Conference system puts redesign on fast track
Four departments in eight weeks!
Can you complete a work redesign plan for a four ancillary departments in eight weeks?
Chilton Memorial Hospital in Pompton Plains, NJ, did. From May 7 to July 1, the 256-bed hospital used a shortcut process called conference style redesign to develop quality improvement initiatives in laboratory, pharmacy, radiology, and cardiopulmonary departments. By July 10, the teams had produced a binder of their recommendations and submitted it to hospital’s steering committee, says Cindy O’Banks, RN, MS, administrator for the cardiopulmonary care center.
The process, developed by Odyssey Partners, a health care management services firm in Atlanta, was specially created "to help organizations quickly and cohesively redesign central support departments," says Tim Harlin, Odyssey partner.
It features bringing together three or four departments once a month for three months hence the name conference. "At each eight-hour gathering, there is a mix of formal education, group discussion, group exercise, and breakout time, with a good amount of homework between conferences," Harlin explains.
Ready to go after three sessions
But at the end of the sessions, you just don’t put your conference notes on a shelf in a binder to collect dust. "Participants leave the third conference ready to implement," he stresses. In addition to quantified service, quality, and economic goals, each department has specific data-supported initiatives to achieve along with time frames for implementation and clearly assigned responsibilities.
And it’s a rapid redesign strategy for facilities that are already putting time and energy into major re-engineering initiatives and don’t want to enter into another lengthy time frame, says O’Banks.
For example, for the past year, Chilton had been concentrating on bringing more patient services to the inpatient unit. "We had already implemented certain work redesign elements [that affected inpatient care] such as deploying EKGs to the floor, and cross-training staff in phlebotomy," says O’Banks. "We had moved the work function out of the central departments, but hadn’t yet tackled specific re-engineering concerns in those core support departments."
O’Banks and Harlin share the steps of implementing change using the conference redesign process.
1. Select departments that have common work elements.
"We knew that if we solicited teams from the lab, radiology, pharmacy, and cardiopulmonary areas that the members would be able to look at issues such as sharing or scheduling services or explore areas of duplication," O’Banks explains. "This synergy creates optimum problem solving."
For example, a centralized scheduling system will be implemented to handle scheduling for cardiology and radiology.
2. Include as many people as possible on each departmental team.
"In this case, bigger is better," says Harlin. "With more members, you’ll build buy-in at the beginning, rather than after the plan is created. You also need to make sure you have the right expertise in the room when it’s time to make decisions."
For example, Chilton’s radiology team consisted of the director of radiology as the team leader, ultrasound, CT, and nuclear technicians, and the transcriptionist. The laboratory team included the director, blood bank supervisor, microbiology technician, pathology transcriptionist, receptionist, and data entry operator. The cardiopulmonary team included the coordinator and respiratory therapists. The pharmacy team included the pharmacist and the clinical pharmacist.
"The main object is to make sure all key functions are represented," she points out. This model emphasizes involvement of front-line staff, rather than senior management.
To make sure the department continues to function smoothly while meetings are taking place, schedule the conference session far enough in advance to cover participating team members, recommends O’Banks.
"Even those staff who don’t come to the meeting have an opportunity to participate in the various initiatives developed at the conference," she adds.
3. Gather four teams off-site for the conference series.
"By alternating breakout sessions and group sessions, each team could provide feedback to the others, often playing devil’s advocate and challenging things the others missed," O’Banks says.
At the first conference, teams are educated in the new process; they quantify goals and identify initiatives. To spark their creativity, team members also received a review of service and quality improvement examples such as reducing redundancy, turnaround, patient wait, and missed appointments.
4. Put work into action.
Between the first and second conferences, teams test their initiatives with data and communicate their intentions to their peers. "At two-week intervals, we held two-hour meetings with each of the departments, Odyssey Partners, and the administration to review status and work plans," O’Banks adds.
At the second conference, participants review their progress, finalize initiatives, and prepare detailed work plans.
Harlin shares some of Chilton’s departmental initiatives:
• Radiology.
Send X-ray technicians from the radiology night shift to cover the emergency department, rather than calling in another X-ray tech from home. Work with cardiopulmonary to decrease by 50% the average length of stay for outpatients who are in hospital for a stress test.
• Laboratory.
Reduce stat turnaround time 25%, from one hour to 45 minutes. Redefine emergency department profiles to improve turnaround time, provide a more targeted diagnostic tool for physicians, and improve utilization of lab services.
• Cardiopulmonary.
Increase patient satisfaction scores by 50%.
• Pharmacy.
Enhance the information system’s capability to reduce adverse drug events, monitor drug interaction, and facilitate automatic retrieval of relevant lab data.
Between the second and final conference, team members continue to meet and communicate actions and progress to peers. Finally, after only a month of meetings, participants finalize work plans. In this rapid improvement process, says Harlin, the work plans must be very detailed. "You must state specifically who will do what by when," he says.
However, it doesn’t have to be elaborate. For example, when the cardiopulmonary care center team wanted to solve the problem of outpatient dissatisfaction in negotiating the logistics of the stress test process, it simply provided a form for receptionists. "We highlighted the names of the patients they were to direct first to nuclear medicine and then to the cardiac department," says Yolanda Gehring, BA, RCP, cardiopulmonary care coordinator. "Then there was no question about where the patient needed to go."
Gehring, who had about eight initiatives running simultaneously during the redesign process, had 100% participation from her department staff.
"It worked because it was our brainstorming that created the solutions, rather than a consultant coming in and telling us specifically what to do," O’Banks says. "People were invested in the process and worked to make it work."
[Editor’s note: For more information contact Cindy O’Banks, Chilton Memorial Hospital, 97 West Parkway, Pompton Plains, NJ 07444. Telephone: (973) 831-5156. Contact Tim Harlin at Odyssey Partners, LLC, 404 Lighthouse Lane, Peachtree City, GA 30269. Telephone: (404) 818-5974.]
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