John Craddock, MD July 2016

Planning for Success: Bone Marrow Transplant Program

Of all the reasons for getting out of bed in the morning, the chance to save a child’s life has to be one of the best. For John Craddock, MD​, (pictured on right; Deb Southworth, John Craddock and Rebecca Coughlin) this is not just hyperbole. He works as a hematologist-oncologist for the Pediatric Bone Marrow Transplant Program at Children’s Hospital Colorado, the last resort for children with blood disorders whose previous therapies have failed.

The program at Children’s Hospital Colorado has been running since 1994, and performs 50–60 transplants each year. However, in late 2013 Dr. Craddock discovered a flaw in their process: several of their patients were being discharged in a hurry, and leaving the hospital unprepared for the transition home.

“Sometimes patients can improve very rapidly,” Dr. Craddock said. “One day we might think they need another week to recover, but the next they might be ready to go home. This can be a problem if our team has little time to prepare the patient for discharge.”

Before a patient can leave the hospital Dr. Craddock and his team need to perform a variety of tasks, including gathering medications, educating the patient and their family on how and when to take them, performing social work assessments and discussing home preparation, diet and line care.

“Our team was completing all of these tasks, but it wasn’t fair to them or the patients’ families, who were bombarded with lots of critical information at the last minute, with little chance to practice or ask questions.”

Developing a Solution

As part of the Institute for Healthcare Quality, Safety & Efficiency (IHQSE​) Certificate Training Program, Dr. Craddock began to develop a new patient-discharge process, working with nurse educator Deb Southworth, BSN, RN, CPON, and performance improvement specialist Rebecca Coughlin.

“Essentially, we identified that we had a captive patient, unable to leave the hospital for several weeks,” Dr. Craddock said. “It made more sense to plan ahead and identify what tasks needed to be done for families before they go home, and develop a timescale.”

The new goal was for the patient to be prepared for discharge no later than three weeks after the transplant, as this is typically the minimum amount of time patients need to recover after an unrelated donor transplant. A new step in the discharge process was also created, called the “patient independence day”. This is a 24-hour period, usually just before discharge, when parents simulate being at home and giving their child medications while still in the hospital.

The results of the new process have been impressive, with patients and their families leaving the hospital more prepared for the challenges that come with transitioning from the hospital to the home.

“We reassess every quarter and have fine-tuned the project over the last few years,” Dr. Craddock said. “Our goal is to have 60% of patients prepared for discharge by the three-week mark, and we find we’re falling around that frame.”

Building Leadership Skills

Dan Hyman, MD​, chief quality and patient safety officer, said that Dr. Craddock and his team did an excellent job of identifying gaps in their discharge planning process.

“They were able to streamline and better organize the work of a multidisciplinary group of staff to better coordinate care and discharge for their extremely complex patients,” he said. “Dr. Craddock and his team utilized the lessons in leadership, teamwork and process improvement they learned from the IHQSE to accomplish their tremendous results.”

Dr. Craddock agrees that the IHQSE has been integral to his ability to lead the initiative, in addition to his strong background as a flight surgeon in the U.S. Navy and Marines.

“When people are good doctors, there’s an assumption that they’re good leaders,” he said. “But that is not always the case. Medical schools do not include leadership training, and residencies have leadership training only through a default of survival – on the job, late at night, when people are nervous and anxious.”

“Although I’m fortunate in that my military background means I’ve had some leadership training, it doesn’t mean that I’m always a great leader. The IHQSE teaches the importance of understanding the personalities in your group, and making sure that the people you are leading are guiding you, and guiding the project.”

The Recipe for Success

This ethos was put into practice with the patient discharge project when Dr. Craddock, Southworth and Coughlin developed a committee to advise on the initiative. They elected to include a parent on the team, which Dr. Craddock acknowledges can sometimes be a risky decision.

“Parents’ suggestions are always very powerful,” he said. “It was our parent member who suggested the patient independence day, for example. But our team wants to make every suggestion happen, to make sure parents feel valued. This can sometimes come at the expense of the intended direction of the committee.”

Dr. Craddock explains that this is why good leadership is important. “While it is important for the committee members to guide the direction of the project, leaders need to prioritize and make sure the ship stays on course,” he said. “When you unite the official leaders on your team with the ‘unofficial’ leaders – those who are respected but who may not have a title behind their name – that’s when your committee will achieve its objectives.”