Children's Hospitals Today - Fall 2021 - 22

FEATURE / IMPROVEMENT
Like other health care facilities,
Children's Hospital of The King's
Daughters in Norfolk, Virginia, faced
similar problems. The hospital had an
ALOS of 5.6 days for patients in its medical-surgical
units. Instead of reacting
after regulations are cemented, the organization
is actively pursuing change.
But rather than handle the problem using
the traditional top-down approach
where leadership drives the change, the
organization wanted to empower frontline
team members to create change.
Diagnosing the problem
The project team at Children's Hospital
of The King's Daughters searched the
literature to see if other organizations
had figured out a solution to the ALOS
challenge. The team members found
several promising ideas, but when they
implemented those changes, they were
either not sustainable or just did not
work. Next, the team reviewed the hospital's
internal survey results, thinking
patients and families would offer
the best information.
The team found some interesting
ideas, but none was thorough enough to
implement-not because the information
wasn't there, but because the problems
patients and families mentioned
seemed to be one-offs; the findings
could not be validated from the medical
records. And because health care is a data-driven
entity, to make hard changes,
the team needed to show an objective
problem before they could address it
with real, sustainable change.
Eventually, they realized there was
no easy way to tackle the work, so they
BY THE NUMBERS
Seeing improvement
A new process led to a
31%
reduction in
discharge time
14.4%
reduction in
average length of stay
decided to collect data using teachings
learned from a partnership with Toyota.
They proceeded with what is called
genchi gembutsu, or " Go to the location
where work is happening, observe quietly,
and learn the process to uncover
the problems. " The group randomly
chose patients upon their arrival to the
emergency department who the team
thought was likely to be admitted. Team
members introduced themselves and
followed the patients through their
hospital stay. While this was an arduous
process, the results revealed everything
needed to reduce the hospital's ALOS.
The team also garnered feedback from
patients and families to see what they
preferred to experience while seeking
care from the organization.
Improving the
discharge process
After collating and analyzing information
gleaned from observations, the
TAKING ACTION
A process for change
At Children's Hospital of The King's
Daughters, frontline team members
were empowered to find solutions to
create change. Here's what they did.
Decided to pursue a
process change to reduce
length of stay.
Randomly chose patients
upon arrival to the ED to
watch and learn from.
Introduced themselves
and followed patients
throughout their stay.
team quickly identified the discharge
process as the best opportunity for
improvement. For one, they found
many inefficiencies and breakdowns
in intra- and interdepartmental communication.
Intra-departmental communication
broke down when clinicians
needed additional information
to perform tasks, but the initiating
clinician was too busy with other patients
to help. Often, the team found
that when the initiating clinician was
no longer busy, the other clinician was
causing further delays. An example of
an interdepartmental communication
breakdown occurred when orders were
entered into the medical record, but,
unbeknown to the physician entering
the order, other departments had to
wait for additional information before
they could proceed.
The team also observed numerous
occasions of education happening at
discharge. However, when patients or
families had additional questions for
the physician, they had to wait sometimes
hours to ask those questions.
These communication breakdowns generated
downtime as patients waited for
the next step in the process.
The team also realized a key component
in the discharge process was
excluding patients and their families.
After discussion and more analysis,
they agreed that to increase capacity
without engineering more bed
spaces, they needed to send patients
home more quickly and turn rooms
over faster. The team hypothesized if
discharge processing could be reduced
by 30 minutes for each patient, then
22
CHILDREN'S HOSPITALS TODAY Fall 2021

Children's Hospitals Today - Fall 2021

Table of Contents for the Digital Edition of Children's Hospitals Today - Fall 2021

Contents
Children's Hospitals Today - Fall 2021 - Cover1
Children's Hospitals Today - Fall 2021 - Cover2
Children's Hospitals Today - Fall 2021 - Contents
Children's Hospitals Today - Fall 2021 - 2
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