Publications & Presentations

National and international publications around the world cite MHQA experts for being on the forefront of the latest research and advancement in healthcare. As true pioneers in the field, our members speak around the country and world on how to bring innovative solutions to healthcare.

Many of the quality and service improvements developed are based off data collected from our own projects through Memorial Health System and SIU Medicine. Our research and presentations are listed below for convenient reference as you research how to produce better patient outcomes.

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See you in 7: Improving Acute Myocardial Infarction Follow-up Care


Batten, A., Jaeger, C., Griffen, D., Harwood, P., Baur, K. (2018). 7/31/2018.

Improving Medication Reconciliation at Hospital Admission, Discharge and Ambulatory Care Through a Transition of Care Team


Kreckman, J., Wasey, W., Wise, S., Stevens, T., Millburg, L., Jaeger, C. (2018). 7/31/2018.

Quality Improvement of Delirium Status Communication and Documentation for Intensive Care Unit Patients during Daily Multidisciplinary Rounds


Aparanji, K., Kulkarni, S., Metzke, M., Schmudde, Y., White, P., Jaeger, C. (2018) 7/31/2018.

Next Day Discharge Rate Has Little Use as a Quality Measure for Individual Physician Performance


Inabnit, C., Markwell, S., Gruwell, J., Jaeger, C., Millburg, L., Griffen, D. (2018) 7/31/2018.

Fundamentally Human: Learning by Design


Structure, Process, and Outcomes guided the Midwest Healthcare Quality Alliance as they developed a symposium combining simulation activities with traditional didactic for a fun and educational activity.
Hafley, C., Kirkbride, G., Wilkerson, J. 7/31/2017.

Increasing Patient Safety Event Reporting in an Emergency Medicine Residency


The objective of this quality project was to increase patient safety event reporting within our Emergency Medicine residency program. Knowledge of event reporting was evaluated with a survey. A formal educational session on event reporting was followed by feedback every two months on events reported and actions taken. In the 14 months preceding the educational session, an average of 0.4 events were reported per month from the residency. In the nine months following the educational session, an average of 3.7 events were reported per month by the residency. In addition, the reported events resulted in meaningful actions taken by the hospital to improve patient safety, which were shared with the residents.
Steen, S., Jaeger, C., Price, L., Griffen, D. 5/1/2017.

Elimination of Emergency Department Medication Errors Due To Estimated Weights


The goal of this project was to reduce weight-based dosing medication errors due to inaccurate estimated weights on patients presenting to the ED. Chart review revealed that 13.8% of estimated weights documented on admitted ED patients varied more than 10% from subsequent actual admission weights recorded. A random sample of 100 charts containing estimated weights revealed 2 previously unreported significant medication dosage errors (.02 significant error rate). Key improvements included removing barriers to weighing ED patients, storytelling to engage staff and change culture, and removal of the estimated weight documentation field from the ED electronic health record (EHR) forms. With these improvements estimated weights on ED patients, and the resulting medication errors, were eliminated.
Greenwalt, M., Griffen, D., Wilkerson, J. 4/3/2017.

Illinois Health System's '30/30/30 Solution' Delivers Results


While change is a management constant, the accelerating pace of transitions along multiple simultaneous fronts indicates ours is an industry looking for solutions. Learn how Memorial Health System has transformed their culture through broad implementation of Lean Six Sigma across the enterprise, completing over 300 improvement projects and yielding nearly $30 million in positive financial impact over a six year period.
Callahan, C., Roberts, T. 10/31/2016.

Secure apps loop in families during surgery


Three hospitals, including Memorial Medical Center, describe how they have put technology to use in improving communication with families while loved ones are in surgery.
Saver, C. 8/1/2016.

