Integration of a Lean Daily Management System into an Antimicrobial Stewardship Program

Abstract

Growing demands and limited guidance on efficient use of resources to advance stewardship initiatives challenge antimicrobial stewardship programs (ASP).

Methods: The primary aim was to incorporate a Lean Readiness and Metrics Board (RMB) into ASP and assess team member accountability and satisfaction with weekly 15-minute huddle participation within 1 year of implementation. ASP team survey data were analyzed for comments regarding Lean integration, team communication, and productivity. The second aim was to develop 5 shared metrics associated with quality, people, delivery, safety, and stewardship and evaluate ASP team productivity by assessing the impact of projects targeted at each specific metric. Pharmacist-physician ASP scheduling conflicts were addressed through identified rounding times under the "People" metric. The "Quality" metric assessed ASP intervention disagreement rate and collaborations that occurred to reduce disagreement. ASP tracked the number of individuals educated by ASP monthly through the "Delivery" metric.

Results: Since August 2018, ASP replaced hour-long monthly meetings with weekly huddles at the RMB. On average, 14 members (88%) of the ASP participate weekly. Team members report improvement in communication and satisfaction with Lean integration. Metric utilization enhanced productivity. For the metrics under "People," "Quality," and "Delivery," reduced scheduling conflicts occurred, the ASP intervention disagreement rate decreased (37.0%-25.6%; P < 0.001), and the ASP educated an average of 79 learners per month.

Conclusions: Weekly huddles at the RMB enhanced communication and team accountability while visually displaying program needs, progress, and achievements. The RMB helps to ensure ongoing institutional commitment, and Lean methods show promise for evaluating and improving ASP productivity.

Fig. 1.

Overview of Lean daily management system. A, Readiness board. B, Program productivity metrics board. P&T, pharmacy and therapeutics; SHARPS, Sharing Antimicrobial Reports for Pediatric Stewardship.

Fig. 2.

Quality metric data. A, Disagreement by month. Dashed line indicates the linear slope for the disagreement rate. B, Disagreement by specialty and clinical indication. BMT, bone marrow transplantation; Gen peds, general pediatrics; Hem/Onc, hematology/oncology; Atyp., atypical; Cdiff, Clostridioides difficile; CAP, community-acquired pneumonia; CF, cystic fibrosis; CRBSI, catheter-related bloodstream infection; Intra-ab, intra-abdominal; NEC, necrotizing enterocolitis; Post-Op, postoperative; Cell, cellulitis; R/o CRBSI, rule-out catheter-related bloodstream infection; R/o VPSI, rule-out ventriculoperitoneal shunt infection; SSI, surgical site infection; SSTI, skin and soft tissue infection; UTI, urinary tract infection; VAP/HAP, ventilator-associated pneumonia/hospital-acquired pneumonia; VPS infection, ventriculoperitoneal shunt infection.