• Article
  • March 11, 2020

Children's Hospital Finds QI Inspiration in Manufacturing

The key is finding processes that lead to better care—no matter where those processes originated.

Darren Migita doubts that most people ever gave it a second thought.

When he and his team at Seattle Children's began implementing standardized care protocols—or clinical pathways—more than a decade ago, most frontline clinicians probably didn't realize the core concepts behind the pathways were borrowed from the manufacturing industry.

"That's the beauty of it. It doesn't matter what you call it or where it came from," says Migita, M.D., medical director of clinical effectiveness at Seattle Children's. "What matters is that it works."

The concept of Standard Work—decreasing lead time and errors in production via a series of uniform and consistently executed processes—is a central theme in manufacturing. Migita recognized an opportunity to apply those same principles in the health care setting.

"It's designed to build care for the patient in steps, so the patient gets the right care in the shortest time frame with no errors," Migita says. "We do this, and patient outcomes are improved."

Consistent improvements lead to global impact

One of the key components of the process is that it's a continuous cycle of tweaking and improving. Upon implementation of a clinical pathway, the hospital constantly measures its metrics, and team members convene regularly to review results in search of enhancements—which are then measured and reviewed even further.

Migita calls it an "addictive process," which has fueled significant expansion of the program since earning Seattle Children's a 2013 Pediatric Quality Award.

Since the award, the hospital has nearly doubled the number of patient conditions covered by clinical pathways—from 39 to 73. To date, more than 55,000 patients at Seattle Children's have received care "on pathway," with many more benefitting from the standardized protocols across the country and around the globe.

Seattle Children's makes the clinical pathways accessible on its website, and Migita estimates about half of the roughly 45,000 downloads it sees every year come from outside Seattle Children's—including from about 15 foreign countries.

3 key takeaways on clinical pathway success

And while the underlying concept has its roots in industry, Migita says Seattle Children's has gleaned extensive information over the 12 years it has used clinical pathways:

  • Strong data infrastructure. The ability to gather and analyze metrics is essential to understanding consistent processes and making improvements. The analytics team must be integrated early.
  • Multidisciplinary teams. The clinical pathway owner is usually a physician or nurse practitioner, but every pathway team consists of all stakeholders, including the data team, informaticists, pharmacists, a project manager, medical librarian and frontline staff. "One single role can't solve all the problems for a given pathway," Migita says. "It takes a village."
  • Medical literature. Best practices from across the pediatric medical community inform and validate pathway protocols. But how do you glean—and update—relevant information for 73 pathways? "The medical literature is vast, but we have a literature review team that sifts through the mountain of medical literature to find the best recommendations for the patients," Migita says. "It's probably been our biggest innovation—it can sometimes take years to do this, but we've been able to really shorten that time frame."

People fuel program's success

Migita says a crucial component to successful clinical pathways is alignment across the organization. Buy-in from management is essential, but the principles of Standard Work require active involvement from frontline staff—they have the most intimate knowledge of the processes being standardized.

"That's where the ideas that are going to solve your complex problems come from," Migita says. "The goals are top down, but the solutions are bottom up."

But the key to unlocking to the potential of the process, according to Migita, comes from the passion of the people involved. That every team member has a voice in creating—and revising—the protocols powers the Standard Work concept in the manufacturing world. And it's perhaps even more instrumental in health care.

"What really drives this are the people—it doesn't matter who you are on the team," Migita says. "When they know that what they're doing is impacting someone else's life, they're invested. That's the unseen engine in all this—that's really what makes it work."

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