Sharing Lean ideas to improve healthcare quality

If a hospital is facing a problem with quality or safety, chances are another facility is having the same problem.

That's especially the case with hospital-acquired infections, which can kill over 100,000 patients a year.

So, a group of providers is teaming up to share best practices on how to fix those problems in a way that enlists Lean management, a philosophy of eliminating waste through constant improvement and incremental changes to an organization's processes.

The Catalysis Healthcare Value Network is made up of 72 providers who engage in ongoing discussions around quality and safety. Catalysis, an Appleton, Wis.-based not-for-profit, connects health systems, provides education and coaching about Lean transformation and coordinates on-site visits at member health systems so members can see the real solutions in action. Membership costs $25,000 a year. Catalysis organizes about 20 on-site visits a year, in addition to hosting webinars and a two-day conference.

One of the solutions currently being disseminated across the Catalysis network attempts to limit bloodstream infections that originate from a patient's central line catheter, a long-term intravenous medication line placed into a large vein in the patient. U.S. hospitals have made strides in reducing the rate of central line-associated bloodstream infections, or CLABSI, but the deadly complication still affects over 30,000 patients a year and has a 12% to 25% mortality rate, according to the Centers for Disease Control and Prevention. That has cost the U.S. healthcare system over $1.8 billion since 2001.

Catalysis member Salem (Ore.) Health is resolving its CLABSI problem by standardizing processes and implementing frequent evaluations of patients' need for a central line. The result is a 64.3% drop, from 14 infections in its fiscal 2015 to five infections in 2016, according to Debbie Goodwin, Salem Health's in-house Lean expert.

As a part of the solution, Salem staff outlined specific roles and steps for central line cleaning, changing, or removal that should be followed the same way every time for every patient. Cleaning staff are taught a standardized procedure, to ensure that room conditions aren't the root cause of infections.

Solutions across the Catalysis network often stress standardization because a culture of bad habits or neglect can spread across an organization and lead to poor outcomes, said Paul Pejsa, director of the Catalysis network.

As a part of its Lean solution, Salem also uses daily “huddles” where staff members discuss the condition of each patient with a central line and whether that line can be removed. Pejsa estimates that over 80% of Catalysis members have a CLABSI problem and are working to reduce it through strategies like those used at Salem. “By thinking and acting differently, these rates can be reduced,” he said.

Many of the solutions developed by Catalysis members tend to stress the involvement of an entire facility in solving major problems, not just a particular unit or department, Pejsa said. It's crucial that the hospital's most senior leaders understand and are open to the Lean transformation process so that they can make significant changes that must be initiated by top executives.

“Where we see Lean transformation fail is lack of engagement from the most senior leadership,” Pejsa said. “If they don't demonstrate themselves and they're not out (making rounds) … we find it extremely hard to sustain that Lean transformation.”

Organizing and standardizing executive “rounds” of the hospital, known by the Japanese term “gemba” in Lean lingo, is one of Salem Health's next projects, Goodwin said. She plans to reach out to Catalysis members to see how they've handled the responsibility.

Being a part of Catalysis has helped Salem Health enrich its understanding of Lean and find solutions to some of its most significant problems, Goodwin said. The health system developed its CLABSI solution largely on its own, but visits and feedback from other systems have helped improve it.

“We find that many of our problems are common,” Goodwin said. “It has helped to have the ability to participate in that network and have that resource, their staff, who can let us know of someone else who might be working on a similar problem.”