Report from ThedaCare

As we prepare for SHARE’s contract negotations with UMass Memorial in 2016, we want to know what other hospitals are doing. We are looking for good ideas that could:

  • Make SHARE members’ work easier, 
  • Increase SHARE members’ “say” at work, and 
  • Improve how it feels to come to work every day.

I visited the ThedaCare hospitals in Wisconsin last week and it was quite inspiring. They believe in two main ideas:

  • Continuous Improvement: They say, “Improving the work is the work.”
  • Respect for People in everything they do.

[For another SHARE perspective on ThedaCare, see this previous blog post]

Their Friday morning "Team Report Out and Celebration" made a big impression on me. Every week, a few teams of front-line staff spend 3 or 4 full days to work on improving some process in their department. At the end of that week, in front of a couple of hundred people, the teams report on what they did. 

Last Friday there were 3 teams reporting out:

  • A PCA (ER Tech), a Respiratory Therapist, and an RN from the ED spent the week re-designing several patient rooms for higher acuity patients. By stocking more supplies in the room, staff now have to leave the room an average of twice per patient, instead of the average of 9 times they were going in and out to get supplies before the re-design. Clearly this is good for the staff and the patient. They improved respect for people, both staff and patients, further by setting up the room so that staff don’t have their back to the patient when looking at the computer, and by improving the room’s ergonomics to decrease staff injuries. 
I really like that front-line staff do the improvement work because they know their work best, and that they have time away from their regular duties for it.
  • RNs from the maternity units on two campuses worked together for the week to figure out why their number of CLABSIs (central line associated blood stream infections) were increasing. They figured out better processes (or “standard work” as they call it), and trained each other. They emphasized "respect for people" in respecting different levels of experience among the staff – with no blame – and giving people the tools and training they need to do their jobs. 
I love it: fix a bad process, don't shame and blame an employee.
  • The Root Cause Analysis (RCA) team re-designed their process to make it faster. These process improvement coaches (like the CITC coaches at UMass Memorial) are on-call for an adverse event. We heard the story of a patient having an assisted fall off an OR table. Right after it happened, a staff person was posted on either side of all OR tables to make sure it couldn’t happen again until they figured out what went wrong. The RCA team would arrive immediately to talk to people about what happened before everyone forgot. Then the RCA team leads a root cause analysis to change how the work is done to make sure that a fall like that can’t happen again.
They see a problem is an opportunity for improvement -- that's a positive outlook that I'd love to see more of at UMass Memorial.

Dr. Dickson leads trips to ThedaCare as an example of the direction he wants our hospitals to go. I agree – they have some very good ideas and it was impressive to see those ideas in action. 

As we collect experiences from other hospitals and other unions who are working to transform healthcare, I’m especially interested in the question: How do we there from here? More on that question to come...