Straight TalkA weekly update from management on the issues that matter most. Mar 2, 2017 Changing culture is an on-going process at NCH. We have evolved from a frontier clinic over sixty years ago to a rural hospital and then for decades to a community healthcare system. We are now a teaching institution with Graduate Medical Education starting with twelve Internal Medicine residents this July. With growth and complexity comes the opportunity to improve—why we now are inculcating a behavioral change that embraces efficiency and effectiveness using lean transformation. Let me explain with some examples, all of which encourage colleagues to ask questions, make suggestions, be engaged, and enjoy the success of improvement. How we structure operations and solve problems have changed over the past three years under the leadership of Director of Lean Transformation Mustafa Abdulali, Lean Transformation Engineer Dirk van Rossum, and Senior Management Engineer Chris Vasta. Examples abound with a common thread of front-line colleagues—who are most familiar with the requirements, processes, and areas needing the greatest change—being most involved. A few notable recent projects are: A nurse has traditionally been responsible for a group of four to six patients. Under the leadership of North Naples Hospital 4th Floor Nurse Manager Angela Devaney, nurses and clinical technicians are now organized into teams in order to give one nurse who may be temporarily overwhelmed assistance by a nurse from their team. Think of four bowlers where each member acts individually versus a soccer team passing the ball among themselves in a very inter-dependent way. This collaboration sounds like a simple mindset change but makes a huge difference for patient service, quality, and safety as well as for more satisfied and happier nurses. Staffing for the variability of the patient census for “season,” time of day, and day of week is particularly challenging in Southwest Florida. We have been told that we have the highest range of hospital census in the nation. I’m not sure if this statistic is true, but I am sure we have among the biggest swings. Every twelve hours, and more frequently in season, we have had a complex, labor-intensive, cumbersome staffing process which, when analyzed by Associate Chief Nursing Officer Gina Teegarden, Director of Nursing Operations Carolina Diaz and others, was streamlined. We are now staffing better than ever. The common theme of all our projects is efficiency and effectiveness. Medication reconciliation, namely understanding what medicines a person is taking upon entering and leaving the hospital, is a huge challenge across America. Director of Pharmacy Kim Thorp and Gina Teegarden along with many others are “on the case,” using everyone’s expertise, not merely brute force to find a sustainable solution. While medication reconciliation is an on-going journey, we have made significant progress. Cleaning surgical instrument trays is a complex and important process that occurs over 72,655 times a year in our Baker Hospital operating rooms. We had the opportunity to redo the Baker Hospital Sterile Processing Department (SPD), using a full size mock-up to create the new space so our colleagues could “walk through” the process. Thanks to the efforts of the SPD team led by Sterile Processing Manager Kieran Boyle many changes were made in the mock-up quickly and inexpensively resulting in a much better final process characterized by fewer steps both physically and operationally. In healthcare we need to be more efficient and effective with our limited resources. Being prudent and using best practices copied from other successful industries will ultimately help everyone live longer, happier, and healthier lives.