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    Learning from Lean: a quality improvement project using a Lean-based improvement approach to improve discharge for patients with frailty in an acute care hospital

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    Author
    Rollinson, Thomas J.
    Furnival, Joy cc
    Goldberg, Sarah
    Choudhury, Aklak
    Keyword
    Emergency Medical Services
    Hospital Medicine
    Lean Management
    Patient Discharge
    Quality Improvement
    Journal title
    BMJ Open Quality
    
    Metadata
    Show full item record
    URI
    http://hdl.handle.net/20.500.12417/1274
    DOI
    10.1136/bmjoq-2021-001393
    Abstract
    A Lean-based improvement approach was used to complete a quality improvement project (QIP) focused on improving speed and quality of discharge of frail patients on two wards at a large teaching hospital in the UK. This was part of a national initiative to embed continuous improvement within the trust. The aim of the QIP was to improve the proportion of prenoon discharges to 33% of total patients discharged from the ward each day. An ‘improvement practice process’ followed, which included seven discrete workshops that took the QIP through four distinct phases—understand, design, deliver and sustain. Several improvement methods and tools were used, including value stream mapping and plan–do–study–act (PDSA) cycles. Ten PDSA cycles were implemented across the clinical areas, including improved planning and data collection of discharge, improved communication between nursing and medical staff, and earlier referrals to community hospitals for discharge. Improved performance was identified through the outcome metric prenoon discharges on both wards, with the average increasing from 8% to 24% on ward X and from 9% to 19% on ward Y, with no other significant change seen in other measures. Pettigrew et al’s context–content–process change model was used to structure the learning from the QIP, which included the impact of varying ward contexts, the format of conducting improvement with staff, the importance of organisational support, the need for qualitative measures, agreeing to an apposite aim and the power of involving service users. The original aim of 33% prenoon discharges was not achieved, yet there was clear learning from completing the QIP which could contribute to ongoing improvement work. This identified that the Lean-based improvement approach used was effective to some degree for improving discharge processes. Further focus is required on collecting qualitative data to identify the impact on staff, especially related to behaviour and culture change. https://bmjopenquality.bmj.com/content/10/4/e001393 http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/bmjoq-2021-001393
    ae974a485f413a2113503eed53cd6c53
    10.1136/bmjoq-2021-001393
    Scopus Count
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    Publications - North West Ambulance Service

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