The QI implementation model at Piedmont Healthcare is unusual and key to some of the system’s success, says Leigh Hamby, MD, chief medical officer with Piedmont Healthcare.
“The traditional way to implement something like a new MRSA program is to issue a policy, a training module, and a sternly worded memo,” Hamby says.
Piedmont Healthcare’s approach is similar to how healthcare organizations launch a new EMR or IT system, explains Michael O’Toole, FACHE, executive director for quality improvement at Piedmont Healthcare.
“When we make a change in the EMR or IT, there is a go-live process with a command center and all kinds of support for people adjusting to that change,” he explains. “We took that same concept and applied it to changing processes on the front line.”
The implementation process takes a week. Prior to going live with the process change, a list of tasks must be completed, such as staff members finishing a training module. The system also schedules a go-live readiness call for leaders to go over everything related to the change, such as confirming that supplies are in place and EMR modifications have been made.
Once the system goes live with a process change, QI leaders at the health system level sign up to cover questions and troubleshoot for every shift at each hospital. Quality leaders visit the units and make sure the staff are aware of the changes and shifting to the new standard work.
“If you’re a core measure chart abstracter for Piedmont Healthcare, there’s an expectation that you’re going to sign up for a CAUTI prevention shift. It may be 11 p.m. to 7 a.m. that you’re in one of our hospitals hanging out with the nurses, chatting about where they go to find the policy on Foley removal,” Hamby says. “If you’re in the quality department, at some point you will be at the bedside.”
The QI department representatives usually include some inservicing with the nurses and make it fun with games and puzzles, O’Toole says. That phase lasts seven days.
“There is a command center, and any issues that come up in these visits can be called in. We either resolve them immediately or put them on our punch list of things to take care of soon,” O’Toole says. “Normally when we go live, we get about 70 to 100 issues on that list.” That number may sound high, and the health system CEO is always asking why it cannot be lower.
However, O’Toole says the issues arise because there are 11 hospitals with variability in physical infrastructure and other factors that become problematic once standardized processes are implemented. The issues often are simple, such as who is supposed to give the patient a daily bath.
Other health systems that use a more traditional approach of simply telling people to do something new and expecting compliance do not even know about that kind of stumbling block, Hamby says. By encouraging staff to ask questions and directing people to stand by with answers, the health system can eliminate problems that might have stymied compliance efforts for years, he says.
“There are just things that you can’t anticipate, but it’s good to learn about them during the go-live phase,” O’Toole says. “The staff can see that we’re standing by and working to resolve those issues, so the process changes are actually adopted more quickly. They see that not only did we come out and talk to them personally, but when problems came up we listened and fixed them.”