‘Breakthrough’ strategy puts hospital on fast-track

When Parkview Memorial Hospital staff conducted a benchmarking site visit at Columbus (IN) Regional Medical Center, they learned of a fast-track improvement process called a breakthrough event.

Breakthrough events are intense days in which staff are immersed in the idea of rapid change and total quality improvement. Results are expected immediately.

Breakthrough events can be intense, but the results are worth it, says Fredricka Joyner, MA, continuous quality improvement and breakthrough coach at Columbus.

The events stimulate teamwork, empower staff, and reduce resistance to change because staff are involved in decision-making.

"In the past, we had teams working on ideas for improving processes that might take a year to develop," explains Joyner. "And at the end of the year, the improvements would only be incremental. The thing about breakthrough events is that they happen so quickly and are aimed at generating improvements of 40% to 50% over past norms."

Columbus used a breakthrough event to redesign its care delivery model, a project chosen as part of an effort to resolve patient complaints about long wait times and interactions with too many caregivers.

At the end of the session, the team announced its new model. One of the key changes involved cross-training personnel to bring numerous clinical tasks, such as phlebotomy and respiratory therapy, to the unit. Technical partners, mostly licensed practical nurses, were also trained to do more tasks at once — such as drawing blood and starting intravenous drips — to reduce patient sticks and wake ups. The cross-training also reduced the number of faces patients see during their stay.

Parkview staff were so impressed with the results Columbus received from the process, they wanted to try it, too. Here is the three-stage process of breakthrough events that Columbus staff shared with visitors from Parkview:

A 30-day planning period.

Staff need to prepare for the event and understand the outcomes expected. The event’s facilitator is usually a key hospital leader in the beginning, but as the staff grow comfortable with the process, anyone can be designated.

— Select an interdisciplinary team of 12 to 18 people.

— Set goals and boundaries. Setting boundaries means being specific about the parameters of the target being addressed. For example, a boundary might be the time from when a patient arrives until registration is complete.

— Gather data for the necessary breakthrough event.

— Create subgroups to tackle very specific tasks.

The event itself.

This lasts two to five full days and includes the following elements:

— Map the improvement process.

— Time tasks and activities.

— Analyze the current process.

— Identify barriers and waste.

— Generate improved or redesigned processes based on breakthrough principles.

— Implement processes.

— Brainstorm additional improvements.

— Document best current processes.

A 30-day follow-up period.

— Institutionalize the improvement or innovation.

— Find and tie up loose ends.

[Editor’s note: For more information on the breakthrough events at Columbus Regional Hospital, contact Fredricka Joyner at (812) 376-5597.]