These reports present the results and outcomes of the

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Rapid Cycle Improvement (RCI) report-outs and other quality reports across departments. These reports present the results and outcomes of the projects. Prior to the initiation of Lean, the main quality improvement tool used by departments was Plan- Do-Study-Act (PDSA). Some staff members also mentioned participating in projects that used Find, Organize, Clarify, Understand, Select-Plan, Do, Study, Act (FOCUS-PDSA). There have been several smaller, less formal quality improvement projects throughout the hospital. For example, in the surgery department a few years ago, a physician spearheaded a quality project team for total knee and hip replacements. The hospital participates in a coalition that provides a forum for area hospitals to share information about best practices and to collaborate to solve patient safety problems. The coalition focuses on improving high-risk processes, such as high-risk medications, surgical safety, and sepsis. Coalition hospitals agree to implement improvements generated through coalition activities. The national health system mandates several patient safety initiatives in all hospitals as part of its overall strategic plan. Participation is required in the following priority areas: falls and fall injuries, pressure ulcers, perinatal safety, nosocomial infections, perioperative safety, Joint Commission national patient safety goals, and adverse drug events. Dissemination of procedures in these areas occurs throughout the health system. For example, in 2008 the national system launched a campaign to have zero preventable injuries or deaths within the health system. This effort and prior safety efforts have been a major focus for the system overall.
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66 Exhibit 2.3. Timeline of Lean and Quality Improvement Activities at Central Hospital Phase Ramp up Implementation Continuation Study period Years 2007 2008 2009 2010 Quarters Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Case Study Data Collection Introduction of Lean New CEO hired Other quality improvement methods reviewed by CEO Lean begins Infrastructure New organizational mission developed Training External consultant obtained to train leadership on Lean principles Leadership trained in Lean Lean projects Door to Balloon charter developed Door to Balloon RCI Door to Balloon monitoring and data collection Procedure Card charter developed Procedure Card RCI Procedure Card monitoring and data collection
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67 Initiation of Lean at the Organization The introduction of Lean at the hospital corresponded with the hiring of a new president in December 2007. Previously, he served as the president of a smaller hospital within HAU Care, which worked with a consulting firm to implement Lean Process Improvement. The new president sought to implement a centralized quality improvement model that would bring culture change throughout the hospital, and he was excited by the results from implementing Lean at his previous hospital.
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