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Safer. Better. Faster.

Guess who has the best ideas to improve patient safety? The people on the front lines.

The mandate was simple: Make your unit safer.

The path to get there — laden with history, procedures, previous attempts, protocol and layers of authority — was a bit less so.

Such was the challenge presented in fiscal year 2013 to the staffs of 4 West Children’s Seashore House and 5 East of The Children’s Hospital of Philadelphia, known during the rapid-cycle improvement initiative’s pilot year as “Innovation Units.”

Asking the Bedside Experts

Initiatives to improve quality and patient safety at CHOP were nothing new. But there was a difference this time: Front-line staff would decide what to change and precisely how to do it.

The approach came from the logical notion that “change happens best when it’s closest to the sharp end — the people on the front lines,” says Ellen Tracy, MSN, RN, NEA-BC, director of medical and subspecialty nursing and one of the project’s sponsors.

Unit staff were given tools — safety and satisfaction reports to identify areas for improvement, a structured approach to change, and support from the Hospital’s highest levels — but the steps they took to get there were entirely their own.

A Wellspring of Ideas

More than 70 physicians, 120 nurses and other team members began identifying ways to improve safety. In weekly meetings, they covered white boards with ideas, emailed more thoughts, and eventually amassed more than 150 ideas to improve patient safety, communication and family satisfaction.

Next they worked on prioritizing, scheduling and seeking any necessary outside help from areas such as Infection Prevention and Control and Information Services.

“Most of the projects required multiple plan-do-study-act cycles,” says attending physician Evan Fieldston, MD, MBA, MHSP, medical director of care model innovation and the initiative’s other sponsor. “With each project, we trialed a change, studied whether it accomplished our goals, and then adopted it, adapted it or abandoned it.”

Since communication was identified as key to improving quality of care and patient safety, the unit-based teams implemented daily communication huddles, change-of-shift safety reports and multidisciplinary rounds that sought input from everyone involved in a patient’s care, including families.

From Skeptic to Champion

Some sharp-end staffers, like Mary Ann Gibbons, MSN, RN, a 28-year CHOP nursing veteran, were initially skeptical. She’d seen many an initiative come and go. Today, she is rapid-cycle improvement’s biggest champion.

“I thought it was just the flavor of the month, but it was so much more,” she says. “Today, change is happening at the bedside — not just the boardroom — and we all have a voice in the changes being made.”

After a year of work, staff members on the two units have completed more than 50 rapid-cycle change projects resulting in improvements on nearly every measure — from care coordination to nosocomial infections, from medication safety to length of stay. Patients are safer and families are more satisfied with their care.

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“Most of the projects required multiple plan-do-study-act cycles,” says Evan Fieldston, MD, MBA, MHSP. “With each project, we trialed a change, studied whether it accomplished our goals, and then adopted it, adapted it or abandoned it.”

Spreading Innovation

Rapid-cycle improvement is quickly spreading. For fiscal year 2014, the initiative has been rolled out to 14 more units at CHOP Main.

If their experience is anything like those of the pilot units, CHOP could see a groundswell of innovation as units bring their own thinking to what Tracy describes as “one of the most challenging and exciting things I’ve ever been involved with.”

Paula M. Agosto, MHA, RN, chief nursing officer and executive sponsor of rapid-cycle improvement, put it another way: “This project allows us to reconnect everyone back to our purpose as a hospital — we’re here to help children.”

Well

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Rapid Cycle First Quote Block

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Today, change is happening at the bedside — not just the boardroom — and we all have a voice in the changes being made.
MARY ANN GIBBONS, MSN, RN

Rapid Cycle: Featurette and caption

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Anyir Hsieh, MD, pediatric resident; Kristina Barkus, RN; and Mary Ann Gibbons, MSN, RN, participate in multidisciplinary rounds. The rapid-cycle improvement team expanded who attends daily rounds to include bedside nurses, families and others involved in a patient’s care.