This is the healthcare delivery providers,

part of the healthcare marketplace specialization.

This is module 2.4.2, innovations in hospitals.

Learning outcomes for this lecture are we will review a few examples of innovations

that are happening in the hospitals right now.

Now lean is not an acronym, but it's a term I want to either look up

if you're not familiar with it or remember as we go through this innovation section.

This particular lecture is quite exciting to me

personally because this is what keeps me going and

gets me excited about what's happening in the US healthcare delivery system.

So this is about innovations that happen in health systems,

particularly in this lecture, we'll look at the hospital.

Now I don't want you to jump directly to the conclusion that innovations

in the hospital will be all about coming up with new cures.

So new cure for cancers.

New surgery equipment or new surgery types, new medications.

That's one of the types of innovations that we will cover very briefly.

So, innovations in the surgical techniques or equipment.

But there are other innovations that are actually as important or more important.

So when human beings come together in teams, a nurse, a physician, a social

worker, and they form a team around a patient, how should that team function?

So that there is minimization of waste.

There is high efficiency and high reliability in the care they provide.

Now that is a process or work flow innovation.

That we will talk about.

Another type of innovation might be in the human factors themselves.

So, are the physicians and the nurses able to communicate in different ways?

Are their work flows and processes better and better so

that the waste and the time that the patient is waiting is reduced?

The test results, for

example, go from where they need to go to where they should be going.

And there's connectivity of data and information flow.

So all of these are different innovations that the hospitals are working on, and

we will cover a few of those in the next few slides.

So let me start first with this model across the US

on a national basis called the Hospital Engagement Network.

And I'll draw it out for you.

So let's say here's the US,

and there are over 3200 hospitals, so

all of these hospitals across the US collaborate together and

form regional hospital engagement networks.

So the one that I am involved with is right here in Minnesota,

called the Minnesota Hospital Engagement Network.

And the way that these hospital engagement networks work is that all of

the members within the network collaborate together.

Come up with what is not working well, or what should be a process or outcome that

we need to improve and then together, they would come up with a new evidence based,

a new protocol, a new process to improve that, and then they measure it.

And if that does improve quality,

then that particular standard is shared with the federal government, CMS, and

then CMS spreads that with all of the other hospital engagement networks,

and those networks then spread it with their constituent hospitals.

So again, 3200 hospitals together improving quality,

reducing cost, improving patient and

family engagement and as a result creating population health.

That's a very powerful paradigm.

And the program comes from the federal government CMS and

they provide grant support and other support.

So, it's a extremely powerful, very positive program for

continuous quality improvement in the US.

Like I said, medical innovations are what we think about typically with research and

development.

So new surgical techniques, new treatment for cancer, or

other diseases, new technology, like devices,

all of that falls under the category of medical innovations.

And a lot of those do happen in a large research in hospital centers.

Other type of technology innovations might be devices that are used to monitor and

treat patients, so I think of a patient that is sitting in

her room in the hospital and there is a audio visual connection.

And not just to the nurses and physicians on a staff at the hospital, but

also hundreds of miles away sometimes to monitor the patient or treat the patient.

So again, e-health and using the e-health technology to connect

the patients to the right caregivers or right treatments.

The other important piece is the data and analytics.

Again, that is the underpinnings of the quality program across the US.

So data is measured, and

then reported, and then analyzed to see what is working well.

What needs to improve and then through that, counter measures on new

innovations are birthed to try to improve what the data shows us.

Now, a patient engagement and coordination can also happen through technology.

So patient sitting in the hospital would get connected

to their primary care clinic for example, through either data or other connectivity.

And so the coordination of care throughout the journey is made possible through

new technology and new infrastructure through information services.

I alluded to this a little bit in my video a few minutes ago.

There are process innovations.

So what is interdisciplinary teamwork?

There's a new model of interprofessional education that is coming up in the US,

how do nurses, and physicians, and therapists, and

pharmacists, and epidemiologists, and others work together.

So what is a powerful team?

How does a team get to know each other and push in the same direction?

A lot of these principles are being learned from industry.

For example, the lean principles of going to the.

Which is going to where the value's created.

So, for example, an executive in the hospital would not just sit in her room.

She would actually go to the patient care units, observe what is happening and

connect with the front line team members to do PDCA cycle,

Plan-Do-Check-Act to continuously

improve PDCA to continuously improve every process and every care workflow.

Another innovation which is quite as simple but a very powerful

one in the rooms might be what is called a white board, called get to know me board.

And so a patient when their admitted, their photograph might be put up there,

the photograph of their physician, and their a nurse might be put up there.

