Sunday, March 3, 2013

5-minute improvement huddles - part III. Sustainability

(Note: links to Part I and Part II)

The changes to our voiding trial process have taken root.  Here are some data from the week after post "Part II".

Time catheter removal ordered
Time catheter removed
Saline instilled?
Time of first void
Immediate (pt incontinent)


0910 (removed by doc)

0940 (removed by doc)

The key changes here are that catheters are being removed promptly and voiding trials are successful earlier due to the new process of filling bladders with saline just before catheter removal.  We'll measure again after 2 months, both to see what time catheters are being removed and how staff and docs feel about the new process.

Now, back to my hidden agenda!

I want to see if we can improve our urology ward processes without establishing formal teams.  More complex changes may require formation of teams, but I wonder if we can get more people involved using the 5-minute improvement huddles at our morning reports.  Shared involvement means shared shared responsibility and ownership of an initiative.  Unfortunately, I have been a barrier to that in the past.

Throughout much of our practice's improvement work, I've been the "champion".  The champion's role is to provide enthusiasm and momentum.  However, if the champion is the only person driving the work forward, it's difficult to sustain the effort when his attention is directed elsewhere.  I don't mean this to be derogatory to my partners and staff - they are certainly committed to improvement.  Rather, it is a comment about the fact that we haven't been deliberate about developing an improvement infrastructure.  To be sustainable, improvement work needs a process that drives it forward independently of individual effort.  I've been guilty of taking sole responsibility for projects, taking on too much, and then dropping the ball.  

On the urology ward, I'm not always present for morning rounds.  If I'm the only one keeping track of a process improvement, things will falter.

Also, we need to build capacity for this work.  Everyone should have a chance to participate and lead these improvement huddles.  I can't be greedy about the "champion" role!

We discussed how to sustain our improvement efforts and we're going to start with a communication board in our meeting room.  We can document current initiatives along with next steps, data to be collected, etc.  I think this will give day-to-day continuity for our work without needing to rely on one person's presence. We'll post reminders about followup on previous efforts, such as the voiding trial process.  I'm also interested to create standard work for our morning report, including time for the 5-minute huddles.

It's a multi-use room that patients and visitors use as a lounge, so we can't post any confidential information.  There were some questions about whether or not it was appropriate to display our improvement efforts publicly.  One of the nurses pointed out that staff already publicly display many quality measures on the ward, and that patients and visitors seem quite pleased to see that we are making efforts at improvement.  (Also, this blog has been sort of public...)


  1. Congratulations on these great results. Your focus on making continuous improvement part of everyone’s daily work is a key underpinning of our new Saskatchewan healthcare management system, where we estimate 80% of improvements will come from staff participating in daily huddles and trying small tests of change, informed by Visibility Walls which track a small number of performance metrics relevant to the team and linked to improvement priorities. The remaining 20 % will come from Lean “events” such as Rapid Process Improvement Workshops (RPIWs). Across the province, we are encouraging teams to have these conversations and Visibility Walls in locations which are highly visible to both staff and the public. We have already seen how pleased patients and families are when they see members of their care team talking together about how to make things better and willing to share their results. Even better, some patients are becoming part of the conversation.

    Maura Davies, President and CEO
    Saskatoon Health Region

  2. Thanks for this comment, Maura, and for the encouragement. As you mention, the changes we're making are part of a broader effort in Saskatoon Health Region and the entire province. In our private practice and on our urology ward, we aren't inventing anything new, but rather trying to implement established improvement techniques. I suspect that many quality/process/system improvement veterans slap their foreheads when they read this blog and think "Well, duh, that's all been done before!" They're right! My main goal with this blog has been to demonstrate that small organizations (private practices, individual wards) can implement change without having to wait for an administrative hierarchy to start the process. Sometimes, I've used a "Golly-gee, look what we just figured out!" approach to get that point across, but in reality, it's all old news. Still, if this approach encourages someone to try the techniques in their work, it's been worth it.

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