Making the invisible visible

2012-2-5 making the invisible, visible

As noted in my previous post, I have had the opportunity to participate in a Rapid Process Improvement Workshop (RPIW) over the last 4 weeks, within the Saskatoon Health Region.  Last week was what is commonly referred to as “Event Week” and is the culmination of all the preparation that is completed in the preceding three weeks.  Event Week brings together a representative team of health care providers, support workers and patients, to apply their fresh eyes and lean thinking to the opportunities that have been identified from time spent on the gemba.

Here’s a picture of the Red Team tasked with making changes on 3600 and the Block unit at City Hospital, from January 28 – February 1, 2013.

2013-02-05 RPIW 24 team pic

Back row (L-R): Alex Mortimer (Ortho Resident), Wanda Olesen (Block RN), Margo Junk (Nurse Educator, 3600), Nicole Laudouceur (Anesthesia Assistant), Sheri Jones (OR Assistant), Maura Davies (Subteam Lead), Bev Cholowsky (Patient Representative), Jackie Mann (Lean Leader), Dr. Jacelyn Larson, Anesthetist.
Front Row (L – R) me (KPO Support), Alenka Rudolph (JBA Consultant), Crystal McAra (Team Lead)


Near the end of the week, one of the members of our team received an unsolicited email, from the family member of a patient who had received care that week.  Her message confirmed that the work we were doing and the way we were doing it — including transparently displaying information about our efforts — was having an impact not only on members of our Red Team, but those who were observing us. With approval from the author, I share her observations of what she saw. I feel it describes the work of an RPIW very well.

“I have been really impressed with the care my mom has received at the City hospital.  It has been very interesting observing the staff   and the environment.  My mom had the pleasure of being admitted for her hip surgery while a process improvement evaluation was being done.  Actually it was more my pleasure than hers.  I found it interesting to observe staff.  The red shirts immediately drew my attention.  It became a distraction trying to figure out what was going on while we waited.  I thought it couldn’t be a bad thing since staff were not rolling their eyes or scoffing when asked to do something.  They looked really into it.  I finally figured it out when I saw the goals on the wall and tally sheets referencing lean principles.  I was impressed it was displayed in such a public place.  I started watching what changes were being tracked or tested.  They moved my mom’s binder to her bedside to try to save time going back and forth to the desk.  They were timing things and watching movements.  I had to laugh when one of the nurses forgot to start timing a patient when they came in.  She missed the note.  She felt so bad.  One of the other nurses suggested she take the patient back out the waiting room and start again.  She said I can’t because he is now nude.  Too funny.

My mom was moved to 3200 after her surgery.  On my way to and from her room I noticed a lot of information on the walls.  The hospital seems to use every available space to display information, share a photograph or use it to display schedules.  Even the nurses station is an open concept in the hall rather than having them hidden behind a desk.  This is not like other hospitals I have been in.  I found it particularly interesting reading a bulletin board displaying stats on WCB claims, sick hours, overtime hours, falls, and infections.  It also had some of those lean principles listed above. I was particularly surprised by the amount of sick and overtime hours. I had heard about it but had no idea.  As a taxpayer I wanted to know why?  Is there not enough staff?  Is this a good use of funds?

I really like this open display of information.  It caused me to have a great conversation about it.  I learned a lot.  I am going to share this open format with the HR folks and managers at the municipality I work for.”

PS – For the keeners out there, here are some of the changes that we tested and ultimately implemented during Event Week:

  • Consolidation of the nursing assessment and the nerve block/spinal processes to implement one-piece flow and eliminate the need for patients to be transported between the two units.
  • Consolidation of the nursing assessments to eliminate an unnecessary patient hand off and to remove a duplicate nursing assessment with an accompanying nursing form.
  • Optimization of the role of the OR Assistant, by significantly reducing the need to transport patients between two units.
  • Relocating the Anesthesia Assistant back within the OR where they are specifically trained to be, rather than being at the bed side performing Nerve Block/Spinal prep activities that can be appropriately completed by a nurse, who is already located within the unit.
  • Elimination of an internal set up process, which now allows patients to complete their final surgical skin prep in the comfort of their own home on the morning of the surgery,  rather than on the ward when they are already feeling anxious and exposed.
  • Implementation of a Visual Control Board to help improve and strengthen communication among interdisciplinary care providers.
  • Cleaning, organizing and optimizing space and equipment within the Service Room on 3600.

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4 Responses to “Making the invisible visible”

  1. Dennis Kendel
    February 5, 2013 at 1:35 pm #

    It was really great to read the feedback from the family member and note that she’d like to introduce open reporting tools in her own workplace.

    • Debra-Jane Wright
      Debra-Jane Wright
      February 7, 2013 at 4:45 pm #

      Thanks Dennis for your comments! I agree, it was very exciting to see a family member notice our efforts to be visible and transparent, and to see her think about spreading it to her own work environment – can’t stop the spread of good ideas 🙂

  2. Anonymous
    February 5, 2013 at 1:18 pm #

    Nice post Debra! When reading it in conjunction with Kishore’s latest posts about ongoing integrated improvement (my words not his), it made me reflect how we might need both of these approaches – the events and the non-events, i.e. the every day, intentional but informal tests of change.

    • Debra-Jane Wright
      Debra-Jane Wright
      February 7, 2013 at 4:52 pm #

      I agree, an RPIW is definitely one way to test and implement change however we can not lose sight of the power of small, incremental tests of change, over time!

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