A large acute-care hospital located in the United States was plagued with a poor reputation, high readmission rate, and weak profitability. As a last resort, the hospital board of directors fired the CEO and conducted a national search for a replacement. The new CEO selected by the board had been running a very successful hospital in a different part of the country. This new recruit was skilled and knowledgeable in PI. She had first-hand experience with methods like Lean Six Sigma and HROs. She came on board and immediately initiated training and much needed culture changes. Hospital-wide PI teams were assembled to assess and prioritize the improvement needs of the hospital. Taking each of the highest priority issues, following the process of identifying measures, measuring performance, analyzing data, identifying the improvement opportunity and continually monitoring performance they were able to make drastic changes in every department. Through this transition process and over the course of a year the new CEO realized sizeable cost savings. Through the PI process, priorities for new equipment and infrastructure were set. One high priority item was a new surgical suite with updated technology. The board approved the construction of the new suite and purchase of the new equipment. Because of the implemented PI processes and monitoring, one month after the surgical suite opened the hospital epidemiologist noticed a spike in postsurgical infections. A PI team was assembled with representatives from the surgery service, housekeeping, nursing, infection control, and HIM. The team meticulously evaluated and improved each of the procedures related to the new surgical suite. Continued monitoring only demonstrated minor improvements in postoperative surgeries. Having exhausted the expertise and ideas of the internal PI team, the CEO contacted external experts and assembled a virtuoso team to come and consult with the internal PI team. Both teams were put into a small conference room and given five hours to review the collected data and the changes that had been made with little to no results. The external view of the outside experts, along with a detailed decomposition of the processes related to the suite, pointed to the construction process. Pulling the specifications and reports from the construction process, the virtuoso team had questions for the construction contractors about the grade of materials used in the room. Specifically they were concerned that the walls and flooring were too porous to be properly sterilized. The contractor confirmed the suspicion and came up with a solution to recover the walls and floor with appropriate materials. Monitoring infection rates closely, the suite reopened for use. Weekly dashboard reports were given to all stakeholders and showed no postoperative infections. At a review meeting at one month, the postoperative infection rate had dropped to a level lower than before the new surgical suite was opened. This is an example of how many different PI techniques were used to improve a hospital and solve a difficult problem.

Real World Case Discussion Questions

1. What are the pros and cons of involving outside experts as occurred in this case?

2. Why is the use and monitoring of dashboard reports important in managing performance improvement in a healthcare organization?

3. What PI techniques were used by this hospital to determine the cause of the post-operative infection rate increase?