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Currents To Medical Center Employees: At a recent communications meeting Rosemary Ellis, quality director, updated the management team on the IMPROVE performance improvement model.  The IMPROVE model replaced the old FOCUS PDCA model and was adopted at the beginning of this calendar year. The JCAHO does not require hospitals to use a specific performance model. However, JCAHO does expect all employees to be familiar with the model adopted by their hospital.  As we approach the expected November week long JCAHO survey, all Medical Center employees should have an understanding of the IMPROVE model and knowledge of a performance improvement initiative(s) within respective service areas. Rosemary's comments below offer a nice explanation of the IMPROVE model. On another matter, a recent Currents newsletter highlighted the Medical Center’s financial performance last fiscal year and explained the need to meet important financial targets in the years ahead to finance the debt on the new phase I hospital facility. To reach our financial targets we must remain focused on reducing costs. Reducing costs does not mean compromising care. Our overall goal will continue to be provision of high quality and compassionate care.  I am asking that all managers continue to carefully monitor and control costs in areas such as travel, phones, overtime, purchasing, and safeguarding of supplies and equipment. Everyone’s support and cooperation is needed in controlling costs.  Thank you very much. W. Stuart Smith Vice President for Clinical Operations and Executive Director, MUSC Medical Center   STAR Productions presents, ‘ENCORE: Ocean’s 11’ Back by popular demand, Rosemary Ellis, quality director, took the floor during the Aug. 19 Communications meeting for an encore presentation concerning the Medical Center’s IMPROVE model (new performance improvement model) and it’s relationship to quality, safety, and performance improvement.  IMPROVE I Identify a problem or an opportunity M Establish a Measurement P Problem analysis R Remedy selection O Operationalize the interventions V Validate the effectiveness of interventions E Evaluate whether your improvement is sustained   “Our all-encompassing goal is to deliver high quality, safe health care. In order to do this, we must develop support structures that result in technologically competent human resources, good communication, shared decision making among caregivers, patients, and families, and culturally sensitive processes,” Ellis said. “We’re trying to do the right thing, the right way.” Ellis reminded managers that the IMPROVE model was designed to guide problem solving efforts when faced with process, system and service improve-ment. When Identifying the opportunity or problem needing change, Ellis cautioned managers to forget about “solving world hunger,” and instead, focus on breaking down the system or process into manageable projects. Focusing efforts results in rapid improvement. She encouraged managers to do two things: set a goal for the project and limit performance indicators when identifying Measures for the project. Encourage teams to set “stretch” goals for a project. If you don’t set a measurable goal for a project, then how are “you going to know when you get there.”  Problem analysis may include collecting additional data on a process/system, direct observation, or focus groups and is considered one of the most important steps in performance improvement. Identifying the root cause(s) of a problem saves time and resources. Generally based on the root causes of a problem, the Remedy (intervention) may be to institute standardization of a process, to automate it, create a checklist, or even add redundancy to the process. Education is also an option but is not considered as effective if not paired with a process change such as standardizing or automation.  Successful implementation (Operationalizing your plan) takes work and planning. If the process owners have not been involved in the development then use a “challenge team.” This team consists of owners of a particular process and they can tell if plans will work for a particular problem. The more change you are asking of people, the more support you should provide during initial implementation. Validate the effectiveness of your interventions by ongoing monitoring through the implementation phase. Learn to expect the unexpected and be prepared to make rapid change. Evaluation of any changes to a process must be monitored. As the process becomes “institutionalized,” your monitoring may consist of an annual measurement of the process to determine is the gains have been sustained over time. Ellis said the overall responsibility for performance improvement, quality and safety resides with the Board of Trustees who in turn delegated the responsibility to the Quality council. The council must oversee and coordinate performance assessments, improve accountability, and plan, design, measure, analyze and sustain them as well. The council allocates financial resources necessary to support organizationwide per-formance improvement and makes reports to the Board of Trustees. Those directly responsible for performance improvement, quality, and safety are the managers of the medical center. If managers and directors would like assistance in creating storyboards for their areas, e-mail Mary C. Allen at AllenMc@musc.edu. Upcoming Juvenile Diabetes Research Fund Walk Lyndon Key, M.D., Pediatrics chairman and Children’s Hospital physician-in-chief, spoke to managers about the Juvenile Diabetes Research Fund (JDRF) and its connection to the Medical Center’s dedication to finding a cure and prevention methods for diabetes.  “In South Carolina, 300,000 people have either Type I or II diabetes,” he said. “Twenty-five percent of inpatient bed days used nationally are for diabetes or diabetes related complications.” Citing how difficult it can be to tell a pediatric, diabetic patient that “they must be sentenced to a life without sugar,” Key mentioned that one of the toughest things to hear a child talk about is whether or not there will be a cure, because the child says, “I can’t take putting needles into my skin any longer.” (Diabetics must sometimes check sugar levels up to four times per day, paired with up to four shots per day.) “We’re close to finding a cure, and finding it only happens through research,” Key said. “JDRF donates almost all of the funds raised through philanthropic efforts to diabetes research. I ask you to please help us continue to support this organization by participating in the JDRF Walk to Cure Diabetes on Nov. 1 in Wannamaker County Park.” For more information on the walk, registration, how to organize a team and for questions concerning sponsorship, contact Mark Ruppel at 792- 5681 or Rebecca Jordan of JDRF at 763-1973.   Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.