Background: Interdisciplinary rounding at the bedside is associated with improvements in patient flow metrics, interdisciplinary communication, and patient perception of teamwork among care team members. At UC San Diego Health, FIT (Focused Interdisciplinary Team) Rounding has been the standard of care on seven diverse patient care units since 2017. However, with the arrival of the Covid-19 pandemic, rounding moved away from the bedside, and the fidelity of our model waned. In the wake of the pandemic there is an opportunity to redesign a humanized, harmonized, optimized process that improves quality and efficiencies for patients and care team members alike. Lean methodology is a valuable tool for developing, implementing, and assessing change in the hospital setting, offering an iterative approach to achieving long-term quality improvement.
Purpose: We aimed to create a multidisciplinary forum to assess the current state of our FIT rounding model, identify themes of opportunity, design the future state and plan pilot implementation of our re-imagined rounding model. We intended to utilize Lean tools and methods to help optimize resource allocation across disciplines.
Description: We held a two-day rapid process improvement workshop (RPIW) to re-design our interdisciplinary rounding model in the division of Hospital Medicine. All care-team disciplines involved in FIT were represented: hospital medicine, nursing, care management, social work, pharmacy, rehab services. Members from patient experience, information technology (IT), and health systems operations were also included. Professionals trained in Lean methodology led the workshop. Day 1 focused on understanding the current state of FIT and developing Lean knowledge. The team learned of tools to examine issues & their root causes, and inform countermeasure development. We created and reviewed detailed workflow process maps (incorporating feedback from key stakeholders), identified areas of opportunity, and submitted ideas for improvement. We envisioned our future state and agreed on high-level guiding principles for solution generation. On Day 2, we split into 4 work groups focused on refining standard work, logistics optimization, electronic health record (EHR) documentation and designing a patient deliverable. We built out implementation, communication, and measurement plans to ensure follow-through on achieving and sustaining our future state. We planned weekly workstream meetings and sponsor check-ins to fine-tune our processes, and concluded the event with a final report-out to all stakeholders. Participants described the workshop as a high-yield, collaborative approach to quality improvement, deepening appreciation across disciplines along the way.
Conclusions: A multidisciplinary RPIW is an effective modality for redesigning an interdisciplinary rounding model. By including all disciplines and taking a grassroots approach, this method garners buy-in from all team members, encourages a culture of change acceptance and excitement for the process. Incorporating Lean training amplifies the efficacy and efficiency of the redesign. Including patients helps ensure patient-centeredness, and including IT facilitates expedited design of EHR documentation tools. Much like the rounding model itself, the multidisciplinary RPIW format facilitates powerful collaboration between colleagues, armed with diversity of expertise and perspective, united in their goal to improve patient care.