Fieldston Evan S, Jonas Jennifer A, Lederman Virginia A, Zahm Ashley J, Xiao Rui, DiMichele Christina M, Tracy Ellen, Kurbjun Katherine, Tenney-Soeiro Rebecca, Geiger Debra L, Hogan Annique, Apkon Michael
Division of General Pediatrics, Departments of Pediatrics and
Division of General Pediatrics.
Hosp Pediatr. 2016 Aug;6(8):441-8. doi: 10.1542/hpeds.2015-0239. Epub 2016 Jul 14.
To develop the capacity for rapid-cycle improvement at the unit level, a large freestanding children's hospital designated 2 inpatient units with normal patient loads and workforce as pilot "Innovation Units" where frontline staff was trained to lead rigorous improvement portfolios.
Frontline staff received improvement training, and interdisciplinary teams brainstormed ideas for tests of change. Ideas were prioritized using an impact-effort evaluation and an assessment of how they aligned with high-level goals. A template for each test summarized the following: the opportunity for improvement, the test being conducted, dates for the tests, driver diagrams, metrics to measure effects, baseline data, results, findings, and next steps. Successful interventions were implemented and disseminated to other units.
Multidisciplinary staff generated 150 improvement ideas and Innovation Units collectively ran >40 plan-do-study-act cycles. Of the 10 distinct improvement projects, elements of all 10 were deemed "successful" and fully implemented on the unit, and elements from 8 were spread to other units. More than 3 years later, elements of all of the successful improvements are still in practice in some form on the units, and each unit has tested >20 additional improvement ideas, using multiple plan-do-study-act cycles to refine them.
The Innovation Unit model successfully engaged frontline staff in improvement work and established a sustainable system and framework for managing rigorous improvement portfolios at the unit level. Other hospitals and health care delivery settings may find our quality improvement approach helpful, especially because it is rooted in the microsystem of care delivery.
为了提升单位层面快速循环改进的能力，一家大型独立儿童医院指定了2个患者负荷和工作人员配置正常的住院科室作为试点“创新科室”，对一线工作人员进行培训，使其能够领导严格的改进项目组合。
一线工作人员接受改进培训，跨学科团队集思广益，提出变革测试的想法。通过影响-努力评估以及对这些想法与高层次目标契合度的评估对想法进行优先级排序。每个测试的模板总结了以下内容：改进机会、正在进行的测试、测试日期、驱动图、衡量效果的指标、基线数据、结果、发现以及后续步骤。成功的干预措施得以实施并推广到其他科室。
多学科工作人员提出了150个改进想法，创新科室共进行了40多个计划-执行-研究-行动循环。在10个不同的改进项目中，所有10个项目的要素都被认为“成功”并在科室全面实施，其中8个项目的要素推广到了其他科室。3年多后，所有成功改进的要素仍以某种形式在科室中实施，每个科室还测试了20多个其他改进想法，并通过多个计划-执行-研究-行动循环对其进行完善。
创新科室模式成功地让一线工作人员参与到改进工作中，并建立了一个可持续的系统和框架，用于在科室层面管理严格的改进项目组合。其他医院和医疗服务机构可能会发现我们的质量改进方法很有帮助，特别是因为它扎根于医疗服务的微观系统。
