In 2013 and 2014, Oregon hospital staff from across the state received Yellow, Green and Black Belt certification in Lean, after completing training programs by Purdue Healthcare Advisors. In total, 140 individuals attended classroom sessions, passed a certification exam, and completed a Lean project. Lean works in health care in much the same way it does in other industries: to streamline processes, reduce cost, and improve quality and timely delivery of products and services. Many successful and highly reliable organizations, such as Virginia Mason, have embedded Lean practices in their culture to standardize work processes for consistent outcomes.
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Central Line Associated Blood Stream Infections (CLABSI) is a type of infection that kills between 30,000 and 60,000 people a year and results in nearly $3 billion in excess costs. The therapy to prevent this is equally real. Yet it is not a drug or device, but a safety program that summarizes evidence into checklists, measures infection rates and uses tools to improve teamwork and safety culture.
Controlling and preventing infections is a patient safety priority for Oregon hospitals. A national initiative, called Stop BSI, began in Oregon in 2009. Nine Oregon hospitals volunteered to join this major national initiative to eliminate central line blood stream infections in intensive care units.
Fourteen hospitals joined OAHHS and the Oregon Health Care Quality Corporation for a prestigious national program to improve the quality and safety of patient care. These participating Oregon hospitals joined in a virtual network where they developed, shared, and implemented quality improvement tools and strategies. The effort was part of Aligning Forces for Quality (AF4Q), a national program of the Robert Wood Johnson Foundation (RWJF) to significantly improve health care in targeted communities.
For 18 months, more than 100 hospitals nationwide worked together to improve the quality of care for their patients in measurable ways, resulting in hundreds of avoided hospital readmissions; improved patient safety; standardized collection of information on patients’ race, ethnicity and language preference (R/E/L); and reduced wait times in hospital emergency departments (EDs).
Twelve care teams from seven Oregon hospitals celebrated their success with the Aligning Forces for Quality Transforming Care at the Bedside (AF4Q TCAB) in 2013. These nurse-led hospital teams from across the state worked for 18 months to improve the quality and safety of patient care as a part of an innovative nationwide program sponsored by George Washington University and the Robert Wood Johnson Foundation, the nation's largest philanthropy group dedicated to improving the health and health care of all Americans.
OAHHS provided the leadership on a state level and facilitated the hands-on implementation of TCAB. Teams made improvements in prevention of falls, falls with harm, and pressure ulcers. Results from TCAB noted a 60 percent decrease in patient falls.
The program also tracked team vitality, an assessment of frontline staff empowerment, engagement and perception of a work environment that is supportive of high-quality patient care. It is measured by a staff survey, in which they rate statements such as: "If I have an idea about how to make things better on this unit, the manager and other staff are willing to try it," and "Care professionals communicate complete patient information during hand-offs." The most notable areas of improvement for Oregon hospitals included access to supplies and equipment needed, response by support services, speaking up about a patient safety concern, and colleagues willing to try a good idea.
Treating any infection can be a challenge, but the best prevention measure, according to the Centers for Disease Control and Prevention (CDC), is proper hand washing, which is key to eliminating health care acquired infections.
The OAHHS Hand Hygiene Project began in 2007 with nine hospitals in a pilot program and eventually included 15 hospitals. The scope of the project was based on both patients and caregivers as collaborative partners in preventing health care acquired infections (HAI). Caregivers assist their peers in increasing hand hygiene compliance, and patients are encouraged to ask their care providers if they have washed their hands.