So the system decided to apply a simple formula based on The 4 Disciplines of Execution Book. The 4DX strategy helped the 309-bed full service hospital reach its goal timely discharges, according to William A. Kenley, CEO of Methodist Le Bonheur Healthcare and Diane Ridgway, COO of Methodist Le Bonheur Germantown Hospital.
Mr. Kenley and Ms. Ridgway outlined the process in a session at the Becker’s Hospital Review 6th Annual Meeting in Chicago May 7. Here is how the hospital was able to create “virtual capacity” on their campus by improving bedturns through the 4DX process.
1. Focus on the wildly important. The first part of 4DX is streamlining priorities. An organization can only realistically work on a maximum of two things it considers “wildly important goals.” The leaders at Le Bonheur Germantown Hospital realized they were giving too many priorities the No. 1 spot.
“If you operate in that kind of environment, you are giving staff the latitude to triage what the No.1 priority is because not everything can possibly be No. 1 — which is a very scary thing frankly,” Mr. Kenley said.
Methodist Le Bonheur Germantown Hospital decided to test the 4DX strategy in a 58-bed unit. They focused on the simple discharges, like total joint patients, rather than the difficult discharges, like SNF patients. They decided their wildly important goals would be to increase bedturns to make “virtual capacity” in the unit.
2. Act on leading measures. Achieving a wildly important goal like this often requires a strategic paradigm shift. It requires the team to define lead measures, or measures that are predictive indicators rather than lagging indicators. For example, Mr. Kenley said, if you are trying to lose weight, a lagging indicator would be weighing yourself everyday, but a predictive indicator would be going to the gym or sticking to a diet.
At the Germantown hospital, staff determined early on they could project when patients would potentially be ready to leave the hospital, Ms. Ridgway said. They were able to use these estimates to manage the team’s expectations and prep the patients and the patients’ families for the tentative discharge time. This way, when the patient was ready, things moved more quickly.
3. Keep a compelling scorecard. The team working on the wildly important goal will create a compelling scorecard to track their progress. The Germantown nurses created the scorecards so the units were able to track how they were doing on the lead indicators and whether it was impacting their reporting goal, the bedturn rate.
“It is vital that the scorecard is made by the team and that the members of the team can see it right in front of them all the time,” Mr. Kenley said.
4. Create a cadence of accountability. This scorecard helps the team self-monitor their progress. The team can see if they are winning or losing, and they can modify their game plan to achieve their results. In order to create a cadence of accountability at the Germantown hospital, the teams held weekly meetings to discuss their results, look at lead indicators and evaluate if their plan was working.
Methodist Le Bonheur Germantown Hospital found 4DX to be incredibly successful. Bedturns increased from 77 in 2012 to 81 in 2013, the ER was busier, patient communication improved and physician satisfaction improved. “Feedback from staff was positive. They said they were very inspired by the framework because it was something they could grab onto,” Mr. Kenley said.
“It’s really about making a point to focus on what’s important for the organization and then making sure the team can focus on this too with the scorecard and the cadence of accountability,” Ms. Ridgway said.
