Maximizing the Benefit of Quality Improvement Activities: A Spread of Innovations Model.

BACKGROUND: Many organizations struggle to efficiently and effectively spread improvement activities. This article presents findings from a model developed to standardize the sharing of innovative ideas within nursing at an academic medical center. PROBLEM: Quality improvement activities were occurring in many nursing units but often did not spread beyond the originating unit. Challenges included variability in operationalizing initiatives, inconsistent understanding of project goals, and the lack of a dissemination process. APPROACH: The Spread of Innovations Model was developed to ensure structure and resources are in place to spread successful initiatives. The model uses Lean problem-solving and engages frontline nurses with senior leadership when spreading internally developed best practices. OUTCOMES: The model was piloted by spreading a catheter-associated urinary tract infection (CAUTI) prevention project throughout nursing. Using the model led to significantly decreased CAUTIs. CONCLUSIONS: Improvement efforts without a process for spreading can lead to inefficiencies and variable outcomes.

Implementing Lean in Academic Primary Care.

BACKGROUND: Lean is emerging as a quality improvement (QI) strategy in health care, but there has been minimal adoption in primary care teaching practices. This study describes a strategy for implementing Lean in an academic family medicine center and provides a formative assessment of this approach. METHODS: A case study of the University of North Carolina Family Medicine Center that used the Consolidated Framework for Implementation Research to guide a formative evaluation. The implementation strategy included partnering with Lean content experts and creating a leadership team; planning and completing QI events and Lean training modules; and evaluating and reporting activities related to QI and training. RESULTS: During the initial period of Lean implementation, there was (1) minimal to no change in the quality of care as determined by the Preventive Care Index (46-48); (2) a decrease patient appointment cycle time from 89 minutes to 65 minutes; (3) an increase in overall practice productivity from $8144 to $9160; (4) a decrease in patient satisfaction from 94% to 91%; and (5) an increase in monthly visit volume from 4112 to 5076. CONCLUSION: Lean had an uneven effect on QI in an academic primary care practice during the first year of implementation.

Creating a Culture of Rapid Change Adoption: Implementing an Innovations Unit.

This article provides an overview of 1 hospital's efforts to proactively identify and test new approaches to care delivery through the creation of an Innovations Unit, including the structure and processes of the initiative, the outcomes achieved, and the lessons learned.