Glossary
TL - Transformational Leadership

TL3EO: Strategic Planning-Describe and demonstrate the outcomes(s) that resulted from the planning described in TL3.

The following are examples demonstrating outcomes derived from TL3.

Example of Efficiency in perioperative services

Recently, the Chief of Surgery, Dr. Holmes MD and the Chief of Anesthesia, Dr. Landauer MD were interested in improving the first case start time in the operating room. This had been an ongoing problem in the OR, causing many delays. The inability to start the first case of the day in a timely manner impacted on the entire operating room schedule. After vigorous discussions in the OR Management Committee, it was determined that a team approach would be utilized. The team decided that, initially, only outpatients would be reviewed and that the overall goal would be to have the patient in the operating suite by 0730. Nursing management in

Operating Room Team
Operating Room Team

perioperative services, Cheryl Owens DNP(c), RN, CNOR and Kelly Loo BSN, RN CGRNA determined that the ideal persons to collect the data would be the Same-Day-Surgery (SDS) nurses, as this was the entry into the system for these patients. Anesthesia agreed to develop a tool to assist with the data gathering process. Presci Alegre BSN, RN SDS nurse was charged with the data collection process. Dr. Holmes MD, Chief of Surgery, determined that he would send a letter to all of our attending surgeons of our intentions urging them to be compliant with start times.

Furthermore, to insure a team approach, it was decided that management be a physical presence in SDS in order to “send a strong message.”

First Case Start Time in the Operating Room Team Members

TL3-Table1

Data was collected from November, 2011-February, 2012. There was one month of data from 2010 that was used as a reference point. The team was diligent during this time period to insure that processes ran smoothly. One issue which was identified was the unavailability of paperwork in SDS on the day of surgery, for example, completed history and physical forms and consents. This was resolved by providing a number for physicians to FAX completed forms directly to SDS. Overall, the team was able to drastically reduce the average number of late minutes per patient from 20.8 to 6 minutes.

TL3-Table2


Example of Efficiency/Effectiveness in the Cardiac Catheterization Laboratory

As a result of increased cardiologists utilizing the Cardiac Catheterization Laboratory there was an increase in volume in implantable cardiac rhythm management (CRM) devices. These devices include Pacemakers and Internal Cardiac Defibrillators (ICDs). These devices are relatively expensive and the organization was considering a price reduction proposal through the Value Analysis Process. In the latter part of 2011, an interdisciplinary Value Analysis Team (VAT) determined that a potential savings had been identified for cardiac rhythm management (CRM). The team developed a strategy for this initiative and determined to work with key stakeholders to develop an action plan. The scope of the project includes the departments in which CRM devices are implanted (Operating Room and Cardiac Catheterization Laboratory). The team included:

TL3-Table3

The action plan included approaching the three companies and proposing a price structure that would result in a significant cost savings to the hospital. The process included working with the cardiologists and the nursing staff in the CCL in order to ensure that they were compliant with the program. Initially the companies had the following percentage of business:

TL3-Table4

The proposed cost savings leaving them at their current market share is as follows:

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All the companies agreed to the cost structure, and the VAT team was very pleased with the results of their negotiations. This has truly added to the efficiency and effectives of the cardiac catheterization laboratory and has resulted in a tremendous cost savings.

Example of efficiency/effectiveness on a Medical/Surgical Unit

The nursing staff from 7 East, a medical/surgical unit voiced concerns about a port-a-cath needle (Huber needle). The Port-a-cath is a venous access system which is inserted into a vein and contains a port or septum which is implanted under the skin. The port is accessed (for medication administration or blood draws) by a specialized needle. The staff was concerned,

because the needle they were currently using was not versatile and lacked safety features. The current needles could not be used for CT scans because they were not power injectable. Because of this, the patient had to undergo another needle stick for the addition of another line. It also lacked a retractable protective safety feature which left the staff vulnerable to needle sticks.

Several staff members approached Janice Kozzi MSN, RN, CNL about this problem. Ms. Kozzi immediately contacted the Purchasing Department in order to have them assist her with the selection of an alternate needle. She found one that had the features she desired and performed a cost/benefit analysis for presentation to the Value Analysis Committee.

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The Value Analysis Committee approved the use and eventual conversion depending on this product being piloted in two areas; The Emergency Department and 7 East. The staff was delighted with the new needle because it is CT rated for power injections and when the needle is retracted a tent forms around the needle insuring safety. We were able to reduce our needle stick injuries from a high of 5 in January of 2012 (needles were purchased and implemented in January, 2012, to a gradual decrease of 4 in February to 2 in March.