Optimizing Healthcare Delivery through Creative Integration of the Institute of Medicine’s Six Aims and Lean Six Sigma


Hospitals are experiencing a significant shift in operational management and quality improvement requirements due to changes created by the Affordable Care Act. By embedding the Institute of Medicine’s (IOM) six aims into the Lean Six Sigma (LSS) process improvement methodology, Memorial Health System (MHS) has been able to significantly increase quality and the number of individuals served while simultaneously lowering costs. The purposeful inclusion of the six aims within the LSS structure ensures the focus of projects and improvement efforts on critical to quality elements that will have the greatest positive impact on patients and their families. This unique structure has enhanced MHS’s quality, financial and patient-centered outcomes.
Roberts, T.S., Wilkerson, J., Callahan, C.D. 7/17/2016.

Significant Reductions in Hospital Acquired Conditions Utilizing a Modified Lean Six Sigma Methodology


The lean six sigma methodology was utilized to structure projects and determine the root causes of sub-optimal performance. Several clinical areas including hospital-acquired pressure ulcers (HAPU), falls with injury, and colon surgical site infections were targeted. The HAPU project saw a decrease in prevalence rate from 6.5% at baseline to 1.15% post-pilot across 17 inpatient units, controlled for three continuous years. The falls with injury project saw a 30% reduction in falls from baseline to pilot across 17 units, controlled for 18 continuous months. The Colon SSI project decreased infections from 6% down to 1% and netted 5 consecutive months of zero infections.
Roberts, T.S., Wilkerson, J., Callahan, C.D. 7/17/2016.

Launch and Grow a Successful Simulation Program


Learn about Memorial Health System and the Midwest Healthcare Quality Alliance's five-step approach to developing stakeholder buy-in, building the necessary training infrastructure, and getting exposure with strategically selected simulation projects. Gain practical insights useful for individuals who are just getting started, as well as those who are established and looking to grow their simulation program and increase their impact.
Millburg, L. 4/13/2016.

Development of A Post Anesthesia Care Unit (PACU) At-Risk Screening Tool


Existing early warning scoring tools, used to identify patients at risk for clinical deterioration, were designed for use with general inpatients and have limitations in the intra‐operative setting. Eight significant variables using evidence-based sources were identified, and a new tool was created that assessed for the presence of these eight identified variables and summed to produce a predictor score. Through cross tabs analysis, patients with a predictor score of 2 or fewer were determined to have low risk for an emergency event. Total score greater than three risk factors demonstrated tool sensitivity at 64.8 and specificity at 63.6.  
Glisson, D., Kirkbride, G., Chamberlain, J., Schmudde, Y., et al 4/10/2016.

Using Lean Six Sigma as a Structure for an Accountable RCA Process


Learn the benefits and drawbacks of the traditional RCA model, and how to modify the Lean Six Sigma process for a robust RCA process that can easily be applied to your organization.
Price, L.; Wilkerson, J. 3/17/2016.

Patient Safety Organization as Strategic Imperative for Second-Curve Healthcare


Understand the outline of a Patient Safety Organization (PSO) informed structure for linking quality improvement, clinical integration, and care coordination across a regional delivery network.
Callahan, C.D.; Hafley, C. 3/17/2016.

Reduction of Colorectal Surgical Site Infection Incidence by 61%- Using Lean Six Sigma in a Tertiary Academic Medical Center


Surgical site infections (SSI) lead to patient suffering, morbidity and mortality, extended length of stay, and avoidable costs of additional care. SSI rates are disproportionately higher among patients following colorectal surgery, occurring in 5% to 45% of cases at an average cost of $26,000 per SSI. The project used Lean Six Sigma to implement an evidence-based clean closure protocol to reduce SSI in colorectal surgery at a tertiary medical center.
Carnduff, G. 3/16/2016.

Lean Six Sigma Sepsis Initiative Saves 24 Lives and $882,000 Annually in a 500-Bed Tertiary Medical Center


Evidence-based practice supports early goal-directed therapy for patients with sepsis. Improving identification of and intervention methods for septic patients in the emergency department (ED) and inpatient units enhances patient safety while reducing costs and mortality.
Reed, S. 3/16/2016.

