“It’s all about identifying and improving on the standard work and applying that standard work every time for every patient.”

- Charleen Tachibana, RN, Senior Vice President, Hospital Administrator and Chief Nursing Officer

Charleen Tachibana, RN

Patient falls are one of the most intractable problems facing hospitals throughout the world.

“Falls among the elderly are reaching epidemic proportions,” says a recent post in the HealthHub blog from Brigham and Women’s Hospital in Boston. “And, as baby boomers age, the incidence is going to continue to rise. But, what’s most troubling is that one out of four elderly patients dies within 12 months following a serious fall.”

The teams at Virginia Mason have been working intensively on falls for years and Charleen Tachibana, RN, senior vice president, hospital administrator and chief nursing officer at VM, says that the critical piece – the essential element to reducing falls – is to identify standard work and stick with it in a relentless fashion. The focus, she says, has traditionally been on the hospital fall rate, but she says that’s missing a critical step.

“I don’t hold you accountable for your fall rate,” she says. “I hold you accountable to implement the standard processes that we know will make a difference. I do that by conducting genba rounds to understand the barriers and support the team in this work.”

By applying the tools of the Virginia Mason Production System through the years, Charleen and her team members have identified the essential components of work that reduce the fall rate. These essential elements include, among other items:

• Hourly rounding by a nurse or patient care technician
• Toileting offered every hour
• Bed alarms in place
• Nurses focused on manageable geographic zones

The key is to remain steadfast over time. “If you’re focused on the fall rate then maybe you have lost sight of the standards,” Charleen says. “You have to get the standards down and you have to understand every time the standard is not in place why it’s not in place and drill into that.”

Hourly rounding, for example, has to happen every hour, 24 hours a day, seven days a week. The same with offering toileting, and “we cannot leave our at-risk patients alone when they’re on the toilet so they don’t attempt to get up by themselves, thinking that they can,” Charleen says.

At Virginia Mason, when a patient falls, an immediate inquiry delves into exactly what happened. “Invariably, when a patient falls, we find that something wasn’t in place,” Charleen says. “Almost every time there is a fall we find that we missed a step somewhere. So we’re working to hard-wire those preventive processes to keep the problem from ever occurring.”

And that means constantly looking for connections – many of which are not immediately obvious – that relate to falls. At Virginia Mason, the teams found that patients arriving on hospital floors from procedure labs in the clinic would sometimes arrive without the nurse knowing that they were a fall risk (because they had been given medication in the clinic that weakened their stability).

That’s been fixed and nurses on the floor now know in advance precisely which patients are at risk of a fall.

Says Charleen: “It’s all about identifying and improving on the standard work and applying that standard work every time for every patient.”

See Real Leadership Happens on the Front Lines of Care for more information about leadership’s role on the genba.

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