Rapid Improvement Model

Biggest challenges

A brisk walk by an able-bodied person from the unit to the train station takes about 15 minutes roundtrip—but struggling with an infirm patient in an outdated or inappropriately sized wheelchair could easily double that time.

Other issues included patient dissatisfaction, staff injuries and the added risk of patient treatment delays or falls, says labor co-lead Casa, noting that “we had to look at the problem from many angles.”

Background

The Capitol Hill Medical Center opened with great fanfare in 2011. Hailed as a beacon for affordable and accessible care just as the national debate heated up on these issues, the center attracted attention—and many new members. One key factor that made the new facility so attractive—its proximity to a major public transit station in the District of Columbia—also turned into a potential Achilles heel.

That was until the Adult Medicine UBT rolled in with the right solutions.

The Adult Medicine team started by using performance improvement charting tools to log the time each staff member took to transport a patient to and from the Union Station subway stop or to ancillary departments within the medical center.

The team discovered many of the elderly or wheelchair-using members struggled to make the long trek from the exit doors of Union Station to the waiting room of the Adult Medicine unit, a medical center starting point for most patients.

The team lobbied for new wheelchairs—and for a new transporter position, an OPEIU Local 2 member who transports many of the patients and coordinates the trips that staff members make to the other departments.

In addition, the team now calls ahead to the lab or pharmacy to ensure tests and medications will be ready, or nearly so, when the patient is brought in. It also gives patients red cards to signal their priority status to lab and pharmacy staff.

Amy Edmondson says innovation depends on a culture of focused chaos.

Those words sound like opposites. They are. Don’t worry. It’s not a mistake.

In fact, innovation depends on four pairs of seeming opposites. As unit-based teams ramp up, involving frontline managers, physicians and employees in finding new ways to improve performance and transform health care, they can benefit from creating a culture of innovation. This is how Edmonson, a professor at Harvard Business School, defines the four cultural contradictions of innovation:

• Chaotic/focused
• Playful/disciplined
• Deep expertise/broad thinking
• Promotes high standards/tolerates failure

Let's take a more detailed look.

Chaotic/focused

“An innovation culture is focused,” says Edmondson. “It is really intent on improving a process or inventing a new business model or coming up with a new product.” At the same time, it is chaotic. “Any idea is welcome and possible—at least until we sort it out. No idea is a bad idea—at least early in the process.”Chaos, says Edmondson, “is about welcoming all ideas, even ‘wacky’ ideas.” Only in a psychologically safe learning environment will employees feel open enough to offer these “wacky” ideas, she adds.

Playful/disciplined

The Labor Management Partnership offers a disciplined process for innovation in the form of the Rapid Improvement Model (RIM) and the plan, do, study, act cycle. But, Edmondson emphasizes, teams use these tools “without knowing in advance what the answer is.” There is a careful and well-managed process, but the content of the conversations about improving performance must be open and inclusive. As teams begin a performance improvement project, UBT leaders need to be very clear about what aspect of performance they are trying to address—not on how the team is going to do it.

Deep expertise/broad thinking

An innovative team is one that values those who bring deep expertise (in a specific topic, subject area or clinical specialty, for instance) and people who are broad, general thinkers who span boundaries. “Both of those skill sets are absolutely essential at the same time,” says Edmondson.

Promotes high standards/tolerates failure

In an innovative work culture, “We hold very high standards but we are also very tolerant of failure,” says Edmondson. “That sounds ‘wrong,’ at first,” she admits, “but it is essential because, in innovation, you will never get it right the first time. You try something, test it out, it’s not going to work quite right and then you either tweak it or throw it out altogether and try something else.”

Spreading new ideas that get results throughout a large organization such as Kaiser Permanente, says Edmondson, requires finding ways to “shine a very quiet spotlight”—another seeming contradiction!—on innovators so others become aware of what they are doing and are drawn to try it too. 

“In today’s world, there are two ways to get the word out,” she says. The first is face-to-face communication, “positive buzz that starts locally and spreads.” The other is internal online social networks as “a way to listen, motivate and share practices that are potentially better.”

“It can catch on,” says Edmondson. “When there are pockets of effectiveness, other people see them, and they want to play too.”