Hospitalist‐Unit Staff Partnership to Implement and Evaluate Improvements in the Discharge Process: Utilizing Lean Thinking as a Common Methodology

1University of Michigan Health System, Ann Arbor, MI
2University of Michigan Health System, Ann Arbor, MI
3University of Michigan Health System, Ann Arbor, MI
4University of Michigan Health System, Ann Arbor, MI
5University of Michigan Health System, Ann Arbor, MI
6University of Michigan Health System, Ann Arbor, MI
7University of Michigan Health System, Ann Arbor, MI
8University of Michigan Health System, Ann Arbor, MI
9University of Michigan Health System, Ann Arbor, MI
10University of Michigan Health System, Ann Arbor, MI

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 109

Background:

Hospitalists often care for patients on multiple hospital units simultaneously, limiting opportunities for consistent interactions and collaboration on quality improvement initiatives with a familiar group of unit staff members. Our hospitalist group partnered with staff members (eg, nurses, nurse aides, clerks, discharge planners, social workers, physical therapists) on a new dedicated hospitalist service unit to develop and test patient care process improvement changes. To help us, we looked to the operations improvement management model of Lean Thinking, developed in the manufacturing industry.

Purpose:

To partner hospitalists with unit staff to develop and test process improvement models, utilizing a Lean Thinking approach.

Description:

Our hospital is part of a large academic health system in the Midwest. The health system has been interested in developing a “Lean” project within the inpatient setting to improve quality, safety, and efficiency of patient care. As a pilot, we evaluated the discharge (d/c) process, which is consistently rated among the lowest patient satisfaction markers in surveys. Hospitalist service patients were preferentially admitted to the designated test unit. Hospitalists and staff on the inpatient unit were provided an overview of Lean Thinking concepts. A 3‐day Lean workshop evaluated the current state of the d/c process, identified areas considered “waste” in Lean Thinking, and developed an improved model of the d/c process (the future state). We performed time‐analysis studies, root cause analysis, and interviewed key participants in the d/c process.

Conclusions:

Poor communication among staff and with patients/families was a key problem identified. Work by hospitalists, clerks, and nurses were batched. An additional problem was that d/c work was done in a serial fashion; hospitalists completed their part, followed by the clerk, and finally the nurse. Each part did not start until the previous step was completed in full. A waste and root cause analysis was performed, and action steps were developed, implemented, and evaluated. Interventions included: improved communication of d/c plans to patients, families, and staff through the use of a white board in the patient's room; write the d/c order early in the day to start a parallel work flow whereby the hospitalist, clerk, nurse, and pharmacist worked simultaneously to d/c the patient; bedside shift change reporting by nurses to enhance communication among themselves and to patients/families; and prioritizing work for the patient being discharged. In a sample of patients discharged from this unit prior to the project, the average lead time to leave the floor from d/c order written was 195 minutes; after several months of implementation, the lead time was reduced by 54% (to 89 minutes). Partnership between hospitalists and unit staff on a dedicated hospitalist unit is critical to improve patient care processes. The use of a common management model such as Lean Thinking aids this collaborative work.

Author Disclosure:

C. Kim, none; R. Chang, none; D. Spahlinger, none; D. McClish, none; J. Grunawalt, none; K. Bombach, none; V. Parekh, none; S. Flanders, none; J. Billi, none; M. Calarco, none.

To cite this abstract:

Kim C, Chang R, Flanders S, McClish D, Grunawalt J, Bombach K, Calarco M, Parekh V, Spahlinger D, Billi J. Hospitalist‐Unit Staff Partnership to Implement and Evaluate Improvements in the Discharge Process: Utilizing Lean Thinking as a Common Methodology. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 109. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/hospitalistunit-staff-partnership-to-implement-and-evaluate-improvements-in-the-discharge-process-utilizing-lean-thinking-as-a-common-methodology/. Accessed July 22, 2019.

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