By Courtney Decker, DHIP Communications
When the DHIP implemented the Duke Quality System (DQS) in 2019, one of its primary goals was to teach and empower team members to identify and solve problems more efficiently and effectively. With this goal in mind, DHIP Operations Lean Improvement Coach Priscilla Lunsford, MIE, saw a need to prioritize problems and focus on improving the processes that led to these problems. As a result, she and her team decided to conduct an ongoing experiment using the SWARM approach to respond to top safety events across DHIP clinics.
“The SWARM approach is a defined call to action when a safety problem occurs," Lunsford says. “We were seeing staff work on problems, but they weren't always clearly defined. Ideally, solutions to all problems are found, but how do we prioritize them to ensure they are all addressed and corrected as quickly as possible? Looking at recent safety data, we decided to test the SWARM approach on some of our top issues and learn about process changes to eliminate these errors."
Developed by UK HealthCare in 2009, the SWARM approach provides a clear, structured way of problem solving that identifies issues, creates long-term solutions and develops critical thinking.
After an SRS report is submitted, the appropriate Regional Director is notified and determines if it should be elevated to receive A3 support. If an A3 is needed, the regional director then communicates to the clinic leader, and the clinic leader then recommends either 1:1 coaching or a SWARM.
If the SWARM approach is selected, staff members, providers closest to the issue, clinic leadership, and improvement coaches like Lunsford “swarm" together (ideally within 24 hours) to learn from the incident, create rapid tests of change, and increase safety.
Once together, the group begins the SWARM process, which includes five key steps - (1) explaining the SWARM process, (2) introducing members of the SWARM, (3) reviewing the facts (who, what, when, where, why, and how) of the problem that prompted the SWARM, (4) discussing what happened and investigating underlying systems factors, and (5) proposing target conditions and developing an action plan to achieve those conditions. After the SWARM process has been completed, solutions are implemented accordingly.
The SWARM approach replaces a more traditional re-education process in response to safety problems and adverse events. Previously when an SRS report was submitted, most outcomes involved re-education of an existing process rather than experimentation with changing it, especially if the events were lower on the severity scale. However, the SWARM approach enables members to better address and correct the root cause(s) of safety events.
“While re-education is still needed, our teams are now focusing more on what part of the process we can change to better support the people performing the process," Lunsford says.
The DHIP's implementation of the SWARM approach in October also represents a shift in how it is being used to improve safety and quality of care across the healthcare industry. While SWARMs have typically been conducted in hospital settings, the DHIP has brought the approach to ambulatory care clinics with early successes.
Recent SWARM successes include changing ambiguously named patient label files within Epic and purchasing additional printers for Duke Endocrinology at Brier Creek to ensure that there is one in each procedure room. Both solutions have resulted in increased patient safety, reduced risks associated with fines/violations and improved employee processes, resulting in costs savings through efficiency and effectiveness.
“By bringing leadership into the process and having a defined help chain, solutions come to light faster and experiments, which result in process changes, can happen sooner," Lunsford says.
With the ongoing implementation of the SWARM approach across the DHIP, Lunsford is hopeful it will continue improving clinic functions, while also empowering individuals, regardless of their seniority level, to engage in the problem-solving process and enhance their scientific thinking skills.
“Our experiment using the SWARM approach is providing us with metrics and data in order to determine whether this is approach truly leads to long-term solutions and better outcomes related to safety events," Lunsford says. “As with any experiment, we must regularly check in on the effectiveness of SWARMs in order to see what needs to be adjusted. We actually have a meeting scheduled in February with regional directors and DHIP senior leadership to assess the experiment's progress to date. However, I'm optimistic that we are headed in the right direction."
