Measures form the structure, but improvement happens at the unit level, says Ritz. In her surgical leadership unit, a multidisciplinary team of surgeons from all core specialties, nurses, pharmacists, therapists, and technicians can act quickly and with broad authority to investigate and change practice. For example, the team recognized an area for improvement in deep vein thrombosis and pulmonary embolism in orthopedic patients.
"So we worked as a team," Ritz says. "We've made drastic improvements. The nursing unit decided to eliminate all bedpans on their floor. The physical therapists increased the number of PT visits per patient in the inpatient setting and started an inpatient gym so patients had to get dressed every morning and walk down to the gym for physical therapy. We worked with pharmacy to teach patients ahead of time how to use those injections if they go home on injectable anticoagulant drugs."
The team approach resulted in a 70% reduction in DVTs and a 40% reduction in PEs, Ritz says. And those same processes can be reported to the steering committee for education on other Henry Ford campuses. "If our model for improvement gets spread to other business units, then great," she says. "We know we can do it, and we are accountable."
The approach that combines unit-level work with system goals is described at Henry Ford as "top down and bottom up."
"We're aligned with what our system goals are," Ritz says. "So we know what our top leadership wants. There are no secrets. Everybody knows we need to reduce harm. We empower the bottom to work to the top to align with those system goals. So we all meet in the middle. We all have the same agenda: patient safety. It is our No. 1 agenda."