Initiatives

Kaizen and 5S

Louis Brier Home & Hospital’s mission and vision are aimed at providing the best care possible to its residents while striving to be recognized as a centre of excellence in elder care. Achieving Accreditation status was one of the milestones set by the Board of Directors and the Leadership Team. However, it is just the start. In order to achieve culture change, engage in continuous quality improvement, innovation and creativity, the Leadership Team, in collaboration with the Board of Directors, decided to apply the principles and framework of LEAN to the everyday work and activities.

In June 2018, together with external experts, we embarked on our LEAN journey and rolled out our first Kaizen and 5S events, focusing on the Nursing Model of Care.

The purpose of the Kaizen event was to radically and permanently improve processes to enhance the resident experience. The project addressed the continuous complaints of heavy workload, low morale, lack of teamwork and communication and inconsistency of work amongst nursing units.

We worked towards achieving a team-based approach, maintaining licensing standards, addressing inconsistencies in practice, as well as adhering to Work Safe BC regulations. We determined TAKT times (the average time between the start of production of one unit and the start of production of the next unit) and learned about level loading (a LEAN technique to even out the workload) between nurses and care aides. Our goal was to improve the challenges around continuity of care and the development of standard work for each discipline: Registered Nurses (RN), Licensed Practical Nurses (LPN) and Care Aides (CAs).

 

5S

In September 2018, we held our first 5S event focusing on supply chain management. 5S stands for the 5 steps of this methodology.

These steps involve going through everything in a space, deciding what is necessary and what is not, putting things in order, cleaning and setting up procedures for performing these tasks on a regular basis.

Staff members from different disciplines were invited to analyze current practices and develop new standards of workflow as it relates to nursing stations, medication rooms, supply rooms, shower rooms and resident rooms.

The 5S Supply Management initiative created a clean, organized, efficient workplace and complimented our Kaizen initiative to better utilize our supplies and equipment.

 

Impact

  • Increase safety for residents and staff.

  • Workload levelled between staff.

  • Better resident experience.

  • Improved teamwork and morale.

  • Improved line of sight between residents and care staff.

  • Current forms easily accessible.

  • Par level preventing overstock.

  • Easy to locate supplies and equipment.

  • Low cost – HUGE Impact.

It was projected that these improvements to the nursing stations, medication rooms and supply rooms would cost up to $60,000 for 6 units. On the one pilot unit, the actual cost of improvements was only $1,200.

 

Evaluation/Sustainability

As an organization, we are strongly committed to ensuring that the rapid improvement events are maintained and sustainable through the following:

  • Determine Quality Indicators.

  • Regular audits and huddles.

  • Collect input from staff.

  • When issues arise, identify the cause and implement the necessary changes to avoid recurrence.

  • Adhere to the 5S principles.

  • Leaders must show commitment to follow through with changes.

We continued our journey through 2019/20 and implemented the LEAN 5S process across several other departments.

 

Laundry Department

In February 2020, the Laundry Department engaged in Lean 5S activity with support from the Care, QRM and Maintenance Teams, as we strive to continue to improve our service and eliminate waste. Opportunities were identified to create a safe and more functional workspace for the staff that promotes efficiencies by eliminating non value-added wastes. We organized supplies, equipment and updated routine procedure to improve the service delivery to the end users.

 

Assisted Living (AL)

In March 2020, the Nursing Team led a Lean 5S event in the Assisted Living Unit at the Weinberg Residence. The focus was on streamlining communication, handover and workflow between the staff in Assisted Living and enhanced collaboration with Multi-Level Care Unit.

 

Multi-level Care (MLC)

In May 2020, the MLC Unit at the Weinberg Residence underwent a Lean 5S event focusing on streamlining communication, enhancing supply management, the in-room distribution process and change of workflow to Team based approach.

Green Initiative

Every day, we use a variety of products that end up in regular garbage bins and, ultimately, the landfill. This garbage disposal process is not ideal and does not support Vancouver’s Zero Waste 2040 Plan. Louis Brier Home & Hospital decided to act by organizing its very own green team, the “Green Guardians,” who aim to improve the disposal of products and explore options for more earth friendly products where possible.

The team has accomplished a significant number of quality improvement projects, one of which was the “Go Green” initiative. The initiative launched in January 2020 and focused on improving our recycling capabilities and minimizing garbage disposals in our building. Colour-coded recycling receptacles were installed throughout the building, which clearly display instructions on what products should be recycled and where they should be placed.

The Green Guardians even travelled offsite to take a tour of Urban Impact’s Recycling Plant in New Westminster to gain some insight and knowledge into the recycling process, which helped when educating employees on how to recycle and minimize the garbage and waste for pick-up.

This initiative is comprised of three drivers:

1.    Addressing polypharmacy.

2.    Understanding usage vs. wastage.

3.    The development of a hospital formulary.

Medication reviews were conducted within the circle of care with a collaborative multidisciplinary approach with physicians, pharmacists, nurses, residents and family members to design processes and implement strategies around polypharmacy and risk reduction for each resident.

The Medication Utilization Management Initiative was chosen to be included in the BC Health Leaders Conference in November 2019.

Medication Utilization Management

Fall Prevention Program

Our falls prevention program has been created based on best practice guidelines. Upon admission, every resident receives a full assessment of fall risk, considering many factors, including, but not limited to:

  • Current mobility level.

  • History of falls.

  • Use of assistive devices (walker, canes, eyeglasses and/or hearing aids).

  • Medication used to prevent fractures and bone loss.

  • Cognitive function.

The falls data collection ensures that resident safety is promoted throughout the organization and all members of the Interdisciplinary Team are held accountable. Appropriate intervention strategies on which approach is best to manage falls for a specific resident are reviewed and discussed amongst the Interdisciplinary Team.

Dementia Care Enhancement Initiative

Vancouver Coastal Health identified dementia care as one of the key priorities in Residential Care and, as a result, they endorsed the integration of reviewing environments, spaces, activities and specific resident needs through a person-centred care focus, using the 3 Q P.I.E.C.E.S. Framework and Gentle Persuasive Approach (GPA) education so that people living in Residential Care can live the best life possible.

The Dementia CARE Enhancement Initiative is a regional project that involves 56 Homes in Vancouver Coastal Health (VCH), including Providence Health Care (PHC). The VCH Dementia CARE Team consists of 1 Team Lead, 1 Resource Nurse and 3 PEER RCAs who carry experience and skills in dementia care, including specialized knowledge and practice of PIECES and GPA.

Louis Brier Home & Hospital joined the initiative in November 2018, after being one of three selected to participate and partner with the VCH Dementia CARE Team in enhancing dementia care. The team started pre-work in the Special Care Unit as the pilot unit and continues to work in collaboration with the VCH Dementia CARE Team and community care partners to implement care processes and practices that enhance the quality of life of people living with dementia and support a safe, meaningful work life for care staff.

Wound Management Program

The Wound Management Program provides a holistic approach to wound management and ensures continuity of care in collaboration with the Interdisciplinary Team. This program provides direction to practitioners through evidence-based practice when managing and/or preventing wounds, which promotes the optimal level of resident function, comfort and quality of life.

A new wound care workflow was developed for our care aides, which provides them with tools such as a new skin integrity check guide in each room and shower, introduction of new skin products, a standard of work guide for skin care products and a new documentation process for each shift.

Our care staff have completed in-depth physical assessment workshops to enhance their assessment skills with focus on early identification, timely intervention and better documentation/communication amongst the nurses and other health care professionals.