ThedaCare, a four hospital community health system based in Appleton, Wisc., is a leading healthcare delivery system and is nationally recognized for its continual process improvement efforts. The hospital recently implemented one of its widest-ranging improvement efforts — a truly integrated, collaborative model to guide all inpatient care. The collaborative model has been widely successful in improving the quality of patient care and making that care more efficient, according to Kathryn Correia, senior vice president of ThedaCare and president of Appleton Medical Center and ThedaClark Medical Center in Neenah, Wisc.
"Lean" process improvement
In 2003, ThedaCare executives searched for a way to accelerate the health system's process improvement efforts and stumbled upon lean management — a management and process improvement method that is focused on eliminating activities that do not add value to the organization's end product. Executives from the health system found a company in their own backyard that had successfully implemented lean processes to the manufacturing of outdoor equipment and set forward in implementing these same processes in their hospitals.
"We knew there was a lot we didn't know, but we decided to get our hands dirty and jump right in," says Ms. Correia. "We brought in facilitators and held week-long rapid improvement events where groups of employees examined various processes and recommended improvements. We looked at the various results from these events and selected a few areas to work on first."
The hospitals started with improving administrative aspects of hospital processes, and then moved to examining enterprise value streams. Eventually, hospital leaders began to focus on improving inpatient care in order to differentiate ThedaCare's inpatient services from its competitors, and put an improvement group to work to figure out a way to meet this goal.
"We decided that our vision for the future was creating a unique inpatient and ER experience, which relates back to the mission of our hospitals, and this became part of our strategic plan," says Ms. Correia. "What resulted from about 18 months of process improvement events examining this was a total redesign of our inpatient care — a truly breakthrough and innovative model for collaborative care."
Model of success
After a year of trialing the new, employee-developed collaborative-care model, ThedaCare began implementing it system-wide — a process which is expected to be completed by 2012. The model has proven extremely effective so far, reducing costs associated with inpatient stays by 25 percent, patients' length of stay by 25 percent and various error margins to nearly zero and significantly increasing patient satisfaction scores.
According to Ms. Correia, the model's effectiveness is due to the input of front-line employees in developing the model. "Innovation happens synergistically. We knew we had to figure out what our differentiator would be in the future for inpatient care, but we weren't quite sure what it would be," she says. "Nurses had a good concept of what they wanted collaborative care to look like, but we needed lean processes to really develop something we could implement."
ThedaCare's collaborative care model is truly groundbreaking and will likely serve as a model for many other hospitals as they look to integrate their services and provide more collaborative care. The model is composed of six critical elements, all of which encourage the collaboration of caregivers and the removal of non-value added activity in the provision of inpatient care. The six elements are:
1. Collaborative rounding upon admission. Within 90 minutes of admission, a nurse, physician and pharmacist round on a patient and his or her family and collaboratively develop a care plan specific to the patient. The three-way rounding ensures that all providers understand and agree upon a patient's course of care, and the presence of the pharmacist additionally reduces the possibility of harmful drug interactions, says Ms. Correia.
2. Evidence-based plans of care. Each patient receives his or her own evidence-based single plan of care, which integrates services from various departments within the hospital. The care plans are developed using care guidelines from Milliman Care Guidelines, a Milliman Company, and all disciplines combine to form a single integrated plan.
3. Nurse as manager of care. In ThedaCare's collaborative model, the nurse is the navigator of patient care and is supported by ancillary paraprofessionals. The nurse is responsible for guiding the patient from one phase of care to the next and makes sure that all quality criteria are met during each phase of care. Nurses often suggest options to physicians in order to advance care at a more optimum rate, says Ms. Correia.
4. Tollgates. As patients move through their care plans, nurses ensure that the patients do not move forward unless they meet certain requirements of their last phase of care. These "tollgates" are based largely on care guidelines and time, and serve stopping points along the path of care. When a patient reaches a tollgate, the nurse will only allow the patient through to the next phase of care if it is documented that the patient has undergone certain measures of quality required in the previous phase of care.
For example, evidence-based medicine suggests that pneumonia patient should receive an antibiotic within four hours of admission. Thus, a ThedaCare nurse is responsible for ensuring that all pneumonia patients receive an antibiotic in this time frame, and if this doesn't occur, the nurse must stop the care pathway and fix the issue before advancing the patient.
5. Electronic medical record. Thedacare uses electronic medical records to track the progress of a patient's care along his or her pathway and share health information among providers from different service areas within the hospitals. The EMRs also include notifications for tollgates, alerting nurses of the need to evaluate a phase of care.
6. Purposeful design of physical space. Finally, ThedaCare redesigned its inpatient floors in order to make care more efficient. Each patient room includes approximately 80 percent of supplies a nurse would need to care for a patient; this reduces the time a nurse would spend traveling from the room to the central supply location, says Ms. Correia. Additionally, the rooms are designed to reduce the steps staff members take to perform various tasks, thereby making care more efficient.
Learn more about ThedaCare.