Nursing quality and informatics framework: A Lean Six Sigma approach to achieving zero harm nurse-sensitive indicators

Mari Akre, PhD, MSN, MS, RN, NEA-BC, CPHIMS, System Clinical Transformation and Nursing Quality Director, Cayuga Health

Jessica Aman, Enterprise Project Coordinator, Cayuga Health

Abby Murray, DPT, Manager, Physical and Medical Rehabilitation Unit and Inpatient Therapy, Cayuga Health

Chris Payton, RN, MSN, ONC, Director, Surgical Stay Unit, Inpatient Rehabilitation Unit and Inpatient Therapy, Cayuga Health

Representatives from Cayuga Health System will share how they revitalized their nursing quality and informatics framework using Lean Six Sigma methodology, high-reliability principles and effective applied clinical informatics. They’ll show how the new framework reduced operational costs and patient harm — including falls, pressure injury and C. difficile infection — while improving patient care and outcomes. They’ll explain how this approach can serve as a model for other healthcare systems aiming to achieve excellence in patient care outcomes and nurse engagement through tightly integrated high-reliability methodology.

Learning objectives

• illustrate how applied Lean Six Sigma methodology and high-reliability practice achieved substantive improved outcomes for key nurse-sensitive indicators;
• explain how to apply these principles to daily clinical practice; and
• discuss strengths and gaps encountered along the journey to clinical excellence and standardization of high-reliability practices.

Care team rounds: Developing interdisciplinary working rounds

Julie Pearson, RN, MPH, Director, Performance Improvement, Mount Sinai Health System

Faye Reiff-Pasarew, Deputy Chief Medical Officer and Chief, Hospital Medicine, Mount Sinai Morningside

Hear how Mount Sinai decreased patient length of stay and improved communication among nursing staff, physicians and patients using care team rounds. Learn how they used Lean strategies such as Plan, Do, Check, Act to manage workflow changes and interdisciplinary staff input.

Learning objectives

• understand the challenges to changing entrenched workflows among staff of different disciplines;
• review the use of quantitative and qualitative analyses to evaluate a LEAN quality improvement initiative, including advantages and pitfalls; and
• discuss how to pivot within subsequent PDCA cycles and decide when to provide additional resources and support for an initiative vs. when to suspend the project.

Lean process improvement: Improving first-case, on-time starts

Carrie Steiner, Senior Director, Operations Excellence, UR Medicine

This session will discuss lean process improvement by reviewing a case study from UR Medicine in which they improved first-case, on-time starts. Come prepared for an interactive discussion about the tools used and best practices, barriers and tips for success.

Daily Lean and innovation: Leadership corner conversation

Moderator: Sri Poranki, PhD

Stephanie Johnson, RN, MS, Vice President, Quality and Risk, St. Peter’s Health Partners and St. Joseph’s Health

Preet Kukreja, MBA, MHA, Director, Population Health Initiatives, St. John’s Episcopal Hospital

Shaghayegh Norouzzadeh, Senior Director, Process Improvement, Northwell Health

During this panel session, healthcare experts will:

• explore how Lean principles improve efficiency, reduce waste and enhance patient outcomes;
• examine Lean strategies for optimizing patient flow within healthcare facilities, including emergency departments, operating rooms and outpatient clinics;
• discuss strategies for engaging frontline staff in Lean initiatives to foster a culture of continuous improvement and empower staff to identify and implement changes that positively impact patient care and operational efficiency;
• discuss how to use Lean principles to leverage data analytics and decision support tools to drive data-driven decision-making, quality improvement initiatives and population health management strategies;
• explore the role of standardized work, including the development of standardized processes and protocols to improve consistency, reduce variation and enhance care quality across clinical settings;
• discuss the importance of continuous learning and improvement, experimentation and adaptability in the Lean mindset; and
• highlight the importance of problem-solving skills and root cause analysis to identify and address underlying causes of inefficiency, errors and waste.

