Revolutionary Partnership Brings New Way of Thinking to Kaiser Permanente
There's no doubt that Kaiser Permanente has pockets of excellence in many areas. But how can we tap our own resources to generate new ideas? How can we find out quickly if a new idea will work? And how can we spread those good ideas once we've found them to improve patient care, safety, or efficiency?
"Our strategic partnership with the Institute for Healthcare Improvement is designed to help us leverage the knowledge and expertise that already exist within our organization by teaching us new ways of innovating together," says Lisa Schilling, RN, patient safety practice leader in National Patient Safety. "The ultimate goal is to enhance our performance in quality, safety, and service to our members and patients, and to become a national leader in quality."
A 15-year Partnership
The Institute for Healthcare Improvement (IHI) is a not-for-profit organization that helps accelerate change in health care by cultivating promising concepts for improving patient care and turning those ideas into action. IHI is internationally known and respected for its cumulative experience and expertise in innovation and health care improvement. Kaiser Permanente and IHI share similar aims and goals.
"Our partnership with IHI is designed to extend over 15 years," says Alide Chase, vice president of Quality and Safety, Program Office. "When we began exploring the idea of collaborating with another organization to help us with innovation and quality improvement, we weren't looking for a consultant to bring in for a round or two of training. We were looking for a long-term relationship that would lay the groundwork for augmenting our own expertise in quality improvement."
Opportunities for Nurses
IHI has a long history of working with health care teams in quality improvement at the front line. "They deeply understand the value of nursing as a leader and contributing member of every health care team," says Chase. "At any IHI event on health improvement, there are always nursing leaders at the staff and management levels as presenters talking about the work they're doing.
"The opportunity for us as an organization to do this work with IHI gives our nursing staff new tools and resources to make changes in their work environment that will improve patient outcomes and increase job satisfaction. It also enables our nurses and nursing leaders to work shoulder-to-shoulder with other frontline nursing staff and leaders from across the country who are seriously working on health care improvement."
A $10 Million CommitmentKaiser Permanente has made a $10 million commitment to its partnership with IHI. Of that, $8 million is reserved for scholarships to train Kaiser Permanente staff and community partners in new skill sets designed to bring innovative change to the health care setting. In 2005, more than 400 employees and community partners from most of our regions attended IHI training programs.
"IHI has engaged in strategic partnerships with only a few organizations they believe have the potential to influence the evolution of health care," says Schilling. "It's a learning environment for both sides. We're bringing IHI's successful innovation technologies to our staff and medical facilities and, in turn, IHI sees opportunities for sharing our positive results with others. By merging our strengths together, we're doing something revolutionary in the world of health care."
Small Tests of Change
One of the ways IHI is helping Kaiser Permanente think about innovation and make improvements that benefit staff, members, and patients is by implementing small tests of change. In hospital units and in ambulatory centers across the Program, our nurses are teaming up with their colleagues to test hundreds of ideas that have sometimes been on their minds for years.
"The idea is that, as we move toward improvement or redesign, we learn to experiment and test various hypotheses along the way, anticipating that not everything will work," says Chase. "This shortens the cycle time between the idea and the ability to start working directly with the team where care is delivered to see if the design element actually works. That's a very different way of thinking for us."
IHI Hospital Collaborative
Our partnership with IHI also gives us an opportunity to learn from and collaborate with others. In Southern California , six of our medical centers have joined with more than 70 other teams across the United States - all with nurses and nurse managers on board - to work on improving patient flow in their hospitals through an IHI Collaborative. Among their priorities are addressing bottlenecks in Emergency Departments, admission processes, and effective movement of patients from perioperative through OR to post-op.
"Can you imagine the potential associated with sending not just one team, but six teams from a single region to meet with more than 70 other teams from hospitals all over the country?" says Chase. "It's a whole different level of exposure for our community of health care workers. They're able to bring back information immediately to their facilities and implement small tests of change around concepts they've learned from others in the collaborative. Their ability to bring that information back and share it with all the rest of us speeds everything up."
21 st Century Care Project
In the ambulatory care setting, ten teams in our Colorado , Mid-Atlantic States , Southern California , Northwest, and Hawaii regions are working on projects as part of an IHI collaborative with numerous other health care facilities to redesign primary care. Each team includes members of the nursing staff.
The 21 st Century Care Innovation Project introduces the small tests of change concept to the outpatient setting and, at Kaiser Permanente, uses KP HeathConnect, our new automated health record system, as a tool. At our Smoky Hills, Colorado facility for example, one team is working to improve the percentage of time a member gets an appointment with his or her personal physician. Another Colorado team in testing telephone visits.
Spread Technology
Once an idea has been tested and determined to have a positive impact on quality, how does it move from one nursing floor or department to the rest of the hospital, the region, and other regions beyond that? Through "spread technology," IHI is helping us to literally "spread" our successes across the Program.
Last year, a team of 50 nurses, nurse managers, and others from our Northwest, Hawaii , and two California regions generated more than 400 ideas when they met to brainstorm ways of improving the exchange of information at shift change. The result, now refined, packaged, and being spread to all our hospitals, is known as the Nurse Knowledge Exchange (NKE).
"Using a spread model we co-created with IHI," says Schilling, "we've already spread NKE to eight medical centers in Northern California , and we're planning to spread to 11 in Southern California and both medical centers in Hawaii and the Northwest. By April of 2006 we hope to have spread this information-sharing program to every inpatient nurse in every Kaiser Permanente hospital across the Program."
Rapid Response Teams
IHI's 100,000 Lives Campaign is an initiative to engage US hospitals in a commitment to implement changes in care that have been proven to improve patient care and prevent avoidable deaths. The goal is to save 100,000 live by June of this year.
One of the six goals is to implement Rapid Response Teams to assess and start intervention on patients who may be failing. The system is triggered by the bedside nurse who notices - or intuits - that a patient may be heading for a medical crisis. Our Roseville Medical Center in Northern California has had a team in place for a year, and all Northern California hospitals will soon have their own teams. The program has since been spread to Southern California , Hawaii , and our Northwest regions. Several of our partner hospitals in Colorado , Ohio , Georgia , and the Mid-Atlantic States are implementing teams, as well.
KP Featured on IHI Web Site
Two Kaiser Permanente projects are currently featured on the IHI Web site at www.ihi.org. The patient discharge project at our Roseville Medical Center is featured in the IHI 2006 Progress Report, "Saving Lives," which is available for viewing on the IHI home page. The Nurse Knowledge Exchange is featured in the "In the Spotlight" section, also on the home page.
The IHI site also offers a variety of downloadable "how to" guides, a winter/spring program catalog, a free monthly e-newsletter, and a wealth of information about a variety of health care improvement projects around the world.
For more information about Kaiser Permanente's specific innovation programs, the scholarship program, and our partnership with IHI, please visit http://kpnet.kp.org/qrrm/ihi2/ihi_main.ht