What We Tried

About a year ago, our health system took on the challenge to train all the directors, managers and staff to look at performance improvement at a different way. We were introduced to some aspects of the Toyota Production System and kata was a part of that. Kata is a way of learning a new habit utilizing rapid cycle improvement PSDA to guide deliberate thinking and problem solving locally instead of jumping to a solution.

We pulled a team together of some of our most experienced kata trained employees and kata coaches to focus on pneumonia (PN) readmissions. We asked ourselves, “Where do we want to be in nine months? What should our goal be?”

We created a three-day event, called Get Better Jump Start (GBJS). The GBJS team consisted of a case manager, educator, nursing, respiratory care, PT, quality, senior leaders and a physician champion.

We did a deep dive into the issue so we could understand the current condition and identify obstacles. We reviewed our PN readmission data for the past 12 months. We contacted and interviewed some of the post-acute care facilities and our primary care physicians and asked how we were doing and what we could learn from them. We had a lot of lessons learned and “ah-ha” moments from connecting the dots and conversations with the team. After the evaluation from this three-day event, we decided to pilot our improvements with the 47-bed Medical-Oncology unit because our data showed most PN readmissions came from that floor.

1. Developed hypothesis targeting obstacles. We decided to focus on discharge education and communication between caregivers internally.

2. Utilized Training Within Industry (TWI). This is a method to train staff to help reduce variation.

We developed a Job Instruction Breakdown (JIB) for all staff (nursing and ancillary) to standardize patient education specific to PN. When training staff, we would use a JIB to identify important steps in a process, key points about the step and rationale supporting the key points. We created Pneumonia talking points for our multi-disciplinary meetings (MDM) and standard work for patients with pneumonia. I think this was one of the most important things that came out of it the TWI. When patient is admitted, diagnosed or develops PN, one of the initial pieces during the standard work is to take that JIB and put it on the white board in the room and educate that the patient is diagnosed with PN. Then every staff member that goes into the room can references the JIB, and review all the important steps, key points, and reasons for key points with the patient and/or family.

3. Utilized TWI on patients. We’ve used TWI on other processes with staff but this was the first time we used it with patients. We emphasized important things related to the patient. We made sure the patient understood the following and more:

• their diagnosis
• PN is high risk for readmissions
• length of recovery time
• medication instructions
• breathing treatments
• reasoning for treatments
• understanding follow up appointment importance
• who specifically would be contacting them (e.g., home health follow-up and why home health was ordered)
• their transportation to and from appointment

Get Better Jump Start Kata Boards

The board on the left focuses on the discharge process. On the right, the MDM process is displayed.