Lean Six Sigma Prevents 96 Acute Kidney Injuries and Saves $675,000 Annually in High-Volume Cardiac Catheterization Lab Program


The goal of this project was to reduce the incidence of contrast-induced neuropathy (CIN) as a result of percutaneous coronary intervention (PCI). From January to May 2014, the cardiac catheterization lab completed 735 diagnostic-only procedures and 487 diagnostic and intervention procedures. The contrast volume (CV) mean was 124 mL, and there were 148 cases with CV dose greater than their glomerular filtration rate (GFR x 3.7). Key improvements included the implementation of procedural Time-out process, starting in May 2014, which included declaration of pre-procedural GFR and a recommended upper CV limit defined by evidence-based literature predictive of CIN (GFR x 3.7).
Yeager, N. 3/16/2016.

Using Virtual Discrete Event Simulation and Lean Six Sigma to Reduce Door-to-Provider Time in a Tertiary Emergency Department


The emergency department (ED) was experiencing an increase in door-to-provider times due to high patient volume. Increased wait time negatively impacted care in patient throughput, costs and patient satisfaction. ED physicians and leadership formulated changes to the ED pod structure that would decrease throughput time and provide better care and a better experience for the patient. A computer simulation analysis predicted: a decrease in door-to doctor time; a decrease in patients leaving without being seen; an increase in the number of patients the department could effectively handle on a daily basis; and a decrease in length of stay for patients.
Wilkerson, J. 3/16/2016.

Lean Pharmacy Intervention Reduces Patient-Specific Batch Intravenous Fill List Waste by 29% in a Tertiary Medical Center


The 2012 New England Compounding Center tragedy and ongoing drug shortages have caused a dramatic increase in internal compounding at many tertiary hospital pharmacies. Using Lean principles, the medical center reduced Batch IV Fill List credits and returns by 29% and produced an estimated $51,000 in annual cost savings
Koehn, H. 3/16/2016.

Lean Six Sigma Reduces Admission Delays in a Critical Access Hospital Emergency Department by 40%


Managing the flow of patient throughput is essential to preventing overcrowding in the emergency department (ED), reducing patients who leave without treatment, and improving the timeliness of patient care, and ultimately, patient safety. Using Lean Six Sigma process improvement methodologies, a critical access hospital reduced the mean time from admit decision to patient discharge from the ED by 40% (p=0.000).
Podeschi, D. 3/16/2016.

Lean Six Sigma Reduces Time to Implementation of Venous Thromboembolism Mechanical Prophylaxis by 78%


A 500-bed tertiary medical center recognized patients were at an increased risk for development of VTE following an audit that showed 81% of patients with an order for mechanical prophylaxis did not have the modality actively implemented. Further data analysis revealed a mean delay of 354 minutes from the time of physician order to implementation. Utilizing Lean Six Sigma methodology for process redesign, the pilot unit demonstrated a mean time of 79 minutes, a 78% reduction, from time of physician order to implementation of mechanical prophylaxis.
Steckel, C. 3/16/2016.

Lean Six Sigma Reduces Non-Value Added Lab Tests for Acute Coronary Syndrome by 77% and Mortality by 20%


Recent evidence shows that CK-MB testing adds no incremental benefit over troponin in such diagnostic assessments, although the two tests are frequently ordered together. The project objective was to optimize cardiac testing and patient care while reducing the volume of non-value-added CK-MB tests performed. A multi-disciplinary Lean Six Sigma team comprised of emergency department, lab and cardiology staff sought to effectively reduce utilization of CK-MB testing without adversely impacting patient outcomes.
Sullivan, P. 3/16/2016.

