November 20, 2017
KANSAS CITY, Kan. — When they launched headlong into Lean initiatives in early 2015, staff on The University of Kansas Hospital's Medicine/Telemetry unit (Unit 62) hoped to improve efficiency and enhance patient care.
Nearing three years later, they not only have streamlined the way they work, but their extraordinary Lean efforts also have opened the doors to improved patient outcomes, increased nursing satisfaction – and now international recognition.
Unit 62 last month received "The Clinical Partnership Award for Academic Health Centers" from Sigma Theta Tau, an international honor society for nurses. The award is given just once every two years, and Sigma Theta Tau, which has chapters in 90 countries, evaluates nursing units around the world for the award.
For the approximately 72 employees on Unit 62, the award is something of a badge of honor. Many departments at The University of Kansas Health System have embraced Lean initiatives, but the 22-bed Unit 62 remains at the forefront – the so-called "model cell unit" among inpatient areas for testing Lean initiatives and translating theory into practice.
"Our team believes what we are doing is simply the right thing to do, so the outcomes are what we expect and what we want," says Nurse Manager Tori Butler, RN. "We're not used to, nor do we expect, recognition for doing the right thing."
Even so, she acknowledges the Sigma Theta Tau award's significance. It validates Unit 62 as a trailblazer – "paving the way and setting the bar high, as it should be," she says. "It is a great feeling to reflect back and see the hard work has made a difference to our patients, but it also has had a big impact overall that others are able to recognize, too."
The sheer scale of competition for the award was also daunting. At the Sigma Theta Tau conference in Indianapolis, "we saw representation internationally – Australia, Japan, Ireland – everywhere," Butler says. "People were amazed at the outcomes and sustainment of our work."
Culture of teamwork
The unit's Lean efforts are wide-ranging. A structured huddle process was implemented daily and for shift changes. Interventions for patient medication education were increased while interruptions during the discharge process were eliminated. Visual management tools were developed to help staff monitor their unit's performance.
Especially key was a new leadership model encouraging frontline staff to share their ideas, particularly those related to barriers to patient care. The model has helped develop nurse leaders at every level. Terms like 'teamwork' and 'interdisciplinary collaboration' are common at hour health system, but they are at the core of Unit 62's culture, Butler says.
The results were dramatic, with patient safety improving across the board: Lower infection rates related to central lines and catheters, fewer falls, readmission rates cut in half, c diff infections reduced to zero.
Meantime, patient satisfaction rose into the upper 90% range, up more than 15 points. Nursing satisfaction, as reflected in several NDNQI measures, also climbed.
Lean efforts continue. Butler meets weekly with Nursing Department leaders to review her unit's progress, and staff from her unit continue to coach other nursing units as they implement Lean and 5S practices.
Transformational work environment
Not surprisingly, Unit 62's ability to pilot Lean initiatives attracted widespread praise, long before the Sigma Theta Tau award.
"In over two decades of nursing leadership, I have never witnessed a culture of engagement and leadership by a nursing team that has not only sustained, but continued to improve, results over a long period of time," says Chris Ruder, RN, vice president of Patient Care Service.
David Wild, MD, our health system's vice president in Lean Promotion, says Unit 62's accomplishments "demonstrate a level of excellence in healthcare delivery and clinical partnership."
And at the University of Kansas School of Nursing, which works closely with our health system, Unit 62's accomplishments are renowned.
"Students and faculty talk about this quite frequently, indicating an attention to detail and outcomes that is rarely seen on nursing units," says Sally Maliski, PhD, FAAN, the school's dean.
Nursing school students are especially impressed by the amount of coaching they see on Unit 62, Maliski says. She notes a relatively new nurse was put in charge of the unit's practice council, and two nurses from the unit have even started teaching part-time at the school, sharing what they've learned.
One of her School of Nursing colleagues "would say that on Unit 62, 'everyone is growing and blooming,'" Maliski says. "This is a tranformational work environment with outcomes to match."