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
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
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.