In 2011, Kaiser Permanente Northern California (KPNC) region's efforts to reduce mortality in their 21 hospitals is showing promise. They developed and launched a region-wide initiative to improve the treatment of sepsis, a serious and often deadly medical condition. The case illustrates the challenges of spreading change in a complex, highly interdependent organization, and presents an alternative framework to traditional management models for addressing such situations. It also asks students to consider how change should be made under conditions of uncertainty, in which best performances remain unknown.
Healthcare has traditionally focused on medical outcomes and financial performance. The big question is always, "How much is it going to cost?" What would happen, though, if healthcare also considered the question of "How does the patient feel?" This case looks at the Cleveland Clinic's attempt to answer the latter question by attempting to institutionalize empathy as part of its delivery of care.
Healthcare has traditionally focused on medical outcomes and financial performance. The big question is always, "How much is it going to cost?" What would happen though if healthcare also considered the question of "How does the patient feel?" This case looks at the Cleveland Clinic's attempt to answer the latter question by attempting to institutionalize empathy as part of its delivery of care.
The case describes an organization's use of the science of improvement to transform their process quality from below average to the top 10% in their industry. The case outlines the protagonist's strategy of developing internal experts who are trained in a common methodology for making improvement and spreading these ideas in their work units.
Brigham and Women's Hospital challenged a team of physicians to improve patient flow from the Emergency Department to Intensive Care Units (ICUs). One of the team members, Selwyn Rogers, Director of the Surgical Intensive Care Unit (SICU) at Brigham and Women's Hospital, encountered workarounds by two physicians attempting to transfer their patients to the SICU because the other ICUs were full. Reflecting on the wasted effort and confusion caused by the workarounds, Rogers sent an email outlining the situation to the team. His email generated a negative backlash and chain of defensive emails from involved staff who felt criticized.
The importance of hospitals learning from their failures hardly needs to be stated. Not only are matters of life and death at stake on a daily basis, but also an increasing number of U.S. hospitals are operating in the red. This article reports on in-depth qualitative field research of nurses' responses to process failures in nine hospitals. It identifies two types of process failures--errors and problems--and discusses the implications of each for process improvement. A dynamic model of the system in which frontline workers operate reveals an illusory equilibrium in which small process failures actually erode organizational effectiveness rather than drive learning and change in hospitals. Three managerial levers for change are identified, suggesting a new strategy for improving hospitals' and other service organizations' ability to learn from failure.
Describes the major phases of an initiative designed to transform the organization and enhance patient safety. Raises interesting questions about how to encourage candid discussion about failures while continuing to hold people accountable for their performance.