ECRI Institute commends St. Luke's Health System (Boise, ID) for its project to improve compliance with healthcare industry representative check-in and credentialing requirements. St. Luke's described the project in its submission for ECRI Institute's 13th Health Devices Achievement Award competition. The team at St. Luke's recognized a problem and followed a strict methodology to identify potential causes and assess possible solutions.
The Health Devices Achievement Award recognizes outstanding initiatives undertaken by member healthcare institutions to improve patient safety, reduce costs, or otherwise facilitate better strategic management of health technology. For details about the winning submission and other finalists, see The Health Devices Achievement Award: Recognizing Exceptional Health Technology Management.
ECRI Institute congratulates Crystal Geibel, Paul Lambert, and the rest of the St. Luke's team.
The Challenge
To increase compliance with credentialing requirements for industry representatives who enter the healthcare facility.
The Context
As is standard practice, St. Luke's Health system uses a check-in and credentialing process to verify that industry representatives who visit the healthcare facility are, in fact, who they say they are. A well-functioning check-in and credentialing process helps provide assurance that:
1. Patients' rights are respected.
2. Vulnerable patient populations are not exposed to, and restricted areas of the facility are not breached by, unregistered visitors.
3. Standard procurement processes are not circumvented by sales reps or hospital personnel (a situation that could lead to the use of products or services that fail to meet the organization's quality standards).
4. The healthcare facility remains in compliance with regulations and standards specifying that organizations know the identity and purpose of individuals present within the facility.
At St. Luke's, industry representatives are expected to check in when they arrive at the facility so that staff can verify that the visitor's credentials are current and that the visitor complies with the health system's standards for patient-centered care. At least that's the plan.
Supply chain management suspected, however, that compliance with the organization's check-in policies was spotty. Before the team could address the issue as one of the organization's operations improvement initiatives, it needed to devise a methodology to assess whether that suspicion was correct.
The Process
The team turned to the organization's electronic health record (EHR) for data. Vendor visits to the organization's surgical services sites are routinely recorded in the EHR. This provided a source of data that the team could use to compare against the number of vendor visits recorded through the credentialing check-in process. This comparison revealed clear discrepancies, which provided compelling evidence to leadership that the issue should be investigated further.
The team chose to use a Six Sigma DMAIC process (Define, Measure, Analyze, Improve, and Control) to identify potential causes and assess solutions. Key steps included:
1. Completing a failure mode and effects analysis (FMEA) to prioritize potential causes
a) This effort was facilitated by observations made during a gemba walk of the care area being studied—that is, going out to the care area, engaging with employees, and observing actual work practices.
b) One contributing factor identified through this process was that the badges provided to visitors at check-in were not clearly visible to staff members who would later encounter those visitors. Thus, staff could not easily distinguish between visitors who had used the check-in process correctly and those who hadn't.
2. Creating an Impact Effort grid to prioritize possible solutions
a) This process showed that one solution—supplying clear badge holders for visitors to wear to display their identification—would require little effort to implement, but would have a high impact.
b) In the grid, this solution was classified as a "quick win," and the team decided to implement it.
The final phase of the process involved spreading awareness. The organization took steps to educate vendors, physicians, and staff about the process.
The Results
The compliance rate at the care area where a pilot study was conducted rose approximately 35% after the intervention. From a low point near 55% before the intervention, the compliance rate rose to 89% or higher—a level that was maintained for at least 11 consecutive months (the most recent period for which data was available). Similar results were observed at other surgical sites, once the new process was implemented there.
Key Takeaways
This project illustrates one way that data captured in the EHR—separate from patient data—can be used to drive process improvements. Further, the project showed that data, alone, is not always sufficient. While team members relied on data to demonstrate the need for the project and to quantify the success of the intervention, they note that the greatest insights came from walking around, observing processes and engaging with frontline staff.
Finally, the project shows that sometimes the simple solutions are the best solutions. The team's analysis identified several possible actions to improve compliance, but the "quick win" approach—supplying clear plastic badge holders—allowed the organization to achieve the desired results with minimal effort.