People receiving chemotherapy in Prince Albert Parkland Health Region are experiencing more patient-centred care at Victoria Hospital thanks to improvements introduced in March 2015.
Previously, chemo patients had to register at admitting when they arrived at the hospital. After that, they often waited an hour or more for staff to prepare their treatment. Now, as a result of the changes, these individuals no longer have to wait in line to register, and start receiving treatment shortly after they arrive.
“The RPIW has been a great thing for our department. The patients really appreciate the fact that they do not have to register at admitting anymore,” says Jen Hareuther, one of the registered nurses working in Victoria Hospital’s chemotherapy unit, which is part of the Community Oncology Program of Saskatchewan.
“Many of our chemotherapy patients are using the last bit of energy they have to come for treatment, so taking the registration piece out was key. Not having to wait in a lengthy line to register allows our patients to come directly to us in the department. This saves an unwell person many steps, and lessens the likelihood of becoming sick from exposure to other patients and visitors.”
Zach, a chemotherapy patient who has experienced long registration lines for appointments and tests, agrees with Hareuther’s assessment of the impact of changes introduced in the RPIW.
“Being able to go directly to the chemo room, instead of standing in line, is a lot better than it was before. Not being in a registration line when your immune system isn’t working normally was a relief. You feel vulnerable when you have no immunity to protect yourself, and you fear every cough or sneeze could potentially be life-threatening.” (Zach, chemotherapy patient)
Hareuther says both the registration process and timelier medication mixing are making a difference. She notes that some treatments can take four to six hours to administer. Prior to the RPIW, a patient arrived at the department and staff called the pharmacy about getting the drug(s) mixed for the patient. This created another wait period, sometimes in excess of an hour depending on how many drugs needed to be mixed. All of the waiting often meant a patient could spend almost the entire day at the hospital.
“So now, for a lot of people, there is no waiting for treatment,” says Hareuther about the changes. “Patients come into the department directly, and their treatment usually starts within minutes of arrival. I have heard from numerous patients that this is a great thing – it allows them to have more time in their day for friends, family and life. Their whole day no longer revolves around sitting in a chair getting chemotherapy.”
In addition, Hareuther says nursing staff now have a better idea of how long a person will be there, which translates into more accurately scheduling patients – meaning more patients can be seen in one day.
“I no longer worry that patient A will run over time and patient B who is scheduled after will have to wait. Or, the possibility that we won’t have a spot altogether for patient B,” says Hareuther. “In the end, RPIW 35 has had a positive outcome for our both patients and staff.”
Holding the gains
A Rapid Process Improvement Workshop usually results in significant changes in how work is being done for physicians and staff members. Sustaining the changes to improve quality and safety – and reducing waste – can be a challenge for everyone involved.
“Sustaining any change is always the most difficult. It’s easy to revert back to what we are used to doing when it gets busy.”
(Cynthia Leschyshyn, Kaizen Promotion Office)
Audit measures, selected at the end of each RPIW, are reported regularly to the event’s sponsor and the senior management team member that leads that particular service area.
“It is extremely important to conduct an effective follow-on with the RPIW sponsors and process owners so that they are clear with their responsibilities in sustaining the gains,” says Leschyshyn. “Two of the most important pieces are educating and training staff on all new processes, and auditing the changes to ensure improvement. The audit metrics are used to identify if the changes have sustained. If metrics are not meeting target, continuous improvement of the changes are implemented as corrective actions.”
Regular reporting and updates on measures (and corrective action when targets are not being met) are discussed by the sponsor and process owners. The health region’s senior management team also reviews all RPIWs and mistake-proofing projects are part of their wall walks.
“Gaining efficiency for the sake of patient safety and quality is extremely important. Reviewing the audits and corrective actions on a regular basis adds another dimension of accountability for continuous improvement. It’s also an opportunity to provide new ideas to consider in the efforts made through corrective action.”
(Pat Stuart, VP clinic support services and performance management)
“Corrective actions are essentially a plan to achieve the purpose of the RPIW by continuously improving upon the changes that were made,” says Leschyshyn. “The corrective actions are best derived from a collaborative process by those who are doing that work.”
“It may involve more education and training on the work standards put in place, or it may involve evolving the process into something better. Audit metrics are tracked and reported to the region and provincially at 30, 60, 90, and 180 days post-RPIW. Sometimes, at the 180 day audit, the audit metric does not meet target. If RPIW changes need more time to meet target, the audit is reset and corrective action outlining continuous improvement goes on until the target is reached.”
Once the audits have demonstrated sustained success, RPIWs (as well as mistake-proofing projects) are moved to the key accomplishments wall. In the past year Prince Albert Parkland Health Region has proudly added 11 RPIWs to its key accomplishments, including work in the emergency department, discharge planning, long-term care, primary care, and mental health.