Lean, Six Sigma techniques reduce incidence and severity of hospital patient falls

Falls in the inpatient setting prolong hospital stays, increase costs and can be fatal, but a Joint Commission program applying elements of Lean, Six Sigma and change management to healthcare process improvement reduced falls 35 percent when it was implemented by seven healthcare systems.

The Joint Commission Center for Transforming Healthcare Preventing Falls with Injury project developed a Robust Process Improvement (RPI) system to identify causes and develop solutions to prevent patient falls. According to the Joint Commission, RPI is a fact-based, systematic, and data-driven problem-solving methodology that incorporates tools and concepts from Lean, Six Sigma and change management.

Falls are tricky to prevent because the potential factors, both systems and people, that lead up to them are so numerous. Hower, preventing falls is also one of the best opportunities to reduce costs and improve care. According to the Agency for Healthcare Research and Quality (AHRQ), about a third of the 700,000 to 1 million patient falls that occur in U.S. hospitals each year could have been prevented.

The Joint Commission estimates that between 30 to 35 percent of patient falls result in an injury, many of which can be quite serious. On average, patient fall injuries increase the length of a hospital stay by nearly a week (6.3 days).

However, when the RPI program was implemented at hospitals in seven healthcare systems the number of patients injured in a fall dropped 65 percent and the total number of patients falling was reduced by 35 percent. Extrapolating from these findings, the Joint Commission translated the potential reduction in falls into savings of approximately $1 million per year for a smaller 200-bed hospital and savings of around $1.9 million per year for larger 400-bed hospitals.

The organizations that helped the Joint Commission test the Center’s fall prevention project at their hospitals were:

• Barnes-Jewish Hospital, Missouri
• Baylor Health System, Texas
• Fairview Health Services, Minnesota
• Kaiser Permanente, California
• Memorial Hermann Healthcare System, Texas
• Wake Forest Baptist Medical Center, North Carolina
• Wentworth-Douglass Hospital, New Hampshire

Working with the Center, the participating hospitals — which ranged in size from a 178-bed community hospital to a 1,700-bed academic medical center — created 21 targeted solutions to address the root causes of falls. These included empowering patients to take an active role in their own safety, utilizing a validated fall risk assessment tool, engaging patients and their families in the fall safety program, providing hourly rounding that includes proactive toileting, and engaging all hospital staff to ensure no patient walks by himself.  

The solutions are being turned into an online resource to teach other hospitals how to apply the same techniques. The Joint Commission estimates that it will release its Targeted Solutions Tool® (TST®) for preventing falls with injury next year.

Other Joint Commission TST modules currently available free of charge to accredited organizations include resources for improving hand hygiene, avoiding mistakes in hand-off communications, and reducing wrong site surgery errors.