Solution Develpment Interview
From: M. D. Anderson Department of Performance Improvement
Date; January 15, 2008

Narrator: In each webcast we try to pull out an expert in the field for the webcast theme and I always marvel at how Estella Woodard had always worked on solutions and they've always come out successful and so I have today with me Estella Woodard, she's the Clinical Administrative Director Diagnostic Center and first questions I'd like to ask you Estella is, what should you not forget about solution, would you share with our interviewers?

Estella Woodard: Well fortunately I've had a wonderful opportunity over the last 15 or 16 years that I've been at M. D. Anderson to be a participant in a wide variety of projects including medical records issues that was certainly a sticky area that we have for sometime looking at improvement we're looking specifically at the involved provider database but this is such a large complex institution that there's a variety of projects that we can focus on. My interest at the present time is looking at specifically performance improvement and quality measures in the operating room. I've recently had the opportunity to participate in the IHC project and we're just actually completing that project now and heading back to Utah for our final presentation. This was a wonderful opportunity to allow us, as faculty, to learn a little bit more about quality improvement and how to structure our projects, how to get an aim statement and measure of baseline metrics and then go on and try to improvement. Specific things that we've looked at in the operating room is simple things like just getting the OR started in the morning on time, the operating rooms are a very costly part of our institution, it costs us nearly $1,600 an hour to run an operating room, and obviously we have a problem with scheduling of the patients, or the patients don't show up on time or we don't have the right instruments that are coming together for the operation and this can be quite costly, so this is one area we're looking at. We're also looking at performance improvement projects don't necessarily have to cost money to do and you can actually have improved patient safety and better outcomes with the resources that we have, specifically we're going to be part of, what, a 100,000 might have saved looking at such things as surgical sight infections which is a serious part of taking care of surgical patients, such things as making sure the antibiotics are delivered on time, making sure that the patient has the right temperature in the operating room, when they come out of the operating room at a normal temperature. Simple things like clipping the patient's hair rather than shaving the patient's hair will cut down significantly in wound infections and also a tighter glucose control, are just some examples of how performance improvement processes looking at specific things can result in not only lives saved but a much more efficient practice.

Narrator: Well thank you Dr. Walsh. From your perspective, how important is effective team work in helping us make cancer history?

Estella Woodard: Yes, one of the main things you need to focus on is the organization strategic plan. Any solutions must be under the umbrella of the strategic plan. First of all what we do is work with our teams to fully understand what the strategic plan is, then as individual team members they look at how am I important to this organization? How do I fit, what do I need to do to make things better? So those are just very basic ideas that we get the group to start thinking about. Once that is done we look at what the problems are from that, we determine what we might start working on and having solutions for. Many of the people within our teams are very interested, they're very focused on their role in the institution, it's very personal. And because it becomes very personal they are willing to organize, be very motivated, talking about it on the telephone, just different ways that they communicate inside and outside of the team, trying to make things better. And with this enthusiasm we've been able to come up with much better solutions.

Narrator: So you included a vast (group), anyone touching the problem, you brought them in.

Estella Woodard: Right, we look at the diversity, we work with multidisciplinary groups, our group is very comfortable we're working with nursing staff because they're with them very frequently. They're comfortable with the physicians and pharmacy and we have also worked so closely with facility services that some of our projects has incorporated their expertise. And their solutions, so we respect all of the groups and realize that in a team you need to diverse(fy) populations of staff members and you need them to all be involved and have the same amount of enthusiasm to make it work.

Narrator: What should every solution have? Would you tell our viewers about that?

Estella Woodard: Every solution should be measurable, sustainable, have some rewards, and celebrate.

Narrator: Ok.

Estella Woodard: We have found that with those four keys we've been very successful because we do the same thing as what we do with plan do check at, we come back and tell the group how well they've done, that feedback tends to make them more motivated to do some additional problem solving so what we've done is we give them the feedback and from that feedback they know that we are sustaining our whatever we've gained and we constantly give them feedback, it's on boards, it's on Lotus Notes, it's in scerna notes, it's in different places so they can get the feedback that they need to know that we are still viewing what they've done as valuable.

Narrator: Do you ever have to change or update the solution so it matches reality?

Estella Woodard: Yes, we've had to go back and do some tweaking. Sometimes it really comes from within the group. They look at what we have gained and they think, well if we try something just a little different would it be better, because much of what we do has to do with turn around time, and though our primary focus is caring, that's what we've chosen in our group, and much of our caring is geared toward the patients. How long it takes us to get something done, how quickly we can get the patient moved through the system is almost paramount in our minds with each of our projects. So because of that our group knows what they can change and because they know they can change this and that we're willing to try, they have been very open and they feel very valued.

Narrator: Very good, very good. Could you give our viewers a few examples of some great outcomes from the projects?

Estella Woodard: One of the projects that we did really had to do with the nomadic tube system. We had huge group of staff working together, we had representatives from twelve disciplines, and all of the people in the group were valued, they were there to make decisions and they made those decisions very quickly. We had what was called a work out session; it was a lot of questions were asked before we started so we knew pretty much when we came in what we were expecting to see. What might be some possible outcomes, it was a four hour session facilitated by you, Duke Rohe and worked really well because everyone was kept on task and we went through all of our problems, answered the questions that we had, prearranged to have a procession, and we made decisions that were helpful for everyone. Because we've gone through this process for the main hospital, we were able to use that same process when we implemented the pneumatic tube in the ACB. So it was something that was very successful on this side of the street and worked quite well when we moved to the other side.

Narrator: Excellent, it sounds like your incorporating all these ideas into how you do things around here.

Estella Woodard: Right.

Narrator: Ok, well as you can see solutions are just second nature to Estella and her crew here so we're gonna have a brief commercial and then we're going to send it back to you Tina.

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Additional Remarks: M.D. Anderson's Patient Education Office also known as PEO works with interdisciplinary teams to give patients, caregivers, and the public information and tools they can use to make informed healthcare decisions. This office was established more than twenty years ago and to date PEO includes staff members with expertise in health education, public health, nursing, writing, editing, and graphics. The PEO provides education on cancer prevention, treatment, rehabilitation, and general health and wellness topics. In addition to these resources the patient information office publishes a quarterly newsletter, the Connection, to keep M.D. Anderson faculty and staff informed on the latest news. The next time a patient asks for more information don't hesitate to direct them to the patient education office where they can obtain copies of educational materials. For more information feel free to visit the Patient Education Office website on