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16 Value improvement at the point of care: an initiative to improve value, flow, and access
  1. William Andrews1,
  2. Poonam Gupta1,
  3. Ian McDonald2,
  4. Salaheddin Arafa3,
  5. Azhar Ali4,
  6. Jeff Rakover4
  1. 1Hamad Medical Corporation Heart Hospital (HMC-HH) Quality Department
  2. 2HMC-HH Department of Nursing
  3. 3HMC-HH Department of Cardiology
  4. 4Institute for Healthcare Improvement


Background The value improvement (VI) approach was developed by the IHI and piloted at Raigmore Hospital, Scotland. It showed positive results by improving outcomes and reducing costs. Our team from a tertiary care hospital in Qatar used it to improve value in a clinically and geographically distinct context.

Objectives To evaluate the outcomes achieved from applying the VI methodology.

Methods The method is rooted in a framework that emphasizes standardization, continuous process improvement, and rightsizing capacity to demand. We collected and acted upon 3 types of indicators: performance, capacity (how resources are used), and financial measures. The main tools include a data box score (weekly updated table of data), a visual management board (showing run chart data, QI analyses, etc.), and weekly communication huddles to report progress and plan next steps.

Results Compared with a 4 - 8 week baseline data collection period, improvements included an increase in discharges before 13:00 by 61% (figure 1), reduction in blood samples per patient per day by 20% (figure 2), increase in nursing time spent in direct patient care by 18% (figure 4), reduction of skin injuries by > 50% (figure 3), completed VTE risk assessments increased 30%, reduction of RN overtime hours by 50% (figure 5), lab sample rejection eliminated, and significant noise reduction in ICU. Currently more than fifty individual projects are completed or underway under the Value Improvement umbrella, the majority of which are showing improvements, often after only a few months.

Abstract 16 Figure 1

Percentage of patients discharged before 1 pm

Abstract 16 Figure 2

Number of blood samples sent per patient per day

Abstract 16 Figure 3

Number of skin injuries, including pressure

Abstract 16 Figure 4

Direct nursing care hours, morning shift

Abstract 16 Figure 5

RN overtime hours

Conclusions We found that the VI approach offered a systematic method for continuously improving the quality of care by focusing attention each week on safety, efficiency, and patient experience. The team improved numerous processes and outcomes resulting in a positive impact on patients and families and increased the engagement of staff in continuous improvement. In this way, we also improved our capacity to undertake and complete quality projects.

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