Thursday, January 24, 2013

Inspired at Children's Mercy Hospitals

I have visited dozens of hospitals over the past two years, spreading the gospel codified in the upper right-hand corner of this blog--patient-driven care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement.  My audiences are invariably polite and engaged, and I try to leave them with a sense of the possibilities before them.  I know that some are inspired to take action, and some are not.  I sometimes wonder if I make a difference.  Is there a more useful way to spend my time?

And then I visit a place like Children's Mercy Hospital in Kansas City and get a jolt of renewed energy and optimism.  And, lo and behold, they tell me that I help do the same for them.  What karma!

I had a jam-packed day at CMH today.  First, it was multidisciplinary Grand Rounds, with a presentation to several hundred people in the auditorium and outlying facilities.  Here's my host, Executive Vice President Karen Cox.  The theme:  "These Things Happen: How Harm Occurs in Hospitals and What We Can Do About It."

But then I got to see the team in action.  I attended the Daily Safety Update, a short (9:10-9:30am) huddle of people from throughout the hospital reporting on operational matters and other issues that could affect patient safety.  It is chaired by Jason Newland, medical director for safety, and Cheri Hunt, chief nursing officer (seen here).

One of the things that Lean organizations do is to promote and encourage standard work in clinical and operational settings.  But managers have to engage in standard work, too.  You may recall that Virginia Mason's COO, Sarah Patterson, explained this when she discussed important aspects of daily management: 

Elements of daily management = leader standard work + visual controls + daily accountability process + discipline.

Whoa! Leader standard work, too! What a concept. Can't be "too busy" for this!

With leader standard work made visible, staff now know, "Oh that's what leaders do!"

The CMH people have put this into place in a clear and effective way.  All participants in the meeting orally fill in the chart of a daily operational report covering key areas.  The reporting is efficient and direct, with areas of action set forth.  For example, Rachael Dameron (above) presented data on the total number of ventilators in use in the various units of the hospital, staff on site last night and today, and any key events.  Meanwhile Sherry McCool (below) reported on transport:  How many runs in the last 24 hours, how many missed runs, how many delayed runs, and anticipated concerns for the next 24 hours.

The Daily Safety Update has created precursor and following events.  Pre-huddles occur in the departments beforehand, so that the required data and status reports will be accurate.  After the 20 minute meeting, subgroups will often coalesce to follow up on issues raised during the huddle.

CMH is not the only hospital that engages in this kind of huddle, but the process they use is as effective as any I have seen.

The rest of my morning was spent with people who work on programs to increase patient involvement in the hospitals' delivery of care.  CMH has several family advisory boards, volunteers from the community who work with the hospital staff to help deliver more patient-centered care.  Here, for example, you see DeeJo Miller, a family centered care coordinator, with Terrance Gallagher, a patient's father, who volunteers his time on one such FAB.   DeeJo is one of the hospital's "parents on staff," paid people whose job functions include special attention to the needs of patients and families.

Among other things, DeeJo and her colleagues conduct educational programs for residents on the issue of patient- and family-centeredness.  One part of that curriculum is to send residents on in-home visits, to see patients and families in their real life settings.  She presented some verbatim reactions from some of the residents as their eyes were opened to life "out there."  Here's a small sample:

Thoughts or concerns prior to your visit:

Looking forward to seeing a family's house.  Dreading the fact that it was 2 hours.  I didn't really know what I was supposed to do.

Tell us about you in-home visit:

It was more laid back than expected.  the whole family was involved.  Mom stated at the beginning that there is "no wrong way to ask a question."  Helpful to talk to the sibling.

What strengths did you see in the family?

Amazing support among the siblings.  "Supervised independence"--The parents let the daughter manage her diabetes; however, they always check on her and double check what she is doing.  They do it in such a discreet way the daughter may not even realize that they are checking on her.

What surprised you the most?

