Built to Excel

From the board room to the front lines, all that Nemours strives to achieve begins with putting children first and drives the continuous journey toward excellence.

Nemours has accelerated efforts to build upon its foundation of delivering safe, high-quality care to children. In 2019, Mission Zero launched at Nemours Children’s Hospital with the Culture of Safety Leadership Summit followed by 14 mini summits to fortify high reliability and just culture. Associates across the system have focused on workstreams that range from becoming “brilliant at basics” to improving leadership accountability.

Quality & Safety: A Rewarding Effort

The commitment to quality and safety is recognized throughout the Nemours system by objective, measurable outcomes that keep children safe. Using over 30 databases for clinical standards and customer survey tools, Nemours compares its progress to industry standards and guides its continuous efforts to provide consistent, high value experiences to every patient family, everywhere, every time.

Some highlights of Nemours’ 2019 recognition for the provision of safe, high-quality care include:

  • U.S. News & World Report recognized seven specialties at Nemours/Alfred I. duPont Hospital for Children (N/AIDHC) in its 2019 “Best Children’s Hospitals” rankings
  • For the third time, The Leapfrog Group recognized Nemours Children’s Hospital (NCH) among its “Top Children’s Hospitals” in the U.S. for exceptional quality and safety; Wolfson Children’s Hospital, Nemours partner in Jacksonville, was also among the 10 pediatric hospitals awarded
  • The Emergency Nurses Association has once again honored N/AIDHC’s Level 1 Pediatric Emergency Department with its “Lantern Award” for quality and safety — one of only 28 U.S. EDs
  • Zero post-operative infection rates for two years straight for Nemours providers in partnership with its collaborating hospital, West Florida Healthcare – Pensacola
  • For the second time, Nemours/AIDHC was recognized with the GOLD level ELSO Award for Excellence in Life Support, demonstrating Nemours’ extraordinary dedication to providing high quality, state-of-the-art care to critically ill patients and ensuring community access to specialized equipment and supplies, defined patient protocols, and staff with advanced education

The Logistics Center celebrated seven years monitoring inpatient vitals across the Nemours enterprise, enabling early detection and response to potential adverse events, including sepsis.

A Mission to Zero Harm: Making It Easy to Do the Right Thing

Nemours strives not only to improve its targeted metrics but to instill a culture of quality and safety that supports, communicates and corrects course when issues arise. Quarterly updates track, benchmark and report progress to plan back to every associate from the C-suite to the nursing teams. Emphasis is placed on a just culture where associates feel safe speaking up for safety, in addition to understanding what is expected, and being empowered to succeed with the right training, tools and procedures.

More than 18,000 issues were elevated and addressed from daily safety huddles across Nemours in 2019.

A culture of quality and safety provides appropriate feedback mechanisms, like daily safety huddles, where all associates are compelled to share successes, visions for improvement and address errors with compassion. Open communication, reliable methods, standards and metrics are essential to Mission Zero.

Getting Better

Continuous improvement efforts play an important role in Nemours’ journey toward excellence. During 2019, cross-functional teams throughout the enterprise participated in multi-day improvement events, day-long workshops, daily huddles, breakthrough improvement efforts and “gemba” visits all designed to improve processes, reduce waste and increase value.

The “Plan. Do. Check. Adjust.” data-driven approach was applied to:

  • clinical standard work
  • difficult IV access (featured below)
  • preservice estimates for hospital-based services
  • operating room turnover
  • discharge planning and inpatient flow
  • onboarding new nurses
  • capital construction processes

Learn how Nemours worked to improve difficult IV access to help kids like Carter.

Through a daily huddle, the PICU at Nemours Children’s Hospital surfaced an issue of nurses being pulled from their department to assist other areas with difficult IV insertions. Not only was this pulling nurses away from their assigned PICU duties it was, most importantly, uncomfortable for patients being stuck multiple times and resulted in delayed care or the need to reschedule appointments. After collecting necessary data, a cross-functional team used continuous improvement methodology and structure to define the problem, identify root cause(s), and create and implement an improved process with family input. Within 15 days of implementing the new process, NCH went from over 40 percent of patients with difficult insertion receiving three or more sticks before the associate asked for help down to four percent. Now 96% of patients receive two or less sticks before the associate escalates for help and the majority escalated are 0 sticks, which means the decision criteria developed in the process is working. While there is still room for improvement, this result is a tremendous win for Nemours’ patients, their families and our nurses.

