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Two health care systems bring home Baldrige award
QI programs at Sharp initiated by 'sponsors'
Not too many years ago, the health care industry was applauding the first hospital recipient of the prestigious Malcolm Baldrige National Quality Award. This year not one, but two, health care organizations were recently announced as Baldrige winners.
They are Sharp HealthCare, of San Diego, and Mercy Health System, of Janesville, WI. Mercy reports that in the last five years it has averaged a 7.1% return on net revenues and has steadily decreased its rates for community-acquired pneumonia, reaching 1.2% this year — significantly below its benchmark of 4%. (Look for an in-depth article on Mercy's QI efforts in our next issue.)
As for Sharp, Nancy Pratt, RN, MSN, senior vice president, clinical effectiveness, notes that "Baldrige looks for organizations where systematic processes are fully deployed, rather than you just getting lucky and obtaining good results you can't duplicate. In other words, they want to see consistent, reliable processes."
Managing blood sugar
For example, notes Pratt, "we spent a lot of time and energy on trying to manage patients' blood sugar — which not all hospitals do successfully."
Sharp put processes in place across the entire system — which includes seven licensed facilities (four acute care and three specialty). "We used standard order sets and advanced practice nurses in our inpatient hospital and did a lot of education and training and standardized approaches to medicines — for instance, we don't use oral agents," Pratt notes. "It took awhile to start to see the needle move, but we've had sustained improvement year after year and we continue to improve."
In fact, Sharp has been addressing diabetes for about five years, using Lean Six Sigma to drive performance improvement. "We have also used some other tools we learned from GE — workout and change acceleration process, for example," says Pratt. "We applied the right tools to the right processes, using Lean for some components, such as getting meals timed along with insulin and delivered within the right time interval."
'No sponsor, no project'
Every process improvement initiative at Sharp has a process owner, a leader or manager, and every project has an executive sponsor. "No sponsor, no project," says Pratt. In fact, she adds, "sometimes it is the sponsor who asks for the project — other times it's whoever owns the process."
To launch the diabetes project, a steering group was put together, comprising stakeholders and key leaders to manage the process. "We put on a lot of education programs so people would be up to date on the latest literature," says Pratt. "We taught them that we were using a basal insulin — a long-reacting drug that stays in the background — and then additional [insulin] to cover what they eat."
The intravenous and subcutaneous insulin were given on a proactive basis, she adds. "We did not wait until their sugar got higher."
Patients who come in for other reasons but who are type II diabetics, receive insulin if their blood sugar is more than 150. "We don't want it over 120, and we may have parameters to hold them a lot tighter," says Pratt.
Blood sugar is usually measured four times a day — before meals and at bedtime. "We're pulling 10,000 blood sugars for analysis, with 1,700 beds in our health system," Pratt notes.
In order to sustain the improvement, Pratt explains, "we refine the measurement every year and raise the bar." For example, she notes, at the beginning of the process the steering committee decided it would not measure blood sugars the day the patient was admitted and the day he or she was discharged. "Now, we're a lot more rigorous; if you come in with bad blood sugar that's fine, but from then on we should be able to control it."
The six pillars
Pratt says that all Sharp activities are grounded in six pillars:
In terms of people, for example, (which includes employees) and service (which encompasses patient relations), "we hard-wire our must-haves," says Pratt. These include greeting people with a smile and saying hello, displaying an "attitude of gratitude," and "using key words at key times."
"We have taught these to all our employees — like taking people where they are going; if someone looks like they need to go somewhere, you ask where they are going and you take them there," Pratt explains.
This was rolled out to about 14,000 employees. How does Sharp do it? "Sometimes we take a situation and divide it up and deploy it out to individual hospitals — and then to each department and each unit," Pratt explains. "We also have an annual meeting at the San Diego Convention Center, and three separate staff meetings for inspiring and celebrating."
The overriding issue Sharp had to address before it could bolster improvement in any of these areas was the fact that "as a system, we were process-ignorant," says Pratt. "Sometimes that was because we did not have one, and sometimes we could not tell a process if it hit us in the face — we just could not articulate what a process was."
Now, she says, "when something doesn't work, people will say it's not working because we do not have a process. We now have a lot of process flow diagrams, and this has helped us make the systematic, standardized changes needed to make our processes better."
This, she continues was "the biggest learning we have made." Some of the changes were enabled through using tools such as Lean Six Sigma, and others came by getting feedback from Baldrige examiners and having everyone read the comments. "They ask what your process is and how you do it, and you have to be able to answer," Pratt explains. "So, we got people together and said, 'Let's map [the process] out.'"
[For more information, contact:
Nancy Pratt, RN, MSN, Senior Vice President, Clinical Effectiveness, Sharp HealthCare, 8695 Spectrum Center Blvd., San Diego, CA 92123. Phone: (858) 499-3119.]