“Improvement Is Fun” and Other Surprises for Even Veteran Improvers
Why It Matters
A needle stick — when a health care worker’s skin is accidentally punctured by a used needle — is a distressing but common occurrence in health care settings. At Corewell Health, the phlebotomy team was struggling to eliminate these events, which can be painful and carries risk of exposure to diseases. “In addition to cost, there’s anxiety,” explained James Bonner, LMSW, MBA, Vice President of Quality, Safety and Experience at Corewell Health. Addressing this problem, he said, was “a testament to how we could support and care for our team members more effectively.”
A project to minimize needle sticks was one of multiple improvement initiatives that Corewell Health has undertaken as part of a practicum with the Institute for Healthcare Improvement (IHI). The practicum provided an opportunity for those working closest to the point of care, managers, coaches, and senior leaders to learn to use quality improvement (QI) methods more effectively. Building improvement capacity and capability is a fundamental part of the IHI “dosing approach” and foundational to Whole System Quality (WSQ), a holistic approach to quality management that helps organizations close the gap between the quality that customers are currently receiving and the quality that they could be receiving. WSQ integrates quality planning, quality control, and quality improvement activities across multiple levels of a system.
Corewell Health is a health system in Michigan with 21 hospital facilities, about 300 outpatient/ambulatory sites, more than 60,000 team members, and more than 1.3 million health plan members. The Centers for Medicare and Medicaid Services awarded a five-star ranking to four of Corewell Health’s hospitals in West Michigan earlier this year for strong performance in key quality measures including lowering patient mortality and readmission rates. So, they were not newcomers to quality improvement when they took part in the IHI practicum. But they found that even their seasoned improvement staff had aha moments during their learning.
When they first met to discuss the practicum, IHI asked the Corewell team to identify about a dozen improvement projects. Within the department of Quality, Safety and Experience that Bonner leads, the team prioritized their toughest challenges. “These were not ‘gimmes’,” said Bonner. “We chose work that was, frankly, stuck and needed help. We needed some new life breathed into them with help from IHI.” These included issues such as falls and pressure injuries. Here are some of the (sometimes) surprising lessons they learned along the way:
- Even seasoned professionals can learn new ways to improve. Experienced improvement staff members at Corewell were initially unsure about joining the practicum given their familiarity with QI tools. However, they were pleasantly surprised by some eye-opening exercises, including one that involved listening to potential solutions proposed by people not familiar with a project who offered fresh perspectives. Some of the ideas, they had to admit, were sometimes better than those they had heard before. Also, Bonner added, “There was an opportunity to rethink some of the tools that [we had] been using and how to apply them in a methodical way to get the results and the outcomes we needed.”
- Going through major changes does not have to stop improvement work. Improvement methods can, in fact, even be helpful during times of turmoil. Corewell Health, like many health care systems, has gone through a merger in recent months. When asked about the scheduling of the practicum, Bonner admitted that system leaders had to ask themselves if making the investment in improvement amid so many other changes would help them move forward with transformational changes throughout their system. They decided that it would. Said Bonner, “This work has not only developed our improvement capabilities, but it has also helped us start to adopt a common language and common framework for our entire organization.”
- Start small to make big impact. Like many organizations, Bonner said, Corewell Health has been inclined to “go big” with improvement work, which can lead to initiating significant changes prematurely. One key learning from the practicum has been how to conduct small tests of change through regular Plan-Do-Study-Act (PDSA) cycle. That gave team members the confidence to say, according to Bonner, “If I’m going to tackle a big problem, a big challenge for the organization, it’s not about big changes; it’s about small things that can have big impact and having the patience to test and to learn and to know.”
One of the most exciting parts of the practicum, said Bonner, was the interdisciplinary nature of the work. IHI asked teams proposing projects to identify a physician leader who could be an executive sponsor as well as subject matter experts close to the work. Nursing leaders and other specialists also got involved and worked together.
As the practicum got underway, Bonner observed staff members deepening their knowledge and skills, and learning to work collaboratively on improvement. “One of the joys that we saw was that it wasn’t just about the project,” he recalled. “It was about the whole team growing together, people developing their roles as leaders, and that investment paying off in significant ways.”
One notable success has been the project to reduce the number of needle sticks. To identify solutions, the phlebotomy team ran multiple PDSA cycles. The first step was to determine the causes of a needle stick. They found that in some cases patients were experiencing anxiety that leads to agitation or physical withdrawal, which can make needle sticks more likely. For patients exhibiting signs of agitation, the team tried an intervention in which staff work in pairs to conduct the phlebotomy draw.
The previous year, there were 10 needle sticks. Since implementing the changes, they tested, there have been no needle sticks. “Our phlebotomy colleagues are excited, enthusiastic, and proud of their accomplishment,” said Bonner. “[What they have learned] can be spread across the organization based on our data and the outcomes we’re seeing.”
As a result of these kinds of wins, the teams have begun to see improvement work not as a chore but as an opportunity. “Our chief nurse executive said, ‘Imagine: improvement is fun!’” Bonner recalled. “That was when I knew we'd struck gold.”
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