Identifying Gaps in Frontline Healthcare Facility High-Consequence Infectious Disease Preparedness.

Hospital infection disease preparedness gaps were brought to the forefront during the 2013-2016 Ebola virus disease (EVD) outbreak. The ability of US hospitals to rapidly identify, isolate, and manage patients with potentially high-consequence pathogens is a critical component to health security. Since the EVD cases in Dallas, Texas, the continuity of hospital preparedness has been questionable. While certain hospitals were designated as EVD treatment facilities, the readiness of most American hospitals remains unknown. A gap analysis of a hospital system in Phoenix, Arizona, underscores the challenges of maintaining infectious disease preparedness in the existing US healthcare system.

Implementation of a formulary management process.

PURPOSE: The application of lean methodology in an initiative to redesign the formulary maintenance process at an academic medical center is described. SUMMARY: Maintaining a hospital formulary requires clear communication and coordination among multiple members of the pharmacy department. Using principles of lean methodology, pharmacy department personnel within a multihospital health system launched a multifaceted initiative to optimize formulary management systemwide. The ongoing initiative began with creation of a formulary maintenance redesign committee consisting of pharmacy department personnel with expertise in informatics, automation, purchasing, drug information, and clinical pharmacy services. The committee met regularly and used lean methodology to design a standardized process for management of formulary additions and deletions and changes to medications' formulary status. Through value stream analysis, opportunities for process and performance improvement were identified; staff suggestions on process streamlining were gathered during a series of departmental kaizen events. A standardized template for development and dissemination of monographs associated with formulary additions and status changes was created. In addition, a shared Web-based checklist was developed to facilitate information sharing and timely initiation and completion of tasks involved in formulary status changes, and a permanent formulary maintenance committee was established to monitor and refine the formulary management process. CONCLUSION: A clearly defined, standardized process within the pharmacy department was developed for tracking necessary steps in enacting formulary changes to encourage safe and efficient workflow.

Centers of excellence in healthcare institutions: what they are and how to assemble them.

BACKGROUND: Centers of excellence-specialized programs within healthcare institutions which supply exceptionally high concentrations of expertise and related resources centered on particular medical areas and delivered in a comprehensive, interdisciplinary fashion-afford many advantages for healthcare providers and the populations they serve. To achieve full value from centers of excellence, proper assembly is an absolute necessity, but guidance is somewhat limited. This effectively forces healthcare providers to pursue establishment largely via trial-and-error, diminishing opportunities for success. DISCUSSION: Successful development of a center of excellence first requires the acquisition of a detailed understanding of the delivery model and its benefits. Then, concerted actions must be taken on a particular series of administrative and clinical fronts, treating them in prescribed manners to afford synergies which yield an exceptionally high level of care. To reduce hardships associated with acquiring this rather elusive knowledge, remedy shortcomings in the literature, and potentially bolster community health broadly, this article presents information and insights gleaned from Willis-Knighton Health System's extensive experience assembling and operating centers of excellence. This work is intended to educate and enlighten, but most importantly, supply guidance which will permit healthcare establishments to replicate noted processes to realize their own centers of excellence. CONCLUSIONS: Centers of excellence have the ability to dramatically enhance the depth and breadth of healthcare services available in communities. Given the numerous mutual benefits afforded by this delivery model, it is hoped that the light shed by this article will help healthcare providers better understand centers of excellence and be more capable and confident in associated development initiatives, affording greater opportunities for themselves and their patient populations.

Collaborative Partnerships: Raising the Professional Practice of Nursing.

The journey to Magnet® provides the ideal platform to demonstrate the impact of nursing and how strong interprofessional partnerships advance care and problem solving in an increasingly complex healthcare arena. Nurses in Magnet organizations use collaborative partnerships to forge innovative solutions, improve nursing care across the continuum, advance health in populations, effect desired change, and improve outcomes.

Studer Group® ' s evidence-based leadership initiatives.

PURPOSE: The purpose of this paper is to analyze the implementation of an organizational change initiative--Studer Group®'s Evidence-Based Leadership (EBL)--in two large, US health systems by comparing and contrasting the factors associated with successful implementation and sustainability of the EBL initiative. DESIGN/METHODOLOGY/APPROACH: This comparative case study assesses the responses to two pairs of open-ended questions during in-depth qualitative interviews of leaders and managers at both health systems. Qualitative content analysis was employed to identify major themes. FINDINGS: Three themes associated with success and sustainability of EBL emerged at both health systems: leadership; culture; and organizational processes. The theme most frequently identified for both success and sustainability of EBL was culture. In contrast, there was a significant decline in salience of the leadership theme as attention shifts from success in implementation of EBL to sustaining EBL long term. Within the culture theme, accountability, and buy-in were most often cited by interviewees as success factors, while sense of accountability, buy-in, and communication were the most reported factors for sustainability. ORIGINALITY/VALUE: Cultural factors, such as accountability, staff support, and communication are driving forces of success and sustainability of EBL across both health systems. Leadership, a critical factor in several stages of implementation, appears to be less salient as among factors identified as important to longer term sustainability of EBL.

The Fort Lewis maternity care project: a pioneering program for enlisted military families in a Prewar Washington State Community.

The Fort Lewis maternity project begun in Tacoma, Washington in 1941, was considered a pioneering project that met the identified maternal/child health care needs of enlisted military families. From the outset, local medical leaders as well as Children's Bureau advisors intended that the project would provide physician-managed pregnancy as well as hospital births and that public health nursing would play a critical role in this maternal/child initiative. The project proved so successful that the model of care established under this program was reinterpreted to meet similar needs for military families in other states as America entered World War II.

Community collaborates on services for mentally ill.

Faced with the closing of the state psychiatric hospital in their community, hospitals, law enforcement, mental health providers, and community agencies in Raleigh, NC, began collaborating on improving care and transitions for the mentally ill. The coalition created a standardized assessment tool and standardized transfer guidelines for mentally ill patients, along with other process improvements. As a result, Duke Raleigh Hospital is transferring more patients to mental health facilities direct from the emergency department rather than keeping them in an inpatient bed waiting for an opening. Hospital case managers get behavioral health patients a follow-up appointment with a mental health provider before they leave the hospital.