Source: United States Navy
The essay competition was held to showcase and share the work performed within Navy Medicine Readiness and Training Commands (NMRTC), Units, Detachments, and supported operational commands and units.
“Many of the issues that clinicians and administrators face in one location are going to be the same, or similar, to the problems and issues healthcare workers everywhere else in the Military Health System are going to encounter,” said Lt. Cmdr. Adam R. Eaton, director, Improvement Sciences, NMFP. “A competition like this is a great way to market these amazing ideas that people have had, implemented, and used to great effect to a large audience at once.”
Essay submissions with a 1,000-word maximum described a completed CPI project with measurable impact and sustainable benefit on any or all of the three pillars (engaged leadership; culture of patient safety; robust process improvement) and five principles (deference to expertise; reluctance to simplify; sensitivity to operations; commitment to resilience; and preoccupation with failure) of high reliability.
“Hopefully, people will read about these initiatives, see how they could be adopted to help with what they’re encountering at their own facility, or even better, add and improve upon those processes and share that with others,” said Eaton. “The more we share good ideas, the more likely we are going to spur further innovation.”
An NMFP N5 committee comprised of reviewers with expertise in CPI, healthcare quality, and patient safety judged essays using the following criteria in descending order of importance: measurable benefits to high reliability, replication potential or success, standardization, multidisciplinary approach, and creativity.
Overall, there were 11 entries; the winning entry came out of NMRTC San Diego for their essay on ‘Multidisciplinary Approach to Improved Barcode Medication Administration at Naval Medical Center San Diego’ and was submitted by Cmdr. Jeremy M. Ray, head, Medical-Surgical Nursing Department, NMCSD; Lt. Cmdr. Jasette M. Fong, pediatric clinical nurse specialist, NMCSD; and Irene G. Grepo, nurse consultant, NMCSD.
“CPI is an incredibly important approach in nursing as it helps identify areas of inefficiency and helps implement changes that improve patient outcomes, enhance quality of patient care and reduce costs,” said Ray. “In the healthcare industry, it is essential to maintain high standards of care to ensure patient safety and satisfaction. CPI can help achieve those goals.”
Their essay described a process improvement that addresses medication errors, a major threat to patient safety and can occur at any point during the stages of medication ordering, transcription, dispensing and administration process.
The wining team created a working group to analyze and improve the implementation of barcode medication administration (BCMA) systems at NMCSD. Through their analysis, the team improved BCMA compliance from 71.2 percent to 90.1 percent compliance over the course of four months in 2021.
“Factors such as patient satisfaction and safety, staff satisfaction, and compliance with policy and regulations are important factors to assess when looking at potential benefits of BCMA,” sad Ray. “Multiple studies have demonstrated that BCMA results in improved medication safety while administering medications. Without a doubt, this process improvement effort has improved compliance and adoption of the MHS GENESIS (electronic health record) BCMA workflow.”
The success of the pilot project led the working group to drive adoption of the Leapfrog Hospital Survey Safe Medication Administration Measure BCMA standards, which push facilities to implement BCMA systems in 100 percent of their medical and/or surgical units, intensive care units, and labor delivery units.
Improvement Sciences is a field that can support virtually any area within healthcare with highly dedicated, skilled and qualified teams to mentor and coach people through the CPI process. NMFP maintains a repository of projects that people have done that’s available to anyone with a common access card.
The CPI program compliments the Chief of Naval Operations (CNO) Jan. 11, 2022, call to action for the Navy to Get Real and Get Better (GRGB) – the initiative to broadly apply the leadership behavior of Navy’s highest performing, strongly self-assessing and self-correcting, units and organizations.
“At its essence, CPI is GRGB,” said Eaton. “GRGB asks us to take a hard, critical look at ourselves, our performance, and environment and see what could be improved. When we are honest and transparent about who we are as a person and a team and how we are functioning, we have a duty to be taking the necessary steps based on that assessment to grow.
“CPI asks the same of people. These (competition) members took a critical look within themselves, their performance, and workspace, and sought out ways to make things better for those they serve, creating innovation,” said Eaton. “The winning project actually built off a project previously implemented within the Command, demonstrating that circular relationship between empowered people, a focus on continuous improvement, and innovation, the principles of GRGB.”
Another tenant of GRGB is to empower people to find and fix problems – and innovate – at their level, from the deckplate to senior leaders.
“When you have empowered leaders and teams, as the CNO describes in GRGB, and they are consciously working on continuously improving, then innovation occurs,” said Eaton. “That innovation will spur these leaders to evolve and improve that new process, resulting in further innovation, and so on. Eventually, you’ve created an environment that has these principles ingrained in its culture.”
In 2018, the Capt. Cheryl C. Ringer Annual Memorial Award for Continuous Process Improvement was created in her honor in order to recognize Navy Medicine military and federal civilian leaders for CPI-related initiatives that accelerate high reliability.
In her previous role as Navy Medicine West (NMW), which is now NMFP, Director for Process Improvement, Ringer spearheaded efforts to permanently staff, fund, and vigorously promote CPI activities and initiatives throughout the NMFP area of responsibility.
“A plaque hangs at the NMFP headquarters honoring the contest’s inspiration and namesake, Capt. Cheryl C. Ringer and the winners’ names will be added to that plaque for perpetuity as a testament to their commitment to embracing positive and meaningful change,” said Eaton.
Naval Medical Forces Pacific provides oversight for 10 NMRTCs on the West Coast and Pacific Rim that train, man, and equip medical forces, primarily in military treatment facilities. Globally, NMFP oversees eight research laboratories that deliver research expertise in support of warfighter health and readiness.