Allegheny Health Network
The Ed Dardanelles Heart and Vascular Center was a new cardiac surgery program developed in a community hospital setting using the operational
excellence (OE) method, which is based on the principles of the Toyota production system. The Operational excellence methodology was taught to the cardiac surgery team. Coaching by the Adams Strategy Group team (known then as KCOE) started 2 months before the opening of the program and continued for 24 months.
The Adams Strategy Group coaches connected with a steering team comprised of the value stream administrative leader, the lead cardiac surgeon and the nursing leader for the carib-thoracic intensive care unit. Coaches educated the teams and did direct coaching on select problems.
Results. Of the 409 cases presented, 253 were isolated coronary artery bypass graft operations. One operative death occurred. According to the database maintained by The Society of Thoracic Surgeons, the risk-adjusted operative mortality rate was 61% lower than the regional
rate. Likewise, the risk-adjusted rate of major complications was 57% lower than The Society of Thoracic Surgeons regional rate. Daily solution to determine cause was attempted on 923 distinct perioperative problems by all team members. Using the cost of complications as described by Speir and coworkers, avoiding predicted complications resulted in a savings of at least $884,900 as compared with the regional average. By the systematic use of a real time,
highly formatted problem-solving methodology, processes of care improved daily. Using carefully disciplined teamwork, reliable implementation of evidence based protocols was realized by empowering the front line to make improvements. Low rates of complications were observed, and a cost savings of $3,497 per each case of isolated coronary artery bypass graft was realized.
Dr. Mike Culig, lead surgeon commented on the deep change that disciplined use of the operational excellence caused, “It takes months for personnel to learn how to use problem-solving sheets. The daily structured meetings create the safe environment to dispassionately and objectively study defects to create trials for solutions. Repeated exposure to this ‘no blame’ process trains people to instinctively react constructively. Rather than asking ‘who is to blame,’ personnel ask ‘why did it happen?’ This transformation is powerful.”
He adds, “The effect of OE (Operational Excellence) has been remarkable. Methodically, problems are addressed daily as they arise, and the risk-adjusted incidence of major adverse events has decreased by 50% as compared with that for the region. Cost savings of $884,900 in the isolated CABG cohort
have resulted. The savings in the other 156 cases are also substantial, but difficult to risk adjust owing to the variety of operations. Emphasis on safety and quality saves large amounts of money by reducing defects in care.”