Improving Physician Clinic Patient Access through Lean Six Sigma


A 10-month review of inbound telephone data revealed 8,776 abandoned phone calls, representing potential appointments and lost revenue estimated in excess of $78,000. To increase the clinic’s capacity, four improvements were identified and implemented. These changes increased patient access to care and patient satisfaction, while also increasing revenue.
Rodgers, H. 3/16/2016.

Lean Six Sigma Reduces Troponin Turnaround Time by 94% for Cardiac Patients in Critical Access Hospital Emergency Department


The project goal was to reduce turnaround time for troponin in a critical access hospital emergency department using Lean Six Sigma methodologies. Key improvements resulted in a 93.9% reduction in turnaround time.
Trader, M. 3/16/2016.

Applying Lean Six Sigma Methodologies Reduces Lead Time for Emergency Department CT Scans by 32%


The goal was to reduce delay in patient care by decreasing patient wait times for a CT exam from requested to start time in the emergency department. Process defects were identified as CT exams that a patient was not ready for and point of care testing not being used on patients who required pre-CT lab testing. Key improvements resulted in lead time for CT exams requiring labs were reduced 10.15%, as well as significant reductions for CT exams between the hours of 11:00 and 19:30, which was reduced to 65.41 minutes, representing a 32% decrease overall.
Kutz, T. 3/16/2016.

Lean Six Sigma Reduces Non-Value Added Amylase Testing by 82% in a Tertiary Medical Center Emergency Department


Analysis of a tertiary emergency department (with 70,000 visits per year) revealed that lipase was ordered with amylase 73.5% of the time, adding significant cost to the patient and system, with no added value to patient care. The project goal was to decrease the use of amylase testing by at least 50% using a physician-engaged team within a Lean Six Sigma framework. Results showed that unnecessary amylase testing was reduced by 82% as a result of this project.
Sullivan, P. 3/16/2016.

Lean Six Sigma Reduces Fall Rate by 54% in an Inpatient Psychiatric Unit in a Tertiary Medical Center


Patient falls during hospitalization can lead to increased inpatient care costs, decreased patient satisfaction, an increase in unnecessary tests and treatments, longer lengths of stay. The project goal was to reduce the fall rate to meet the National Database for Nursing Quality Indicators (NDNQI) top quartile performance for behavioral health which was 3.23. Using Lean Six Sigma improvement methodologies, the inpatient psychiatric unit was able to reduce its fall rate from 5.4 to 2.49.
Sharma, V. 3/16/2016.

Lean Six Sigma Enhances the Traditional Hospital-Based Root Cause Analysis


The organization sought to create a root cause analysis (RCA) structure that endowed greater focus, efficiency and effectiveness in the process. Due to pre-existing Lean Six Sigma structures within the organization, a similar model for revising the RCA process by using the LSS Define, Measure, Analyze, Improve, Control (DMAIC) structure was created as the base. This model ensured rapid turnaround of event reviews and process changes that impacted the true root cause(s), as well as supported the just culture model that creates an engaged and satisfied workforce.
Wilkerson, J. 3/16/2016.

Lean Six Sigma Project Improves Medicare Wheelchair Funding Approval Rate by 76%


The organization used Lean Six Sigma process techniques to identify and support improved efficiencies in Medicare wheelchair approval within a durable medical equipment hospital affiliate. The improvement process focused on reducing wait time and creating additional capacity for newly referred patients. Implemented changes reduced the cycle time by 76%.
Gilmore, C. 3/16/2016.

Lean Six Sigma Reduces Risk of Medication Errors Due to Medical Dispense Overrides by 53% in a Critical Access Hospital


Medical dispense overrides allow nurses to dispense medications from the Pyxis machine without pharmacy review in emergency situations. However, increasing incidence of medication overrides can lead to greater risk of medication errors. For a 3 month period, a critical access hospital recorded 510 total Pyxis medical dispense overrides, at an average of 5.9 times per day. The project team set a goal of reducing overrides to less than three per day. The team discovered a workload balancing issue was causing bottlenecks in the process. Interventions implemented resulted in a decline to 2.8 overrides per day, reducing overrides by 53%.
Enloe, J. 3/16/2016.

