Hospitals and improvement: TQI fair demonstrates hospitals' practice

When Middletown Regional Health Systems hosted a Total Quality Improvement fair last summer, what became clear was the fact that improvement methods are becoming integrated into the hospital's practice and culture. The fair featured storyboards outlining improvement projects from throughout the hospital system.
 
One demonstration of the process improvement in the large southwest Ohio health care system was the study given to the use of restraints for hospital patients who require them for their own protection from injury.
 
'The objective is to minimize the time in restraints, ' says Karen Kneer, director of quality management for the hospital system. To reduce restraint episodes, the nursing staff may utilize other approaches to enhance patient safety. Alternatives to restraints include arranging a visit from a volunteer or family member, providing a distraction with a movie or music, moving the patient near the nurses' station, making more frequent checks on the patient, or simply giving the patient a pencil and paper. These strategies and others often calm a patient who might otherwise attempt to remove oxygen or other sustaining devices, or who in trying to get up is likely to fall.
 
In order to evaluate the use of restraints by nursing staff, a team collected data related to patient time in restraints and number of episodes, relative to the bed census. Information that is kept includes alternatives that are attempted per nurse, the average rates for the entire hospital, and for specific shifts (day, evening, night).
 
The team discovered that becoming aware of the number of restraint episodes enhanced the nursing staff's evaluation of alternative approaches, while recognizing that restraining patients is often the only viable alternative in a given situation.
 
Middletown Regional Health Systems, serving southwest Ohio, has received national attention for its quality, with commendations by the Joint Commission on Accreditation of Healthcare Organizations in 1997 and 1998. The hospital is one of only a handful in the nation that have received this commendation, along with its JCAHO accreditation, for the second time in a row. In its journey toward continuous improvement of processes, Middletown Regional Health Systems has relied on SQCpack for data analysis.
 
In addition to its prestigious JCAHO commendations, the health care facility was recognized in 1997 as the first recipient of the Ernst A. Codman Award. Codman was a pioneer in the use of data for process improvement in health care organizations.
 
Donna Banks, former quality management assistant for the hospital (and now project coordinator for a MRHS corporation, Southwest Ohio Family Medicine), has been involved in the organization's efforts to utilize data in making decisions and evaluating processes.
 
One of the ways that the hospital has continued to improve, according to Matt Savage, lies in the ongoing training that employees receive. Since 1995, PQ Systems has provided a number of on-site training seminars to assure that staff members understand statistical process control using SQCpack. By providing the training at the hospital's own facility, more people can take advantage of the learning, with less impact on work schedules.
 
Data is collected on a variety of measures in the hospital, including records of missed appointments in sports medicine, elapsed time in providing triage, X-ray, and other services, and admitting patients. Among the projects that have been addressed in the improvement process are length of time for payment from insurance companies.

'Hospitals have plenty of data. The point is to collect this data and use it to improve processes, ' Banks says.
 
Certainly the awards that it has received demonstrate the hospital's commitment to this concept, but hospital staff members agree that what is more important to them are evidence of clearly improved service to patients and streamlining of processes. 'This is what makes a great hospital, ' says Donna Banks.