TWI: The Link to Lean In Healthcare

Joan Ching, RN, MSN Administrative Director

Hospital Quality and Safety

Virginia Mason Medical Center

TWI Webinar

Oct. 13, 2009

Our Strategic Plan

Copyright 2008 Virginia Mason Medical Center All Rights

Reserved. Any further use of these materials is prohibited.

Standards

“Without standards, there can be no improvement.” -Ohno

Standards provide stability.

Stability provides visibility.

Visibility provides targets for kaizen.

(purrier)

© 2009, Virginia Mason Medical Center

Copyright 2008 Virginia Mason Medical Center All Rights

Reserved. Any further use of these materials is prohibited.

Standard Work

Benefits:

• Insures that work and expectations are safe and reasonable

• Allows you to see abnormal conditions as soon as they occur

• Serves as a basis for future improvement efforts

• Makes it easier to train staff

• Ensures that we are creating value for every customer, every time

A prescribed, repeatable sequence of operations assigned to a single team member.

Select Right Topic

• Tied to Organizational Goals

• An Important Problem to Solve

• High Visibility

Hand Hygiene and Patient Falls

When to TrainSEPTEMBER   SEPTEMBER

Sunday Monday Tuesday Wednesday Thursday Friday Saturday   Sunday Monday Tuesday Wednesday Thursday Friday Saturday

  13 14 15 16 17 18 19     20 21 22 23 24 25 26

12:00 AM Martha P.               12:00 AM              

1:00 AM                 1:00 AM              

2:00 AM                 2:00 AM              

3:00 AM                 3:00 AM              

4:00 AM                 4:00 AM              

5:00 AM                 5:00 AM              

6:00 AM                 6:00 AM              

7:00 AM                 7:00 AM              

8:00 AM                 8:00 AM              

9:00 AM                 9:00 AM              

10:00 AM  Debbie Kelly

MarthaPurrier

    JanineW.

    10:00 AM   

  MarthaPurrier

MarthaPurrier

JanineW.

 

11:00 AM           11:00 AM   

   

12:00 PM                 12:00 PM              

1:00 PM        Fe

Schanz

      1:00 PM    Fe

Schanz

       

2:00 PM       CharleneTachibana

      2:00 PM            

3:00 PM             3:00 PM            

4:00 PM   JanineW.

  Arni Verkler

AlenkaRudolph

      4:00 PM   AlenkaRudolph

Arni Verkler

JanineW.

CharleneTachibana

   

5:00 PM    

JoanieChing

    5:00 PM      

6:00 PM               6:00 PM    

Joanie Ching

 Arni

Verkler

   

7:00 PM               7:00 PM          

8:00 PM               8:00 PM          

9:00 PM                 9:00 PM              

10:00 PM                 10:00 PM              

Time Table: Units

Time Table: Staff

Engage the Leadership

• Certified Leaders’ Collaborative- Certified Leaders in VMPS

• Monthly Managers’ Meeting- all VM Managers and Leadership for the organization

• Quarterly KPO Update- whole organization

• KPO “Stand Up” Meetings

• Grand Rounds- Physician Cont. Ed.

Engage Unit Leaders

• Unit Leaders trained early or first

• Unit trainers utilized as well as external trainers

• Leaders taught how to conduct follow up

• Packets on units to track progress

• Frequent updates included progress (#s) as well as stories

3rd Quarter Focus: Safety/Quality DefectFalls

• Falls University, Falls Collaborative

• Multiple PDSAs

Purposeful hourly rounding training completed. (Sept. 30)

Pharmacist responds to Falling Star alerts. Reviews medications post alert

Kaizen Events:

Toileting

Falls related to meds

Kaizen event:

Nursing/PT Integration Falls University

(weekly huddle) started

Falls Collaborative team formed (multidisciplinary team)

Results“For a long time now, I’ve taught my staff that the majority of patient falls occur during the toileting process.  Knowing, however, wasn’t enough to hardwire actions to prevent patient falls.  TWI provides the hardwiring and rigor … toileting is planned for & built into my staff’s work flow. It’s really made a difference on Level 8.”

Rowena Ponischil, Director, Levels 7/8

With the implementation of hourly rounding using TWI methodology, a unit that consistently averaged 1-2 falls/week has gone 45 days without a fall. It’s too soon too tell but appears promising.

Results

• “Recently I entered a patient's room on Level 10. From her bed, this patient watched me wash my hands. The patient remarked, "That is so interesting! EVERYBODY coming in here washes their hands the exact same way! I've never seen anything like it!"  

Ellen Noel, Med-Surg CNS