Progress, bit by bit

A hodgepodge of items, illustrative of things here at BIDMC and elsewhere:

Doctors working on Lean

First, excerpts of a note from Dr. Clif Saper, our Chief of Neurology, to his faculty and residents, about Lean training and going to gemba. We are getting a great response from the doctors as they learn to apply this approach to the work of the hospital:

I want to thank everyone for coming to the departmental meeting with the Lean group on Wednesday. I hope you enjoyed the introduction, and are as excited as I am about the potential for engaging all of our group in redesigning our work. The key take-home point I want to make is that this has to be a ground up effort, by the people actually doing the work. The goal is to empower you at the front line to redesign your workplace. This will not be easy, and it will not be quick. In fact, we do not expect to finish, ever, but to gradually refine our approach, on a continuing basis, over many years.

The homework for the first month is to “go to gemba” to see how our workplaces function, from the point of view of patients (who are our “customers”), our own docs, referring docs, and the staff who enable our work (front desk group on Shapiro 8, nurses and ward clerks on Farr 11).

I would like each of you to go to gemba (choose your site, but I expect that the residents will mainly concentrate on Farr 11 and the attendings mainly on Shapiro 8, but if you have a passion for the other site, please by all means indulge it). Take a pad of paper, and a watch with a second hand.

I would like you to decide to watch the process from the perspective of one individual (or type of individual, as you may end up watching more than one) in the gemba. For the clinic, you may choose a front desk worker, a physician, or a patient. For Farr 11, I would like you to watch morning rounds (some segment between 7am and noon) from the perspective of a ward nurse, resident, or patient (or patients if you choose more than one). Please write down on your paper a running list of what you observe, in the order you observe it, and try to time the different components of the process. Please plan to do this for at least one full hour, some time in the next three weeks.

The goal is to discover wastes (you will need the list of the 8 wastes that you received at the meeting). If you lack a copy of the list, please email Gregg Ramsey, our teacher on Wednesday, and he will send it to you by email.

Remember to announce yourself to the staff and doctors you observe. Just say that you are participating in the Neurology Lean project, and are there to observe today, to try to improve the patient experience. Please announce yourself also to patients (or have the doctor you are following do so), and ask their permission for you to observe.

I would then like to set aside some time before our next meeting on July 7, to review with groups of you what you found. My hope is that your own discoveries will allow us to divide up into working groups to tackle issues that we identify.

I look forward to seeing what you have found....

Surgical results

Next, a note from Dr. Charles Vollmer, who heads up our pancreatic surgery program with Dr. Mark Callery. The note is to the doctors in a number of departments who support this program:

This week Mark and I celebrated a significant milestone with the performance of our 600th major pancreatic resection over the last 8 years together here at BIDMC. This has come with an overall perioperative mortality rate of 1.3%, as well as other benchmark quality outcomes.

As you can tell from the size of the address string above, this has not come solely at our hands, but rather has been achieved by a collaborative effort among some of the world's finest doctors in the field of pancreas care. We are indebted to your skill, acumen, foresight and friendship. With continued dedication and hard work, we look forward to sharing further accomplishments with you.

Odds improving in Las Vegas

This quote from an article from Deloitte:

Las Vegas employers push hospital transparency, performance

Last week, the Health Services Coalition, a group of 24 self-funded insurance plans representing large employers in Las Vegas advised 13 area hospitals that they would direct their 260,000 enrollees to Intermountain Healthcare facilities in neighboring Utah if quality and transparency efforts did not improve. Specifically, the 20-year-old business coalition is seeking to change incentives from volume to quality and efficiency.

NHS puts it out there

And finally, this report from The Guardian about the British National Health Service's real-time clinical transparency.

The new government's information revolution rolled into hospital wards with the publication today of rates of hospital-acquired infections, such as MRSA, on a weekly basis.

Andrew Lansley, the secretary of state for health, confirmed that from today people will be able to check the weekly meticillin-resistant Staphylococcus aureus MRSA and Clostridium difficile (C diff) rates at their local hospital. He also published 12 weeks of data, giving the public their first view of the level of detail the department has been able to obtain.

From early next month, infection figures for all hospitals in England will be published every seven days on data.gov.uk. In March, there were about 20 outbreaks in English hospitals of MRSA, whereas by May this appeared to have dropped by half.

Previously, the infection rate for MRSA and C.Diff at NHS hospitals were released on a yearly basis and as an average for each NHS trust - which may comprise several hospitals.