rarely speak of the night he killed himself, we are all thinking about it. I don’t really know how to say it other than directly. I miss Alfred. I really miss him. There is so much silence. I wish we could talk about him more.

When speaking about her experiences with the National Alliance for Mental Illness (NAMI), Teresa Pasquini wrote, "We were on the same team that nobody wanted to be picked for..." I never told her at the time, but it is a brilliant description.

The team nobody wanted to be picked for.

As I put together the list of stats below I had a shocking and painful realization. I am on this team! It's amazing how I never noticed before. It's been ten years and it never dawned on me that the list below applies to me and my family. I never wanted to be on this team, no one does. Worse yet, because of the stigma and silence that surrounds suicide, excluding a relatively small number of people, one knows very little about others on the team.

Like me and my family, about 3.7 million people in the U.S. currently mourn a loved one’s death by suicide, and the number grows by 190,000 each year.

So as you read the numbers below, I'd like you to consider this not as simply a list of bad news. Sadly, these are my teams stats.

Some facts about suicide from the World Health Organization (WHO)

•In the year 2000, approximately one million people died from suicide: a "global" mortality rate of 16 per 100,000, or one death every 40 seconds.
-It's 2010 now! How many have been lost? Read the next line--too many

•In the last 45 years suicide rates have increased by 60% worldwide. Suicide is now among the three leading causes of death among those aged 15-44 years (both sexes); these figures do not include suicide attempts up to 20 times more frequent than completed suicide.

•Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998, and 2.4% in countries with market and former socialist economies in 2020.

•Although traditionally suicide rates have been highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of countries, in both developed and developing countries.

•Mental disorders (particularly depression and substance abuse) are associated with more than 90% of all cases of suicide; however, suicide results from many complex socio-cultural factors and is more likely to occur particularly during periods of socioeconomic, family and individual crisis situations (e.g. loss of a loved one, employment, honor).
- WHO

Unfortunately the list goes on.

There are however so many amazing people working to change these stats. I'm inspired by Contra Costa Crisis Center. When I read their Strategic Plan I noticed the number one objective listed was to "help people at risk for suicide stay alive." I recall reading the newsletter they sent out earlier this year about perfect depression care. I love the bold aim. I believe in bold aims. I also noted that they looked to The Henry Ford System's Depression Care Program for inspiration. What a great model. The rate of suicide in Henry Ford's patient population decreased by 75 percent from 89 per 100,000 patients to 22 per 100,000 in the first four years of the program's implementation, significantly lower than the annual rates for suicides in similar patient populations. For the last two and a half years, that rate has been zero per 100,000!

So many lost, so many left behind, all preventable...and with bold leaders like these, there is hope.
~Anna

Many thanks to Hive Strategies for the generous comments about my blog. I'm humbled to be included in this group of bloggers.

I found the Hive Strategies Blog very interesting and inspirational as well. The Core Values are fantastic. Well worth the read!

http://www.hivestrategies.com/2011/03/sometimes-you-need-a-little-inspiration/

Perinatal Rapid Improvement Event (Kaizen) Overview

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.

The Kaizens to date have covered:
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.