Implementing a Robust Process Improvement Program in the Neonatal Intensive Care Unit to Reduce Harm

Abstract

Introduction: Preventable harm continues to occur with critically ill neonates despite efforts by hospital neonatal intensive care units (NICUs) to improve processes and reduce harm. Attaining significant and sustainable improvements will require training including leadership support, mentoring, and patient family engagement to improve care processes. This paper describes the implementation of a robust process improvement (RPI) program in the NICU to reduce harm.

Methods: Leaders, staff, and parents were trained in RPI concepts and tools. Multidisciplinary teams including parent members applied the training and received regular mentorship for their improvement initiatives.

Results: Participants (N = 67) completed pretraining and post-training surveys. Training scores (0-10 scale) improved from an average of 4.45-7.60 (p < .001) for confidence in leading process improvement work, 2.36 to 7.49 (p < .001) for RPI knowledge, and 2.19 to 7.30 (p < .001) for confidence in using RPI tools; relative improvement of 71%, 217%, and 233% respectively. Participants applied their RPI training on improvement initiatives that resulted in improvements of central line blood stream infections, very low birth weight infant nutrition, and unplanned extubations.

Conclusions: Implementing an RPI program in the NICU to reduce harm resulted in significant and sustainable improvements on their improvement initiatives.

Figure 1.. Box plot on the pre- and post- robust process improvement (RPI) Yellow Belt Training Survey Results (zero-10 scale) overall (N = 67) on Confidence in Leading Process Improvement Projects, RPI (Lean, Six Sigma and formal change management) Knowledge and Confidence in using RPI tools (all three indicators had a p < .001).

Figure 2.. Box plot on the pre- and post- robust process improvement (RPI) Yellow Belt Training Survey Results for Staff (zero-10 scale) staff (N = 62) on Confidence in Leading Process Improvement Projects, RPI (Lean, Six Sigma and formal change management) Knowledge and Confidence in using RPI tools (all three indicators had a p < .001).

Figure 3.. Box plot on the pre- and post- robust process improvement (robust process improvement) Yellow Belt Training Survey Results for PAC members (zero-10 scale) parents (N = 5) on Confidence in Leading Process Improvement Projects, RPI (Lean, Six Sigma and formal change management) Knowledge and Confidence in Using RPI Tools (the three indicators had a p = .030, p = .008 and p = .004 respectively).