Background: Readmission rate at UMASS Memorial Hospital medicine division is high at 15.5%. Majority of patients are admitted to Hospitalist service. Given the challenges in obtaining real time readmission data, physician engagement is poor. Etiology of most of the readmissions gets attributed to system related issues. To improve physician engagement, the concept of weekly Idea board meetings (based on lean methodology) around the issue of readmissions was started in October 2017.
Purpose: Main purpose of setting up the idea board was to improve the physician engagement. Process of identification of the problem was made simple by writing it on a piece of paper and posting it on idea board. As Hospitalist are also front line providers especially in a non teaching service, their input is key in designing a system to solve the problem. Mini A3 methodology with PDSA was used to solve each idea resulting in improving the problem solving skills of every team member.
Description: Idea board was set up in the Hospitalist office with theme of readmissions. All the Hospitalist were trained regarding the function of Idea board. Basic information regarding lean methodology and problem solving based on 5 WHY and PDSA was given and was used through out the year. Total of 26 Hospitalists participated in weekly meetings for 15 minutes through out the year. On call Hospitalist attended the weekly meeting in person and rest of the group was emailed about the progress and action items. Total of 24 new ideas came on the variety of topics including use of multidisciplinary rounds, early identification of patients for palliative care and how to use LACE+ score. Out of these 12 ideas were fully implemented, 7 of them are in phase of PDSA cycles of implementation and 5 are in parking lot and are on hold. Hospitalist felt they were involved in this key initiative resulting in overall decrease in readmission rate by 5%.
Conclusions: We saw an Improvement in hospitalist engagement in this important initiative in terms of identification of this system wide problem. We also noticed an improvement in the problem solving skills of the front line providers using lean methodology, we are starting to see an improvement in the readmission rate. Idea board based problem solving usually gets under utilized in hospitals and is a good tool to improve physician engagement. Idea boards can also be used in a variety of other themes.