Reducing COPD readmissions from the bottom-up
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Hospitals traditionally use committees to help usher in change. But these committees are simply not designed for major, transformative undertakings. When committees are faced with imperatives like minimizing COPD readmissions, they’re limited in what they can accomplish. Let’s take a look at why hospital committees have a hard time moving the needle.
Lack of time
When hospital committee meetings are wedged into the schedules of very busy staff — who typically only meet for an hour once a month — it can be hard to affect big change. Brainstorming, tackling big issues, and coming up with qualitative solutions takes a lot more time.
Politics
Committee members may be concerned about saying something disruptive, even if it should be heard. Furthermore, it can be hard to reach a consensus in short time, forcing leaders to choose what they think is best (often without full resolution).
When there’s a lack of consensus and you’re up against the clock, what do you do? Try going bottom-up.
Contributor
Keith T. Kanel, MD, MHCM, FACP
Clinical Associate Professor of Medicine University of Pittsburgh
Break free from the traditional committee format
Keith T. Kanel, MD, MHCM, FACP, a Clinical Associate Professor of Medicine at the University of Pittsburgh, shares his success in affecting change from the bottom-up. Dr Kanel advises breaking away from the traditional format of hourly committee meetings each month and, instead, hosting a Kaizen event. Kaizen is a Japanese word that means “change for the better,” and Kanel believes Kaizen events can be the key to spurring true change.
How a Kaizen event works
A Kaizen event typically takes anywhere from 3-5 days, during which a range of disciplines contribute to the decision-making process in an effort to address recurring issues. Dr. Kanel encourages a longer format to give members time and space that’s needed to come up with bigger, unconventional ideas.
Kanel’s Kaizen process
Staff members take the first day to assess the current state of the problem
They traverse the current hospital setting to observe what’s really happening with patients and the process
Team members shares their observations to develop a plan of action
Team members shares their observations to develop a plan of action
Kaizen is an ongoing, relentless pursuit of excellence with an ultimate goal of spurring radical change and performance improvement. While formal Kaizen events are a great way to foster engagement, Kaizen is also a concept that can be practiced daily by employees on an individual level as a way to further drive engagement and empowerment
Insider insight:
Identify your meta-leaders
"Meta leaders are people that are usually plucked from within a process. They’re oftentimes outspoken, they are oftentimes high energy people. They usually reveal themselves when you put them into these group settings, which is one of the advantages of the group settings – to let these people really shine." - Keith T. Kanel, MD, MHCM, FACP Clinical Associate Professor of Medicine University of Pittsburgh
Identify these leaders and empower them in the decision-making process. Whether it’s a nurse, a pharmacist, or a respiratory therapist, their contributions can lead to huge realizations about the gaps in care. Find your meta-leaders – they’ll help empower the unexpected.
Insider bottom-up case study: The Primary Care Resource Center Project
Baseline state of affairs
Seven health systems in Pennsylvania and Northwest Virginia were struggling with COPD readmission rates. These rates were far too high and, despite new policies and procedures, teams had limited success in reducing them.
Identified key issues
They discovered that due to the lack of inhaler training, and the staff’s unfamiliarity with new technologies, patients would often be discharged not knowing how to use their devices. Too often, patients were discharged with medications, but then had no way to pay for them. At the time of this study, they discovered generic inhalers were taken off the market, forcing patients to accept significantly more expensive options they couldn’t afford. The result? They abandoned their inhalers and ended up back in the hospital.
The process: Go bottom-up
The Primary Care Resource Center Project was developed and tested this approach. In doing so, they discovered huge gaps in care that were often surprising.
Developing a plan of action
Seven health systems in Pennsylvania and Northwest Patient empowerment, better inhaler training, and medication solutions were a must. Clinical and pharmacological interventions Nurses and pharmacists teamed up to educate patients and families on inhaler usage – and follow the patient through the transition of care. This established trust and familiarity and helped to address critical issues. Providing inhaler and financial support Recognizing that medication costs were often preventing patients from obtaining their necessary inhalers, the pharmacists made sure they were in support programs to help minimize costs. Breaking the lifestyle and environmental barriers
High-risk patients were provided with air conditioners to alleviate issues triggered by hot, humid weather, while smoking cessation initiatives had previously failed due to lack of funding were replaced with new programs.
“Every patient had unique barriers, so we had to break away from our tradition of having a standardized approach to care transitions. We needed to create a more flexible approach.” - Keith T. Kanel, MD, MHCM, FACP Clinical Associate Professor of Medicine University of Pittsburgh
Getting others on board
It can be tricky to gain support for a bottom-up approach. Time is already limited, but these take even more time. Funds are already limited, and these cost even more. But the long-term payoff potential is extraordinary.
Take a progressive approach to implementing the Kaizen process
Start with a pilot program at one location
Share results
Enlighten and inspire
Expand usage
The keyword is enlighten. Show your administration and staff that these events can help transition your institution to a better future of care delivery. A bottom-up approach is disruptive. And that’s one reason why it works. COPD is complex and demands a multifaceted care approach, beyond the walls of the hospital. But by tapping the insights of your staff and approaching the problem from the bottom up, you gain valuable insights that reduce readmission rates and improve the quality of care for COPD patients.
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Further reading
COPD insider
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