Tuesday, November 12, 2013

The word from Mt. Sinai

There’s some good stuff happening at Mt. Sinai Hospital in downtown Toronto, and I thought I’d take a moment to share examples with you. I was there because the folks at the hospital had invited me to give grand rounds and also to participate in some sessions with senior leadership and with their quality improvement champions. As is often the case, I learned more than I imparted, and I walked away impressed with the organization’s commitment to quality and safety improvement, transparency, and staff engagement.

Here’s one example. While I had heard about the concept of a patient navigator before today, including at my own former hospital, the navigator service was usually designed to help people of different cultural backgrounds maneuver through the complicated labyrinth of the tertiary care system. At Mt. Sinai, they have taken the concept to its logical conclusion, providing patient navigators for all general internal medicine, surgical oncology, and inflammatory bowel disease patients.

Here, for example, is Heather Siekierko, a navigator assigned to the “D” group of doctors and nurses serving patients in the general internal medicine area. When a patient arrives on the floor from the emergency department, Heather is already on the case, handling a multitude of tasks that previously would have taken time away from nurses or other clinical staff. Heather’s academic training? Fine arts!

With one navigator assigned to each of the four clinical teams, there used to be some confusion as to which person was assigned to which team. A doctor might spend time asking, “Are you in our group?” The problem was solved when a doctor suggested creating simple badges indicating each navigator’s group affiliation.

This program is supported by philanthropy, as the payment regime from the province of Ontario does not include funding for this kind of service. It is so effective, though, in terms of patient satisfaction and clinical improvement, that the hospital is working on a way to provide sustainable funding.

Here’s a second example, implementation of the Releasing Time to Care™ approach developed by the UK’s National Health Service. The focus is on team huddles, design of work flows, and attention to key clinical indicators--most importantly characterized by empowering front line staff to identify concerns and drive improvements themselves. As folks at Mt. Sinai have noted:

RTC is about changing the way we manage and do our work--it is not an "add-on" improvement initiative but rather a fundamental strategy that is embedded in the core works of our units and our team.

The program is supported and enhanced by a remarkable degree of transparency. Take a look at these charts—presented for all to see—on the walls of the clinical care floors. There’s no holding back when things do not go according to plan. Everyone is aware.

As you can see from these two falls-related pictures from two different floors, these presentations are not necessarily high-tech computer-generated graphs working off sophisticated databases: They are filled out by hand or constructed by the staff on the floor. People’s participation in creating the visible displays of key metrics is part of the process. They own the numbers, and when the numbers indicate problems, the team swarms on the issues and creates experiments of possible solutions. The feedback on the effectiveness of those experiments is quickly and clearly displayed to all in real time.

So that’s it for now. Two examples of thoughtful attention to the issues facing many hospitals. To the Mt. Sinai folks, this is a good start, but they are modest in their assessment of what has been accomplished. From my vantage point, this is truly front-line driven process improvement, enhanced by support from the senior leadership and from members of the Toronto community. The momentum has been building, and I, for one, expect to see great things in the future.


Naomi Kaufman Price said...

From Facebook:

Love the visuals: don't need high-tech to communicate what matters.

Paul Levy said...

Exactly right!

Paul Levy said...

Here's a more extenisve presentation on the patient navigator program: http://blogs.hbr.org/2013/11/inpatient-patient-navigator-program-reduces-length-of-stay/

Anonymous said...

Health Canada in Canada (including top-notch places like Mt Sinai) is free too!