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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

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 trus...

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Autores principales: Rollinson, Thomas James, Furnival, Joy, Goldberg, Sarah, Choudhury, Aklak
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627410/
https://www.ncbi.nlm.nih.gov/pubmed/34824143
http://dx.doi.org/10.1136/bmjoq-2021-001393
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author Rollinson, Thomas James
Furnival, Joy
Goldberg, Sarah
Choudhury, Aklak
author_facet Rollinson, Thomas James
Furnival, Joy
Goldberg, Sarah
Choudhury, Aklak
author_sort Rollinson, Thomas James
collection PubMed
description 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.
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spelling pubmed-86274102021-12-10 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 Rollinson, Thomas James Furnival, Joy Goldberg, Sarah Choudhury, Aklak BMJ Open Qual Quality Improvement Report 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. BMJ Publishing Group 2021-11-25 /pmc/articles/PMC8627410/ /pubmed/34824143 http://dx.doi.org/10.1136/bmjoq-2021-001393 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Quality Improvement Report
Rollinson, Thomas James
Furnival, Joy
Goldberg, Sarah
Choudhury, Aklak
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Quality Improvement Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627410/
https://www.ncbi.nlm.nih.gov/pubmed/34824143
http://dx.doi.org/10.1136/bmjoq-2021-001393
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