Labor and Birth Improvements at Mercy Hospital St. Louis. Issue 1 (June 2015) - Thompson, Heather
Abstract Poster Presentation Purpose for the Program Mercy Hospital St. Louis is ranked among the top 20 hospitals in the nation related to birth volume, and approximately 8600 neonates are born there annually. In 2009, it became obvious the labor and birth unit in this hospital needed significant updating so the decision was made to build a new unit. In the months post move, the team recognized that many of the workflow processes and culture needed to change based on new demands. Proposed Change To begin the process, the organization turned to Lean daily huddles called "innovation time." This protected time with no meetings allowed all unit leaders, managers, and senior staff time to take Gemba walks, observe unit operations, seek improvements, and remove barriers in the moment. This approach has dramatically improved team understanding of accountable metrics and has led to ideas to improve those metrics and communication across the organization. With new coworker engagement, the unit embarked on a 9‐month Lean project to evaluate current processes and clarify future goals. Each month a group of frontline coworkers and supervisors came together for a week‐long rapid improvement event (RIE) to work through A3 process improvement methodology, observe the current state, trial new solutions, study results, and create a plan for implementation. Implementation, Outcomes, and Evaluation Major improvements were seen in scheduled induction times and operating room (OR) cesarean birth and recovery times. Only 47% of women were being seen on time for scheduled inductions, which decreased patient and physician satisfaction and influenced women to seek health care at competing hospitals. By creating standard work in the process, the patient satisfaction rate increased to 85% within the first month and was 98% by March. The rate of on time cesareans increased from 52% to 74% through reassigning staff roles and implementing standard work. With a 2‐hour recovery time for these cases, only 29% of women met that goal, and most fell into a 2½‐ to 3‐hour recovery period. After the RIE, 50% of women met the goal. Implications for Nursing Practice The labor and birth unit at Mercy Hospital St. Louis is experiencing a 6.8% growth, whereas the overall local market is down 3.8%. The desire to continue to provide exceptional care while being reminded of the current dynamic health care environment motivates us to continuously improve and maximize value for our patients.