Keep Loved Ones Looped In: Surgery Status Updates


Learn how to engage nurses and physicians in the communication process to meet patient companion expectations in the surgery waiting room.
Darwent, L. 2/21/2016.

Live Simulation, TeamSTEPPS, and Quality Improvement: Learn to be Leaders.


Live simulation and demonstration on how to utilize simulation for process improvement and enhancing team skills and collaboration, through the planning and execution of repairing a ruptured abdominal aortic aneurysm.
Desai, S.S.; Ketchum, J., McDowell, C.M., Roberts, T.S., Whitaker, T., Wilkerson, J. 1/18/2016.

Improving the Success of Strategic Management Using Big Data


Strategic management involves determining organizational goals, implementing a strategic plan, and properly allocating resources. Poor access to pertinent and timely data misidentifies clinical goals, prevents effective resource allocation, and generates waste. We have pioneered an approach using big data to create competitive advantage by identifying trends in clinical practice, accurately anticipating future needs, and strategically allocating resources for maximum impact.
Desai, S.S.; Roberts, T.S.; Wilkerson, J. 10/7/2015.

Impact of a multi-institutional comprehensive hospital pressure ulcer prevention program.


Memorial Medical Center’s hospital acquired pressure ulcer prevalence rates averaged 6.01% from FY08-11. Key improvements include (1) Development of a "PUP Kit" consisting of a PUP Bundle and bedside communication tools, (2) Creation of "Team-Up to Turn" approach at standardized times with support tools, and (3) Enhanced role definition and training for unit-based Wound Ostomy Champions. Memorial Medical Center PSI 03 Pressure Ulcer observed rate for the FY2016 HAC reduction program was 75% below the expected rate per eligible 1000 discharges and 54% below the national risk-adjusted rate.
Roberts, T.S., Wilkerson, J., Callahan, C.D., Desai, S.S. 10/7/2015.

Short-Term Quality of Care Outcomes of Tunneled Dialysis Catheters, Arteriovenous Fistula, Arteriovenous Graft, and Early Cannulation Dialysis Acces


Tunneled dialysis-catheter (TDC) infections remain a leading cause of morbidity and mortality in end-stage renal disease (ESRD) patients. Arteriovenous fistulas (AVF) and grafts (AVG) require concurrent TDC while maturing. Early cannulation AVGs (ECAVG) permit immediate hemodialysis (HD) and avoid the use of TDCs. The purpose of this study was to evaluate short-term outcomes after dialysis access.
Desai, S.S., Dua A, Callahan C. 10/1/2015.

Design of a Healthcare System Quality and Safety Infrastructure

As our reimbursement model shifts from fee for service to value based care that pays for performance, establishing a comprehensive performance improvement quality management system is essential for sustainability. This program discusses a comprehensive quality management system approach.
Callahan, C.D. 7/15/2015.

Creating a Quality Improvement Project Pipeline and Project Portfolio Management Structure for a Multi-Hospital System


Due to exponential expansion of a Lean Six Sigma program, an evolution of the project portfolio management structure was required to keep pace with anticipated future demands. The Operations Improvement Team designed and implemented both a centralized project information tracking system and a portfolio management structure. This has resulted in an efficient project selection, prioritization and portfolio management process.
Wilkerson, J. 4/1/2015.

Applying Lean Six Sigma Methodologies Reduces Lead Time for Scheduled Outpatient Procedures in Medical Imaging by 87.5%


The goal was to reduce the delay in patient care by reducing patient wait times, both from requested to scheduled time and at time of procedure. Key improvements include (1) Assignment of nursing and radiologists' resources to procedures in the scheduling system; (2) Removal of double bookings between CT and Ultrasound biopsies; and (3) System check of available rooms, nurses, and radiologists when scheduling a procedure in Medical Imaging.
Kutz, T. 4/1/2015.