Daughter was insulted by the doctor's attempt to equate her insulin pump to video game Mario Cart.  She said it was "cheesy."  High functioning children--they were more adult-like than kid-like.  Don't remember what life was like before the diagnosis.  child's openness, how much she knew and verbalized what she didn't want to talk about.  Child's attitude mimicked Mom's attitude.  The normalcy of it all. 

What, if any, is the value of meeting in the home versus meeting somewhere else?

Made me think about the difference between just telling a family what to do and realizing how much work it takes to follow the instructions.  Makes you think more about making sure that the family has what they need for home.

I sat admiringly through all these sessions, which demonstrated a thoughtful execution of the principles I mentioned at the start of this blog post.  But I was even more impressed by the constant, "What do you think of this?"  "Can we do it better?", questioning I received from the staff as the day went along.  This is a group of people who are discontented with the status quo, who are modest about what they know and what they have accomplished, and who insist on getting better.  I was told later than my visit gave them a shot in the arm, a reminder of what is possible, but it was actually they who did that for me.  What a marvelous day with marvelous people!


Anonymous said...

Re home visits, if the residents got nothing more out of it than this,it would be worth it:

"Made me think about the difference between just telling a family what to do and realizing how much work it takes to follow the instructions."

As the daughter of a 91 year old who was completely flummoxed when asked to add an evening pill to her already-difficult regimen of morning pills, I beseech all physicians to pay attention to these issues - simple to you, but not to us.


Anonymous said...

An amazing, memorable day that will push our hospital to a new level. Your thoughtfulness in your blog and throughout your visit is a great example on how to be an effective and great leader. Even though you were at CMH for one morning you helped invigorate a hospital in more ways than ever can be imagined.

Anonymous said...

The hospital was 'a buzz' all day with excitement around your visit. The residents I rounded with this morning and afternoon talked to me more about quality and safety today than ever before. Thank you so much for a great day and for re-invigorating all of us.

Kourtney Govro said...

Paul, I am so pleased that you had a chance to experience one of the best hospitals in the country - my children (all of them at one time or another) have been patients. Children's in KC is why I started the company - the challenge of how do we do it better was on the lips and minds of EVERY individual. I am constantly blown away by their willingness to innovate and their ability to motivate and move a giant team of individuals towards a common goal. We in KC are truly blessed to H&R such an organization! Thank you of your post and sharing with your readers about our jewel.


Posey Plays said...

CMH is our hospital, so I am glad to hear it is so highly regarded! We've been through several clinics -- some of course better than others -- but always professional. I hope that people like you and the folks at CMH will continue to work on great healthcare for our kids!

Anonymous said...

Your lecture was wonderful and inspiring. I am currently in an MSN program and your lecture, book and what we are doing here gives me much excitement and validates what I am studying right now. I love working towards improving quality and safety and am proud to be a part of what we are doing at CMH.

Paul Levy said...

Thank you so much!

Miriam Kaufman said...

I was fortunate enough to visit and speak at CMH recently. I was also hugely impressed by their enthusiasm and the thoughtful way in which they set priorities and plan new things. When a vice president introduced one of the events and said "We aren't doing this because it will save money. We aren't doing this to be more efficient. We are doing this because it is the right thing to do" I was blown away. As a Canadian, I didn't expect a high-ranking executive to have his eye on anything but the bottom line. CMH rocks!

Rachael said...

Thank-you for spending time with us this week and your compliments in your blog. We continually strive to improve our processes to ensure the best experience for patients and families during what may be the most difficult moments in their lives.Your recognition of our hard work has made me beam with pride for being part of the something special that is Children's Mercy Hospitals and Clinics. Thank-you! And I agree with Ms. Kaufman CMH rocks!

Anonymous said...

I too very much enjoyed your Grand Rounds presentation and am looking forward to reading your book. So much of what you said was inspiring, but what really meant the most to me were your points about treating people with respect and with the intent to help them be better. When that happens, everyone is made better. It seems so simple, but not always as easy to practice.