“Would you let your mother stay in this room?” Successes and Failures in Empowerment and Respect on the Frontline
Dr. William Huen & Reyland Manatan
Background: Clean hospital rooms are foundational to patient experience, flow and safety. After opening our new hospital in May 2016, staff identified delayed “bed turnover” (cleaning and preparing rooms post-discharge) and 23% room cleaning defects.
Goals: Decrease “bed turnover” from 154 to 90 minutes and eliminate cleaning defects from 23% to 0% by March 2017.
Current State and Analysis: We used 70+ observations, process maps and A3 thinking to understand bed turnover, uncovering 154-minute lead times and 23% cleaning defect rates. Analysis: 1) Outdated cleaning standards missed new room features (e.g. larger rooms, showers, monitors, workstations); 2) Defective nursing-housekeeping communication forced 111 minute delays, 6 calls, and 9 data entries, per room; 3) Midday peaks in hourly discharges exceeded capacity of housekeeping staffing models; 4) Hierarchical culture and uneven improvement tool knowledge precluded frontline ownership of improvement work.
Future State: Countermeasures: 1) Fifteen standard work iterations improved cleaning processes and supported increased time allowances from 45 to 70 minutes, 2) Communication standard work reduced defects and waiting; 3) Shifting 2 housekeepers better matched midday discharge surges; 4) Teaching PDSA, standard work, daily huddles and measurement transformed culture and ownership by housekeeping staff.
Outcomes: Cleaning defects decreased to 0% and total lead time continuously decreased by 48% to 80 minutes, despite increasing cleaning time from 45 to 70 minutes.
- Observing and engaging staff revealed shocking gaps and assumptions in bed turnover.
- New hospital created unintended consequences and opportunities.
- Frontline engagement with lean tools enabled sustainable improvements.
Dr. William Huen is Associate Clinical Professor of Medicine at UCSF, and serves at Zuckerberg San Francisco General Hospital as Associate Chief Medical Officer and Medical Director of Quality Management and the Kaizen Promotion Office.
Dr. Huen practices medicine and teaches housestaff and students on the Inpatient Medical service and Medicine Consultation service at Zuckerberg San Francisco General. Integrating his passions for quality improvement, education and multidisciplinary collaboration for vulnerable populations, Dr. Huen is dedicated to improving the patient experience, staff experience and systems within the health care safety net. Recent involvement includes implementing aspects of the hospital’s Delivery System Reform Incentive Program, establishing the Quality Data Center to develop and track key quality metrics, co-teaching the SFDPH Quality Improvement & Leadership Academy, enhancing the patient and staff experience through the Lean model of health care improvement, and implementing computerized provider order entry in the inpatient setting.
Dr. Huen received his AB from Princeton University in the Woodrow Wilson School of Public and International Affairs and his MD at the UCB-UCSF Joint Medical Program. He also received an MPH in Health Policy and Management and MS in Health and Medical Sciences while at Berkeley. Dr. Huen completed his residency in Internal Medicine at the San Francisco General Hospital Primary Care Program at UCSF.
Reyland Manatan is a General Services Manager of the Environmental Services Department at Zuckerberg San Francisco General Hospital. He was first promoted to the Porter Supervisor position on June of 2015. Prior to that time, He started his Environmental Service career as a front-line Porter for the Department of Public Health in 2008. He is co-owner to the development and implementation of the Discharge room turnaround workflow efficiency project lead by the Kaizen Promotion Office at Zuckerberg San Francisco General Hospital. Additionally, he promotes the True North goals aligned with ZSFGH & EVS to consistently provide a clean, safe and healthy environment to all patients, staff and visitors with compassion and respect.