ED IV Infusion Charge Capture: Documenting Stop Times Increases Efficient Care while Enhancing Revenue


The goal was to reduce errors in failure to document stop time for IV infusions to zero. Along with the goal of accurate documentation was the goal to increase revenue by capturing lost charges. Without a proper stop time documented, billing was unable to appropriately charge patients for IV infusions received while in the ED.
Slonaker, N. 4/1/2015.

2014 Quality Award Recipient: Lean Six Sigma Methodologies Reduce Red Blood Cell Transfusions by 32% in a Tertiary Medical Center.


Evidence-based guidelines now support restrictive red blood cell (RBC) transfusion practices to enhance patient safety and reduce costs while maintaining or improving patient outcomes, including all-cause mortality. Using Lean Six Sigma process improvement methodology, a 500-bed tertiary medical center reduced RBC transfusion rates by 32%, producing reduced adverse transfusion reaction risk and a $2.8 million annual expense reduction, with no associated negative patient outcomes. Through a modern hospital blood stewardship programs, the regional community also benefits through reduced demand pressure on increasingly scarce blood resources.
Callahan, C.D. 4/1/2015.

Integration of Lean and Six Sigma Methodologies into a Hospital Operations Management Improvement Program: Implications for Strategic Management


The rigor and statistical framework of Six Sigma analysis permits robust root cause analysis of major patient-related issues in a hospital setting. The Lean methodologies permit continuous process improvement at the patient level. Combining these two approaches allows critical analysis, consolidation, and validation of key projects that impact the quality of patient care. The utilization of a scoring system and continuous process improvement can be used to identify key points of failure that adversely impact patient safety and the value stream.
Wilkerson, J., Roberts, T.S., Callahan, C.D., and Desai, S.S. 3/16/2015.

Evaluation of a nurse driven protocol to remove urinary catheters: Nurses’ perceptions


This article describes nurses' perceptions of the effect of a nurse-driven protocol in a Magnet-designated hospital. Post-protocol implementation data indicate improved job ease and positive patient feedback following protocol implementation. Younger or less-experienced nurses were likely to use the protocol.
Olson-Sitki, K., Kirkbride, G., & Forbes, G. 1/1/2015.

The Effect of Hospital Factors on Mortality Rates After Abdominal Aortic Aneurysm Repair


Dua, A.,Furlough, C., Ray, H., Sharma, S., Upchurch, G., Desai, S.S. 8/11/2014.

Overcoming resistance to implementation of integrated care pathways for total joint replacement.


Manning, B.T., Robinson, B.S., Callahan, C.D., Adair, D., & Saleh, K.J. 4/1/2014.

Application of statistical process control to physician-specific emergency department patient satisfaction scores: A novel use of the funnel plot.


Griffen, D., Callahan, C.D., Markwell, S., de LaCruz, J., Milbrandt, J.C., & Harvey, T. 3/1/2014.

The bankruptcy of healthcare measurement: Current state and future solutions.

Rahn, D.L., Roszhart, J., & Callahan, C.D. 3/1/2014.

Complexity of delivering orthopaedic care: The stakeholders speak.

Saleh, K.J., Adair, D.M., Manning, B., Saleh, J.K., Callahan, C.D., & Bozic, K.J. 3/1/2014.

Why can’t we all get along? Rallying towards standardization in Orthopaedics.

Saleh, K.J., Adair, D., Callahan, C.D., & Bozic, K.J. 6/1/2013.

Why can’t we all get along? Rallying towards standardization in orthopaedics.

Callahan, C.D., Adair, D., Bozic, K.J., Manning, B., Saleh, J.K., & Saleh, K.J. 4/1/2013.

Executive Lean Six Sigma White Belt Course.

Callahan, C.D. & Roberts, T. S. 4/1/2013.