One of the great benefits of continuous improvement is that you stay one step ahead of problems. If your staff are always on the lookout for things that COULD go wrong, and are taking steps to correct minor problems now so they don't escalate into bigger problems later, you're much more likely to avoid costly large-scale problems in the future.
Nowhere is this more true than in health care, where little errors in standard procedures could have life-threatening consequences. The KaiNexus software platform helps our customers stay on top of their continuous improvement work, so that all opportunities for improvement - no matter how small - are properly addressed.
New York Methodist Hospital in Brooklyn, NY began using the KaiNexus software platform earlier this year, and have since identified about 150 opportunities for improvement that improve quality of service, boost staff and patient satisfaction, increase safety, and save over 5,000 hours of time. This is the story of one of those opportunities for improvement that, left unaddressed, could have had deadly consequences.
In July 2014, someone in the Emergency Department noticed that there was a problem with the way isolation patients were being handled in the ED. When someone checked in to the hospital with a highly contagious disease such as MRSA or was identified as immunocompromised and needing reverse isolation, they were immediately placed in isolation. This protects both the patients and the hospital staff. In theory, this worked fine... but ED staff knew that the system was flawed. The person who submitted this opportunity for improvement realized that in the past week, three patients had been put on isolation without the nurses being notified, so proper protective procedures were not followed.
The safety problem here wasn't the result of inattentive nurses or doctors, but rather, it was a failing in the standard procedure. When a patient was put on isolation, the order was simply one of many fields on the patient's chart. In order to see it, the chart had to be carefully examined by everyone coming in contact with the patient - a physical impossibility, given the flow of patients and staff in an ED. When this opportunity for improvement was identified, the solution proposed was for the charge nurse to be notified when the isolation order was placed so that the rest of the staff would be notified.
Entering this opportunity into KaiNaxus opened the door for further analysis and communication, resulting in an even better solution! Now when a patient is put on isolation, an icon is generated on the tracking board that all hospital staff use to monitor important patient information. That way, all staff can see it, and there's no chance that the order will slip through unnoticed.
This one simple idea is a great example of why it's important to notice and bring attention to things in your workplace that aren't working very well, rather than sweeping them under the rug or accepting them as the status quo. Finding solutions to little problems like this one can make the difference between providing safe patient care and accidentally spreading infectious disease.