Aligning to UTMB’s value of Working Together to Work Wonders, Pamela Cruz, nurse manager for the Clear Lake Campus sixth floor inpatient unit, said, “It takes a village to move patients through the hospital.”
In an effort to do just that, team leaders Cruz and CLC Emergency Department Nurse Manager Adrienne Escobedo set out to improve patient throughput from the CLC ED to Med Surg. The CLC ED and inpatient units participated in a model cell 2.0 facilitated by the System Optimization and Performance department.
UTMB Health embraces a lean management approach to process improvement. Lean supports a "system" approach to Best Care, and UTMB utilizes model cells to foster and spread an environment of lean management. A model cell is an eight- to 12-week journey addressing important strategic or operational objectives and represents an area willing to pioneer in a process improvement capacity. A model cell 2.0 focuses on more complex problem-solving.
The aim of the CLC ED 2.0 model cell was to reduce the admission decision to admission time for CLC ED patients from an average of 100 minutes to 60 minutes or less within six months.
Cruz highlighted the importance of getting patients out of the ED into a more comfortable inpatient setting, delivering the right care at the right time to achieve the best possible results for every patient.
During the model cell process, collaboration was key between staff and managers from the emergency department, inpatient charge nurses, PPC and Environmental Services to better understand the process.
One important step of the model cell was the incorporation of Gemba walks, which allowed management to visit the front line to better understand the barriers and frustrations front-line staff were experiencing. (Gemba walk is derived from the Japanese word “Gemba” or “Gembutsu,” which means “the real place,” so it is often literally defined as the act of seeing where the actual work happens.)
Using these lean tools, the team identified numerous opportunities for improvement such as the need for better communication between departments and standardization around the process of calling reports. To address this, the ED and inpatient charge nurses were empowered to create a standardized report that met their needs, then worked with IT to integrate this into EPIC.
Agents of change in model cells include Rapid Improvement Events (projects that take a week or so to finish) and PDSA cycles (Plan-Do-Study-Act—planning a project, doing the project, studying the outcomes and acting on if the project was successful or not).
Through their RIEs and two PDSA cycles, the model cell team was successful in reducing their average time from bed assignment to admission from 82.4 minutes in December 2022 to 52.3 minutes at the end of April 2023. Since implementing these changes, the CLC managers have worked together to continuously monitor throughput times. The team has made this a priority by reporting out throughput times for their units regularly, sharing the information with staff, displaying the data on visual management boards and recording any delays in the charge nurse shift reports so they are addressed as quicky as possible.
When we asked Cruz about the team’s experience working in a model cell, she explained that it was challenging to juggle schedules so everyone could attend, especially when short staffed, but once everyone saw the benefits of the work, they were happy to participate. Her advice to others interested in doing a model cell: “Be very patient and be open to feedback from staff.”
If you’re interested in using lean thinking to leverage process improvement in your department, please visit our website: www.intranet.utmb.edu/pi