And then the hobbies and the life story of a patient is written on there so

that the staff that come into the room know the patient and

can build a relationship with the patient.

The other thing that is powerful is sometimes the daily schedule of who's

coming to see the patient, what x-ray or other tests are going to be done that day,

really keeps the patient and the family oriented

to what is happening in this very fast-paced hospital environment.

So again, one way of engaging the patient and family.

So patient and family engagement.

So that's one of the patient engagement initiatives.

There are several others.

For example, getting the patients to come into meeting or on committees.

Having the patients give data in realtime and

feedback around how their hospital stay is going so

that the gear staff and the systems can evolve and be customized.

So all of these are examples of a process innovations that are happening in

hospitals right now.

Let's do a short quiz.

Similar to process there might be work flow innovations,

and I've called a few of them out.

So for example, there is this very powerful issue, or process of timeout.

So, before surgery the surgeon initiates a brief pause.

So it's a pause where the surgeon, the nurses, the technicians,

the anesthesiologist in the operating room, everybody pauses and

practices mindfulness.

So they look at the patient.

They look at the surgery that needs to be done

if the right knee was to be operated on, they will make sure that they

visualize the marking on the right knee before the surgeon actually makes the cut.

So again, one simple way of making sure that the right procedure and

the right surgery is performed.

Another innovation is the safety huddle.

So for example, some hospitals every morning,

at 7 in the morning would have a conference call.

So, a hundred or so staff and leaders would call into this daily conference.

And they would review the daily workings of the hospital.

What are some of the things that they are anticipating for that day?

Are there any vulnerable or very sick patients that need to be watched out for

or looked out for?

And any other key areas that need to be discussed?

And all in a space of about 10 to 15 minutes.

So again, a very powerful way to connect and make sure that the day goes well.

There are many workflow innovations in medication safety,

so how medications move from the pharmacy to the patient

care unit to the nurse and eventually to the patient.

All of these workflows have been charted out and

innovations in how the medications move.

And how the human beings interact with the flow have been put in place, and

they have led to incredible improvement in the processes of medication safety and

reduction in side affects, reduction in adverse outcomes, and

as a result, improvement in cost.

One of the ways that this can be done is through RFID or

tracking systems which can be attach to equipment, so

at any given moment in time a hospital personnel can find out where

a particular piece of equipment is and track that down very easily.

Better coordination has many examples.

So in the pre-acute settings, for example, there is emergency department,

there is free standing, or ambulance that is bringing a patient in.

Both of those could be connected through IT with the hospital emergency department,

so the physician here can actually see what's happening inside the ambulance and

give direction to the ambulance crew on what to do.

So, connectivity through information technology,

also there's connectivity with the primary care provider.

So a patient is in the hospital and their care, and the care plan

is shared seamlessly with the primary care provider who is sitting in her clinic.

Similarly with post-acute, after the hospitalization, the patient

is discharged in to the community, there is a process of making a phone call at

the patient's home, by a nurse or other clinician to see how the patient is doing.

And make sure if they have any questions,

those are answered, as a way to prevent readmission.

Again, a very simple measure to make sure that the patient is safe,

and the care plan is progressing.

And all of these could be types of case management as well across

the care continuum.

Talked a little bit about the inter-professional education

where physicians, and

nurses, and therapists, and pharmacists are now being trained together.

So you know how a team works, not just an individual discipline, but

how does a team work so that everybody can be pushing in the same direction,

which is towards quality improvement of the patient.

The curricula for the medical school,

nursing school are being evolved to really look at this particular concept.

Innovations in people and people processes, so

one of the counter measures is a debriefing sessions or

stress debriefing after maybe a high stress event or a death of a patient.

So clinicians would come together and debrief and learn from the event.

Or also be able to talk with each other and get some emotional support.

Part of this is also, as I talked about, front line important improvement.

So, on the unit, right where the patients are,

the nurses, the pharmacist, and the physicians would get together as a team.

And sometimes it's called a unit council, and this council would look at

their own unit, and look at what quality improvement needs to happen on that unit,

again very powerful because it is not coming top down from executive leadership.

But, it is really home grown by the unit and by the people that will

actually be working with those processes on a day to day basis.

Summary, I've covered a few brief innovations.

There are numerous more, but hospitals are leading these every single day.

I see this everyday in Minnesota and across the nation.

This is leading to triple aim benefits, and

the innovations could be in quality improvement, in technology,

in medicine, in workflows, and also in human resources and people.

2.4.2 What Innovations are Occurring in Hospitals?

Healthcare Delivery Providers

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