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“We have seen the culture change here and it is palpable. Since LifeWings, there have been zero sentinel events in our ICUs. 

 

Our nurse turnover dropped dramatically, and our culture of safety survey scores rose significantly.”

Dan Hoffman, MD

CMO

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ORTHO SERVICE LINE CASE STUDY

 

Team Charter/Objective

 

Optimize the DRG 470 patient flow; including improvements in patient quality, safety and satisfaction, bed availability, process efficiencies and reduce overall operating costs.

Accomplishments

  • ALOS reduced to 69 hours in November

  • Project Zero efforts reduced Surgical Site Infection for TV Ortho-Neuro patients

  • Increased bed capacity (eleven Ortho-Neuro beds on the ninth floor) to meet +24% increase in patient volumes

  • Standardized Order Sets and Dressings

  • Documented current state discharge process and patient instructions.

  • Established communication board in the Ortho – Neuro conference room

 

Financial Impacts and Benefits

  • November P&L and waste reduction benefits (annualized) = $1,015,855.

  • Improved Immediate Use Steam Sterilization by 33%

  • 47% improvement in first case on time case starts

  • Reduce Central Sterile Processing reruns

  • Improved case cart accuracy

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Rad Oncology Reserach Paper

Objective

 

This paper demonstrates how the communication patterns and protocol rigors of a methodology called crew resource management (CRM) can be adapted to a radiation oncology environment to create a culture of patient safety. CRM training was introduced to our comprehensive radiation oncology department in the autumn of 2009. With 34 full-time equivalent staff, we see 100-125 patients daily on 2 hospital campuses. We were assisted by a consulting group with considerable experience in helping hospitals incorporate CRM principles and practices.

Implementation steps included developing change initiative skills for key leaders, providing training in teamwork and communications, creating site-specific tools for safety and efficiency, and collecting data to document results.

Accomplishments

Our safety record has improved. Our near-miss rate before CRM implementation averaged 11 per month; our near-miss rate currently averages 1.2 per month. In the 5 years prior to CRM implementation, we experienced 1 treatment deviation per year, although none rose to the level of “mis-administration.” Since implementing CRM, our current patient treatment setup and delivery process has eliminated all treatment deviations. Our practices have identified situations where ambiguity or conflicting documentation could have resulted in inappropriate treatment or treatment inefficiencies. Our staff members have developed an extraordinary sense of teamwork combined with a high degree of personal responsibility to assure patient safety and have spoken up when they considered something potentially unsafe. We have increased our efficiency (and profitability); in 2012, our units of service were up 11.3% over 2009 levels with the same staffing level.

Conclusions

 

The rigor and standardization introduced into our practice, combined with the increase in communication and teamwork have improved both safety and efficiency while improving both staff and patient satisfaction. CRM principles are highly adaptable and applicable to the radiation oncology setting.

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Surgical Debriefing Research Paper

 

Objective

 

Crew Resource Management (CRM) training includes teamwork, communication, decision making, and the routine usage of checklists and protocols. The principles of CRM were developed in high-risk, high-reliability industries where mistakes cause disastrous consequences. In recent years, CRM practices have been introduced to hospitals to improve patient safety. This paper examines the role of debriefing in the operating room, in helping to make the surgical suite safer for patients.

Accomplishments

Through CRM training that emphasizes communication and standardized processes, Memorial has experienced outcomes that include improved quality, improved safety, reduced untoward outcomes and sentinel events, improved patient experience, and improved patient satisfaction. Although it is a natural and inevitable human condition to revert back to poor habits, CRM eliminates such process and protocol variability, substantially reducing this creep towards previous habits by requiring conscious effort and concentration at the point of care.

Memorial saw significant increases in safety, communication, and satisfaction in every hospital as a result of implementing CRM and as evidenced through Memorial’s safety culture survey scores.

A year following the implementation of CRM training, physician satisfaction increased  substantially in every category, including perception of overall quality, place to practice, patient safety, teamwork collaboration with nursing, and communication with nursing. In addition to physician satisfaction, Memorial’s staff members developed an extraordinary sense of teamwork combined with a high degree of personal responsibility to assure patient safety, as demonstrated by the 2010 safety survey. Here, teamwork within units and employee satisfaction experienced significant increases across every hospital. In this way, the standardization of communication procedures that CRM facilitated has created an environment where all employees are able to proactively contribute to patient safety.

Conclusions

 

With dysfunctional communication patterns responsible for a considerable portion of adverse events in the hospital setting, effective CRM training in other high risk industries is gaining appeal. But change routinely meets with resistance. Strong leadership from the top levels of the organization has proven to be the key to effective implementation within Memorial. By concentrating on the successes garnered through a well implemented debrief and follow-up process, surgeons, anesthesia professionals, and staff are more likely to be open to the other aspects of the CRM Patient Safety System. By encouraging all members of the team to be fully involved in assuring the patient’s safety, hospitals can draw on the full capabilities of their team members to continually improve their practice. Memorial highly recommends this approach to creating a culture of patient safety.

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Case Study in Managed Care Assessment & Negotiation Support

 

Situation Analysis

330 Beds, 88% Occupancy, Out of Network

The following Case Study highlights an example of our work:

  • Assisting a 330-bed hospital, Running at 88% occupancy,

  • In a competitive market; with a dominant Blues plan

  • Managing a hostile negotiation 

  • Achieving fair and favorable results in a Out of Network situation

  • Previous negotiations stalled at a CPI increase

 

Our team was brought in to conduct an assessment and assist in breaking the logjam.

Conclusions

 

  • Assessment/Negotiation Support Produced; $74M in returns over 5 years

  • 8.5% increase to Broad Network product

  • 8% discount off Broad Network rates from inclusion in (new) Narrow Network product

  • $750K one-time payment rom Medicare Advantage product

  • $13M Agreement to forgo recoupment in overpayments on drugs and implants

  • Reduced denials with strengthened contract language