Hospital and The Doug Williams Group
Work Together For Dramatic Process Improvement
Statistics Indicate Highly Successful Effort
by John Fries
The past few years have been a time of progress and growth at Aventura
Hospital and Medical Center, a 407-bed, acute care facility that serves
the South Florida cities of Aventura, Hallandale Beach, Pembroke Park,
Hollywood, Golden Beach, Sunny Isles Beach and North Miami Beach.
Five years ago, prompted by a 10-percent growth in market share, the
hospital launched a $130 million facility expansion plan that includes
the addition of a nine-story tower with 245 private patient rooms with
private bathrooms, six-story parking garage, and numerous features and
Aventura, an affiliate of HCA Corporation, is both progressive and proactive
regarding quality and internal processes, and continually identifying
ways to improve both. Kathleen Morris, administrative director of quality
management, leads these initiatives.
For the past several months, Aventura Hospital has been working closely
with The Doug Williams Group, a highly respected management consulting
firm that specializes in performance improvement. The firm, which has
offices in Miami and Jacksonville, helps hospitals and other companies
and organizations to improve customer and employee satisfaction and
increase profitability. The Williams Group enjoys an excellent reputation
and has a distinguished client roster that is a virtual "WhoÕs Who"
of successful South Florida businesses, many of whose testimonials appear
on the firmÕs web site.
Since February, The Doug Williams Group has been working with Aventura
to identify, evaluate and improve a number of processes. First on the
list was the need to shorten the time it takes for inpatients to receive
their prescribed medications. This is, essentially, a five-step process
that encompasses people and technology: a physician prescribes medications
at the patientÕs bedside. The order is sent to the hospital pharmacy,
where a pharmacist fills the order, and sends it to the nursing unit.
The medications are then administered to the patient.
Brian Wilson, senior management consultant with The Doug Williams Group,
is a quality improvement expert who has extensive experience in facilitating
hospital quality improvement processes. Wilson is also a registered
nurse, who, prior to joining the Williams Group, had spent more than
20 years working in acute care hospitals, with the majority of his experience
in emergency services. He has an extensive knowledge of Š and strong
familiarity with Š the hospital environment, having both led and served
on countless QI teams. Since February, Wilson has been working extensively
on-site at Aventura, facilitating the hospitalÕs quality improvement
Facilitating Development of a New Process
"I met with Kathleen several months ago to discuss her goals and objectives,"
said Wilson. "Then, I performed an audit of the hospitalÕs existing
medication administration process. This enabled me to pinpoint where
there were obstacles and opportunities for improvement," said Wilson.
Wilson then worked with Morris to assemble an internal process team.
"It was important that the team consist of staff-level employees who
are part of the process on a daily basis," said Morris. The team is
made up of representatives of the nursing and pharmacy departments and
the intensive care, telemetry and med/surg units. ThereÕs also a physician
on the team, who serves as liaison with the hospitalÕs medical staff."
Once the team was in place, Wilson and Morris began meeting with them
on a regular basis to facilitate. As in many quality improvement initiatives,
it was necessary for members of the team to break the medication administration
process down to its component parts, and address each.
"This enabled us to determine where there were opportunities for improvement,"
he said. "For example, we identified opportunities to improve communications
between the nursing units and the pharmacy. Once the opportunities were
identified, various solutions were explored and evaluated, ultimately
shaping what would become the revised process.
A key part of the initiative Š and the teamÕs number one priority, according
to Morris Š was the development of new sub-processes that would enable
the hospital to track and document the timeliness of ordering, receiving,
dispensing and administering STAT medications to patients. "Ultimately,
we developed an action plan that allowed us to improve the process so
that it would be much more efficient." The revised process incorporated
a series of checks and balances throughout the process to ensure that
it was going as planned. "We also included a process to monitor and
ensure compliance with hospital policies and procedures," said Wilson.
The revised process was put in place over the summer, and staff throughout
the hospital was educated regarding its use.
The Technological Side
In mid-summer, new digital scanning technology was put into place. Medication
orders are no longer faxed to the pharmacy, but are now digitally scanned.
When a physician writes a prescription for an inpatient, the script
is digitally scanned on the nursing unit and a digital record is instantly
sent via computer to the hospital pharmacy. Once the record is received
and opened, the pharmacist can enlarge the onscreen image for enhanced
readability. He or she also reviews the medication order with the patientÕs
prescription history, drug interaction information and more, that is
stored in a database.
"WeÕve also developed a new prescription order sheet for physicians
that will be implemented this fall," said Morris. "All STAT orders will
be marked with a special box indicating the need for immediate response.
As the computer processes the hundreds of pharmacy orders that are entered
each day, a special optical character recognition feature will read
the STAT notation and place each STAT order at the top of the list of
orders to fill in the pharmacy."
A significant further enhancement to the safe delivery and administration
of medications will be implemented in January 2005, with the implementation
of the Electronic Medication Administration Record, or eMAR for short.
"This is an HCA corporate initiative that further improves the safety
of medication administration," said Morris. "With eMAR, when the medication
arrives back at the unit, a nurse uses a personal computer at the patientÕs
bedside and scans barcodes on the medication package, the patientÕs
medication administration record, and a bar-coded wristband worn by
the patient. This immediately confirms for the nurse that the correct
dose of the correct drug is being provided to the correct patient,"
For as much efficiency and safety as this technology ensures, even it
is being improved upon, thanks to the efforts of Morris and Wilson.
In the not-too-distant future, Aventura Hospital is planning to take
yet another giant leap forward by installing a robot in its pharmacy.
Using existing barcode scanning technology, the robot will dispense
and package the medications more accurately and efficiently than the
present manual system. This automated process will further improve the
timeliness of the medication delivery.
Although the process improvement initiatives have been in place for
a relatively short period of time, efforts are proving highly successful.
There has been a significant decrease in the time it takes for patients
to receive their medications, as well as a decrease in the number of
process errors related to the overall medication administration process.