Navigating the winds of change: An ongoing event

Michelle Karedes, Senior Director, Strategic Facility Planning, United Health Services

Rafaela Spence, Director, Performance Excellence and Improvement, United Health Services

Ann Teng, DO, MPH, MBA, FACOEM, Chief Wellness Officer; Medical Director, Medical Command Center; and Medical Director, Occupational Medicine and Employee Health, United Health Services

During this session, a strategic facility planning expert who has led teams through large-scale facility projects during the COVID-19 pandemic and an occupational health physician who led a healthcare organization’s COVID-19 response will discuss perspectives around change management do’s and don’ts. You’ll learn strategies for leading teams without direct oversight, lessons from the field and the power of after-action reviews. Best practices for sustaining leaders through change or “how to put your oxygen mask on before assisting others” will also be discussed.

A conversation on health equity: Let’s get started

Moderator: Annie DePugh, RN, BSN, MPH, System Director, Population Health, United Health Services

Julie Hunter, MD, MPH, FASAM, Medical Director, Addiction Medicine, UHS Binghamton General Hospital

This session will cover the approach to health equity for an identified behavioral health population of interest. We’ll discuss how common comorbidities influence behavioral health conditions and how this understanding can elevate clinical impact. We will also consider approaches to caring for disparate populations and meeting people "where they’re at."

Building a career in healthcare improvement

Moderator: Lisa Schmutter, MPA, BSN, RN, Director, Quality and Patient Safety, NewYork-Presbyterian Hospital

Joan Guzik, MBA, Director, Quality and Efficiency, Quality Institute, United Hospital Fund

During this session, we’ll discuss the many aspects of healthcare quality improvement, the skills required and the various career pathways that quality professionals may pursue.

Minutes matter: Improving timeliness of sepsis screening

Margaret Grogan, MPA, BSN, RN, Nurse Manager, Mount Sinai Hospital

Stephanie Guareño, MS, MBA, Senior Nurse Process Improvement Manager, Mount Sinai Health System

Sepsis is a leading cause of morbidity and mortality for hospitalized patients in the U.S. This is especially disconcerting since the outcome can be altered by simple screening interventions clearly linked to early recognition and treatment. Learn how this team used A3 thinking and leveraged their daily management framework to empower and engage frontline staff to improve the completion of the sepsis screening questionnaire within one hour of admission or transfer to the unit. Discover the successes and failures in the PDCA cycle of improvement that led to sustained compliance of 95% since implementation. Specifically, we will share how the team restructured their workflow and strengthened core elements of their daily management framework to incorporate additional members of the care team to make the minutes matter.

Learning objectives

• illustrate how daily management develops improvement capability in leaders;
• identify key process changes implemented to improve compliance with sepsis screening; and
• demonstrate how clarity of focus enables one to achieve sustained results.

Integrating artificial fetal monitoring intelligence to improve patient safety

Shanna Sapienza, DNP, RNC-OB, C-ONQS, C-EFM, Obstetrics Patient Safety Coordinator, NewYork-Presbyterian

Natali Valderrama, Patient Care Director, Labor and Delivery, NewYork-Presbyterian

In 2023, NewYork-Presbyterian set forth to improve situational awareness, intervention time and communication among team members regarding Category II Fetal Heart Rate Tracings by adopting an artificial intelligence system, Perigen Vigilance, an early warning system and clinical decision support tool that aids in the interpretation and risk classification of fetal heart rate tracings and maternal vital signs on labor and delivery. Learn how their interdisciplinary approach to educating staff on the new software and embedding its use into daily workflows improved uptake after a secondary campaign of the program from 12% to 90% during a three-month period. You’ll also learn how the technology enhanced clinical efficiency and timely intervention.

Learning objectives

• explain the impact of artificial intelligence on labor and delivery;
• compare methods of implementation; and
• understand the importance of an interdisciplinary approach to project implementation.