With the defined goal of stairstep improvement in quality, safety and reliability of patient care, Sacred Heart''s operational and improvement leadership determined that a dedicated process design project team was required. The need for diverse and experienced leadership was met by establishing a project team of three professional engineers, four medical professionals and two organizational development professionals. The project duration was to be 1.5 years.

The challenge of changing the culture, and processes, of the organization while concurrently focusing on the logistics of the move required the involvement of front-line staff. Teams of front-line staff were developed, including 100 physicians. An innovation was to include patients and family members on the teams. We found that nothing changed a caregiver''s mind more than hearing patients experiences first-hand. In total, 1,200 staff in 65 functional teams, 50 clinical teams and 15 ancillary teams were involved. The project budget, $1.75 million, paid for the project team, staff time spent on process design teams, and for teams'' onsite process testing.

The approach used to operationalize the goal was to develop a unique-to-the-situation methodology based on work simplification, process improvement and lean principles. This methodology was first developed into a training curriculum in which more than 100 front-line leaders and managers were trained. Thereafter, the project team facilitated the front-line teams in design sessions lasting from two to 15 days.

Teams flowcharted the desired new process step-by-step asking what, who, when, and where (and why), and assessing each step against the seven wastes of lean, and our patient-centered-care guidelines. For clinical processes, failure mode effects analysis was used for patient safety, asking: Is there a step in the process that can fail and harm the patient? If so, how can we redesign the step to reduce that chance of harm? In total, approximately 1,000 hospital processes were analyzed, of which 80% were changed.

In addition to the classroom design sessions, teams spent many hard-hat hours in the partially built facility, walking their units and assessing their designs. Once the building could be occupied, the teams returned to test their processes, to the degree permitted by newly installed technology. Fully functioning new technology was one of the biggest challenges the process design teams faced. As a result, just prior to opening, Sacred Heart took the unique step of conducting three rounds of onsite multi-day simulation testing that involved a core group of staff from all departments, simulating nearly 50 patient scenarios. This simulation testing was facilitated and supported by a consulting firm.

As a result of this effort, all staff in every department, clinical and ancillary, were trained in a new way of delivering patient care when opening day arrived. About 25% of the staff actually worked the new processes in simulations and other sessions. One recommendation would be to involve even more staff in hands-on training.

A challenge experienced immediately upon opening was that not all technology systems, both facility and IT, were stable. This, combined with a patient census that grew far more quickly than planned, allowed no time for staff to acclimate and gain confidence with a stabilizing new process, nor have a reasonable transition from their empty-building training to reality.

The teams attempted to identify measures to track how the new processes are trending. This follow-up work is proving difficult for some teams who are focused on daily work-related duties; however, we already have some detailed quantitative and qualitative process data and continue to monitor the high-level data we track including the number of medication errors, patient and employee satisfaction and infection rates.