For part 3 of this series of blogs we are going to look at the second work stream identified by the Kaizen Chiefs - measurement and presentation of performance data. A dry and slightly dull topic at best, a stick used to beat us at worst. How do we prove our new processes are working? More importantly, how do we get people to care about the numbers?
This was one of the toughest parts for the Kaizen team to get to grips with. We all understood that our performance against targets wasn’t optimal. We had some acceptance that this was not entirely due to crowding and exit block. But the only measure regularly presented was our performance against the 4 hour standard, a whole system measure. How could we know which areas require improvement if we weren’t identifying and measuring them?
During the solution based part of the Kaizen we had some storming ideas… what if we had a time based approach to our patient journey….what if we requested inpatient beds within a certain time limit….and they were ready within a certain time after that….what if we gave the specialities coming to see patients in the ED a time target???
Neil, our Clinical Nurse Manager, spent much of this conversation with his head in his hands. We had come up with virtually every escalation policy already in existence. The problem, it would seem, was not that we didn’t have targets, but that we failed to remember we had targets. There are probably a number of factors that had led to this lack of awareness. If you work in an ED you probably know there are a vast number of protocols, SOPs and checklists underlying everything we do. In this mass of information, things get lost. Also with the high staff turnover, doctors every 4 months and large intakes of nurses our collective ED institutional memory becomes eroded.
The real solution? Presentation of the key data in a simplified form….everywhere. The key escalation points during the patient journey are now highlighted in all clinical areas. For the performance data we took the relevant time measures, from the escalation policy, and we now display them on our performance board, which is updated daily. This board has been placed in our teaching room, where all the staff handovers take place.
So the real question is have we altered the teams view of performance data? We’re working on it! The data is great for letting us celebrate our successes (100% of patients discharged home from the ED left within the 4hr window on Sunday…..whoop, whoop, Go Team Weekend! : ) ). It is also good for picking up shifts where things didn’t go so well, enabling us to analyse the factors that tip us into non-compliance (surges in patient numbers, patient acuity, exit block, staff illness etc. etc.). It still feels a bit like a number crunching exercise but we are moving away from a culture of blame and towards a culture that enables us to celebrate our achievements (in the ED and throughout the hospital), to learn from the bad days and hopefully improve our performance for the next time.
The performance data are numbers, but they are numbers that genuinely reflect the quality of care we are giving our patients. That’s important to all of us.