About the Book

Annotated Contents

Chapter 1.  Why it matters
Even when healthcare professionals seek care for themselves or their families, they find the current system non-navigable. In this chapter you will hear a very personal story intended to describe, in excruciating detail, why healthcare improvement matters: because every medical statistic has a face.

Chapter 2.  Eliminating infection

• Section 1. Regional project reduces infections. When 30 Pittsburgh-area hospitals pooled their knowledge and determination, central line-associated bloodstream infections declined by 63% over four years.
• Section 2. Eliminating central line infections in 90 days. In an effort led by one physician, Perfecting Patient CareSM techniques all but eliminate central line infections in two intensive care units within 90 days.
• Section 3. Sustaining the gain against central line infections. When one inspiring leader leaves the organization after a major gain, how can it be sustained? (Quick answer: find another physician leader.)
• Reducing antibiotic-resistant infections. A sustained, wide-ranging Perfecting Patient CareSM program at the VA Pittsburgh Healthcare System reduced a strain of antibiotic-resistant infection (methicillin-resistant Staphylococcus aureus or MRSA) by more than 85%.
• Redesigning a system: the wheelchairs. It’s an emotional issue among staff. Will there be a wheelchair when my patient needs one? Will it be the right configuration? Will it be clean? Wheelchair availability and cleanliness are system issues, requiring the application of Perfecting Patient CareSM throughout the entire VA Pittsburgh Healthcare System.

Chapter 3.  Moving closer to the patient

• Section 1. Housekeepers: key to reducing injuries and infections. When a 20-year veteran housekeeper developed occasional back pain, the hospital looked to process improvement to fix the problem. In the process, they developed a better way to clean the rooms and paved the way for better infection control.
• Section 2. Putting nurses in the driver’s seat. Giving nurses standardized ways to respond immediately to certain emergencies makes patients safer and nurses more satisfied.
• Section 3. Stop the revolving door on nursing turnover. A nurse-led program stopped the exodus of nurses in a liver transplant unit, bringing turnover from 12% to zero in a year.

Chapter 4.  Making handoffs safer

• Section 1. Eliminating tangled lines leads to other improvements. The symptom: tangled IV lines following cardiac surgery. Solving the problem meant looking at every handoff from admission through discharge.
• Section 2. Safer shift change. High-tech and low-tech ways of imparting more complete information about each patient to the next shift more quickly.
• Section 3. Eliminating falls. Better handoffs reduce falls.

Chapter 5.  Reducing medication errors

• Section 1. Low-cost, low-tech pharmacy improvements. Watch as two hospital pharmacies, UPMC South Side and LifeCare Hospitals of Pittsburgh, implement low-cost, low-tech quality improvements.
• Section 2. Identifying every patient. In a small community hospital where neighbors are the healthcare providers, not everyone feels the need to band every patient. It takes complete collaboration to change this culture.
• Section 3. Secret of deploying high-tech machines: People first. Getting medications to patients on time 99% of the time requires high-tech assistance—and sometimes the services of a plumber.

Chapter 6.  Eliminating the wait

• Section 1. Streamlining the Ambulatory Surgery Center “as quality permits.” The Ambulatory Surgery Center at The Western Pennsylvania Hospital implemented improvements as fast as they could go, but no faster than quality permitted. Patient dignity was at the forefront.
• Section 2. Let’s eliminate the waiting room. Why should patients wait? Why should they be asked the same question over and over? Looking at processes from the patient’s point of view led to improvements at West Penn’s Ambulatory Surgery Center.
• Section 3. Eliminating “Code Red” in a hospital Emergency Room. The Emergency Room at Forbes Hospital applied for an “Extreme Makeover” from the quality chief, and got one. Staff and patients were the beneficiaries.
• Section 4. Getting to the Operating Room on time in a big-city hospital: the 98.6% solution. Patients were arriving on time in the surgery suite about half the time. Within weeks, almost all of  of them were. Staff called it the 98.6% solution.
• Section 5. Streamlining intake for children and mentally ill patients. The most vulnerable patients, children and the mentally ill, shouldn’t have to wait for appointments or be held up on intake.

Chapter 7. Applying best practices

• Section 1. Can controlling blood glucose reduce post-surgical infections? VAPHS physician, Harsha Rao, M.D. presented a glucose control protocol to the community that is being used for tight control of blood glucose following cardiac surgery. The result is declining infection rates.
• Section 2. Best diabetes care applied in two community health centers. The advantages of the renowned “Wagner Model” for delivering diabetes care are beyond dispute. Actually implementing the Wagner Model is difficult. Eileen Boyle, M.D., a physician with a local federally qualified health center, finds that Perfecting Patient CareSM makes the Wagner Model possible.
• Section 3. Building a better diabetes appointment. Instead of the patient going to a series of doctors, Harsha Rao, M.D., the team of healthcare providers come to the veteran during a one-hour appointment.
• Section 4. Nine Myths about Electronic Medical Records. While electronic “fixes” may not always pan out, one private practice decided to install an expensive Electronic Medical Record system without delay. The results have paid off for patients, physicians and healthcare professionals alike.

Chapter 8. Transforming a medical specialty

• Section 1. Small improvement yield big results at pathology lab at UPMC Shadyside. What would it take to apply the principles of Perfecting Patient CareSM to the numerous, hand-done processes in a pathology laboratory? One hospital’s improvement work led to improved turnaround times and improved satisfaction of workers and patients.
• Section 2. Culture change transforms Henry Ford Hospital Pathology Department. One physician and one process engineer lead the nation’s 13th largest pathology unit toward vigorous, rapid-cycle work redesign that is largely employee-driven. The key to all improvements? Culture change.