Culture of Continuous Improvement
Lean Management Efforts
System Transformation at Medical Center
Contra Costa Regional Medical Center (CCRMC) began the journey to reinvent its system of health care in 2005. With new technologies and health reform on the horizon, a team of employees was formed to ensure the county's safety net would be ready for these changes. In 2008, CCRMC obtained a grant from the Safety Net Institute to facilitate and implement the Lean management system. Lean management aims to provide the highest quality of care through zero defects, standardizing work, empowering staff and increasing patient satisfaction. One of the major tools of Lean is the Kaizen. Kaizen is a process for continual, incremental improvement. It is putting the power of improvement in the hands of the staff and patients. The participants have included doctors, nurses, administrative staff and, most notably, advocates, patients and their families.
The CCRMC Change Agent Fellowship Program was developed to enhance the skills and capacity of our future leaders. Fellows in the program go through extensive internal and external training and participate in or facilitate Lean events, such as Value Stream Mapping and Kaizen. Fellows who graduate from the Program continue to be champions of change at CCRMC, as well as mentors to the next group of Fellows.
Improvement Work Under the Medicaid Waiver
Contra Costa Regional Medical Center and Health Centers is involved in a bold and far-reaching effort under a new five-year Medicaid (Medi-Cal in California) Waiver that will allow us to make significant, widespread improvements in access and care throughout our system. The project, entitled the Delivery System Reform Incentive Payments (DSRIP) program, is designed to build on the improvements and innovations we've already accomplished and to help us prepare for the full implementation of Health Care Reform in 2014.
Telephone Consultation Clinic Wins CAPH/SNI Award
The Telephone Consultation Clinic (TCC), an innovative service being delivered to patients through a partnership between CCRMC & Health Centers and the Contra Costa Health Plan Advice Nurse unit, won top honor in this year's Quality Leaders Awards. The Quality Leaders Awards, which are given by the California Association of Public Hospitals & Health Systems and the Safety Net Institute, recognize innovative and creative system improvements in California public hospitals and health systems. About 75% of patients who are referred to the TCC have their needs met without an in-person visit. The way the TCC works is a patient calls into the Advice Nurse line and an on-duty nurse determines whether the patient is eligible for a phone consultation with a physician or family nurse practitioner. LVNs and support staff from the Advice Nurse unit make followup calls to patients to gauge their satisfaction with the TCC service. As of the fall of 2013, the TCC enjoyed a 98.5% patient satisfaction rate.
CCRMC Wins Quality Award for Perinatal Program to Reduce Repeat Cesarean Births
Contra Costa Regional Medical Center (CCRMC) was pleased to receive the Quality Leaders Top Honors Award from the California Association of Public Hospitals and Health Systems and its quality improvement affiliate, the California Health Care Safety Net Institute. CCRMC's Perinatal Unit won the award for its innovative program, the "Vaginal Birth after Cesarean (VBAC) Improvement Project."
The unit developed the program to give women who have had a C-section the opportunity to avoid this surgery with their next birth. Providing this option is a challenge for many hospitals because there must be numerous systems in place to make sure it can be offered safely. But CCRMC's perinatal team was determined to make this choice available to its patients, knowing that a vaginal delivery has many benefits over a Cesarean birth. The team created its own comprehensive, evidence-based process that assured the safest outcome possible for both mother and baby.
The program has succeeded in increasing the number of vaginal deliveries among VBAC patients and there have been no long-term complications for these patients or their babies. With CCRMC delivering about 15 percent of all babies in Contra Costa County, this project has the potential to provide hundreds of women with the option to avoid subsequent C-sections with the assurance that all safety precautions have been taken.