Essential and Expensive

In fact, the multidisciplinary rounds were so popular with the nursing staff that night shift nurses who were missing the early rounds wanted to participate as well. So now they do, the difference being they are lead by ROB, a "robotic assisted body" that is controlled remotely by Huml and allows him to see and speak to both nurses and patients via video.

Service Line Success Key No. 3: Collect data
In healthcare, achieving consensus on the importance of addressing a problem is usually easy; it's implementation that typically proves difficult.

For instance, to reduce incidents of ventilator-associated pneumonia, the IHI encourages adoption of a series of interventions known as a ventilator bundle. Most hospitals will agree that the four components of the bundle are important steps in preventing pneumonia, but many don't follow the protocols every day for every patient, says Rainey, who has been chairman of an IHI working group on outcomes improvement for 13 years.

The difference between most of the time and all of the time in the ICU can mean lives. "There's no wonder drug. It's just a matter of closing the gap between good intent and actual execution," he says.

Improving care, particularly when it comes to reducing infections and errors, is a matter of measuring care, then standardizing it. For instance, when Baystate Medical Center began measuring compliance with deep vein thrombosis prophylaxis, one of the components of the ventilator bundle, compliance was just over 50%.

"If you were to query people and ask if they do this for their patients, everyone would say of course they do it. But if you don't measure data then you're not certain what you're really doing," says Higgins. After implementing checklists, posting the results publicly on a quarterly basis, and integrating the procedure into the computer entry system, Baystate was able to bring compliance up to 100%.

Denver Health Medical Center identified three domains—severe septic shock, acute respiratory failure, and hospital-acquired infection—to focus constant quality improvement efforts and incorporate some of the lean process improvement strategies used in other parts of the hospital. But then it went a step further and posts performance results publicly in the ICU.