Nemours recognized there was an issue and determined there was something more that they could do about it… we were extremely impressed with that. Now, it’s one stick and we’re good.
— Kraft Family

Extending Quality to All Children, Regardless of Where Care Is Provided

A commitment to keep kids close to home means, on any given day, Nemours providers are managing as many children within Nemours’ collaborating hospitals as within the walls of Nemours’ freestanding children’s hospitals.

To ensure one high level of quality regardless of where care is provided, Nemours and its partners are developing integrated care pathways. This work takes on many forms, depending on the type of services provided or goals for improvement, to ensure consistent care across the Nemours network.

Thanks to Nemours for the hard work in developing our Neonatal Nurse Practitioner (NNP) program at AdventHealth Heart of Florida. It has assisted in the growth of our program and thus increased the education level in our nurses. Using the NNP program, our discharge times have significantly decreased. Our quality measures have continued to increase as well. Your NNPs have organized an education program for our staff which provides additional educational opportunities each shift. Tammy M. continues to challenge her providers with brainstorming opportunities to grow our staff as the practitioners work with our program. HCACAPS have reflected increased patient satisfaction regarding provider relationships since the program began.
— Brenda Morgan, MHSA, BSN, RNC-OB, Perinatal Services Sr. Nurse Manager, AdventHealth Heart of Florida

Partnership support is intended to elevate care for the community and add value to the institution, and may include:

  • initial assessments to identify care gaps
  • establishing shared dashboards to measure quality improvements and daily management systems
  • expanded access to providers or nurses, as needed
  • monthly check-ins with hospital administrators
  • assistance in identifying recommended hardware, software and other health care resources
  • retrospective review of transfers to improve efforts to keep care local
  • variety of education and training as well as on-site simulation for codes and rare events
  • hosting partner providers within Nemours locations to familiarize culture

A HEART FOR HIGH-QUALITY CARE

The Cardiac Center at Nemours/Alfred I. duPont Hospital for Children has served as a standard bearer in excellence, with a record of superior outcomes over the course of more than 20 years. The Center was one of the first to be designed as an integrated cardiac practice unit — now considered the hallmark of a quality cardiac program.

The all-new Cardiac Center at NCH is elevating Nemours’ vision for superior service by further innovating its model of integration.

Using Integrated Facilities Design, the process for planning the new Cardiac Center at Nemours Children’s Hospital (NCH) applied lean principles and leveraged the expertise of multiple stakeholders, from respiratory therapists and pharmacists to nurses, physicians, and patients and families.

All cardiac services are co-located within the 40,000 square-foot Cardiac Center, including a cardiovascular operating room and hybrid catheterization lab. Thirty critical care beds are stationed adjacent to the cath lab, providing for a safer and more seamless experience. Rather than one large nurses’ station, multiple desks populate the unit to ensure nurses are close to their patients. Line of sight between nurses and physicians is maintained at all times through the all-glass physician workroom. New IT systems ensure providers can securely monitor their ICU patients from their computer or phone.

The NCH Cardiac Center helps buoy Nemours’ cardiology team throughout Florida, including 13 outpatient sites. Further integration across the health system is anticipated as Nemours deploys a single echocardiography system.

Going Wider and Deeper to Help Cardiac Patients

The Nemours Cardiac Center at Nemours/Alfred I. duPont Hospital for Children has continued to find new ways to support children with heart conditions and their families. In recent years, its multidisciplinary team has expanded to include a genetic counselor and an embedded psychologist.

New technologies are also being employed to support care and outcomes:

  • genetic testing can offer further insight into the genetic cause of a cardiac condition, informing the course of treatment and benefiting the immediate and extended family of the patient
  • developmental screening can help identify children who may experience developmental delays, ADHD or learning disabilities as a result of a serious heart condition or its treatment; earlier identification can result in earlier intervention and improve quality of life
  • advances in noninvasive imaging enable access to information that once was only discernible through a cardiac catheterization
  • a Nemours-developed high-risk cardiac tracker accessible through the Nemours App includes a daily log for parents to track the child’s vitals and personalized one-sheets for parents to provide to the child’s other care providers

JOURNEY TO ZERO

Nemours’ journey to a culture of safety and quality is rooted in its patient-centered mission. A solid foundation for achieving Mission Zero is built upon the health system’s:

  • Organizational Values
  • Standards of Behavior
  • Continuous Improvement Mindset
  • Progress Toward a Just Culture
  • Advanced Enterprise Data Management System