Marin General’s program had a rocky start because of competing hospital initiatives that overwhelmed staff.
We applied for a grant to improve our care transitions and to reduce non-elective readmissions without realizing that other big initiatives at our hospital would compete for the energy and attention of staff. About one year prior to implementation of our care transitions work, the hospital initiated Clinical CareStation—incorporating nursing into the EMR. The rollout was rocky, leaving the nurses skeptical of any other new software innovations (which was core to our transitions program). The second initiative was a computerized physician order entry system (CPOE). This was also a rocky rollout, effectively distracting our staff from the newly implemented transitions program.
Marin General is a non-profit hospital in Greenbrae, CA. It has 250 beds and serves a mainly affluent suburban/rural population with pockets of low-income Latinos, African-Americans, and state prison inmates. Their transitions program began in 2011 and is influenced by the Care Transitions Program and Project RED.
What We Tried
This isn’t “what we tried,” but rather “what we would do in hindsight.” When we were planning the transitions launch, we would have benefitted from meetings with leadership to map out a hospital-wide timeline across programs. Yes, we did review the transitions program timeline with them. At the time, it seemed aggressive, but achievable—but if we had considered the Clinical CareStation and CPOE rollouts, we would have realized it was too much to ask of our staff within the proposed timeline.
We probably fell behind a good 4–6 months on our project plan because people couldn’t juggle so many new processes at the same time. When the CPOE rolled out, there was a clear dropoff in our transitions tool usage. Had we known beforehand that these initiatives would have such a large impact on the staff, we wouldn’t have started our transitions work at the same time.