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Lean health care

Nancy Yu, MD, CPE, Sr. Regional Medical Director, Southwest Medical Associates

OptumCare Mountain West Region

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Health care providers across the country are feeling the strain of mounting responsibilities and dwindling time. With the desire to give patients the best care, clinicians are looking to new management strategies. 

At Southwest Medical Associates, part of OptumCare®, Lean management is working to cut waste, ensure consistent care, and give patients and providers what means the most to them: time.

History of Lean

Lean methodology is helping health care administrators and providers improve quality and efficiency. Adapted from the auto industry giant Toyota, this management philosophy was brought to health care in 2002 by Virginia Mason Hospital in Seattle, WA.

Using the principles of Lean, including cutting waste and defining standard work, the hospital dramatically reduced ventilator associated events. This garnered interest from stakeholders throughout health care.

Pieces of Lean

The most powerful principle of Lean is simple: Use the patient perspective. In the name of improved patient care, workers step outside of their roles and think of their work as a part of a whole. 

The patient may move from checking in and waiting, to rooming and waiting, to seeing the doctor and waiting and finally to checking out. When staff can see all phases of a clinic visit together it becomes clear that reducing time waiting would improve the patient’s experience. 

With this knowledge, they can begin to innovate.

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Value stream mapping gives a visual representation of the entire workflow of a department or clinic, from the time the patient enters to the moment they leave. 

Once complete, the map is analyzed for waste. The map of time and material waste is a powerful visual, and the first step in refining the clinic’s processes.

In Lean processes, each employee role is defined by standard work. After studying the patient flow, this set of tasks is created by the staff member who will be carrying them out. 

For example, to create the standard work protocol for rooming a patient, the medical assistant (MA) compiles a list of to-be-completed tasks. They observe the rooming process, searching for gaps and redundancies. Medical assistant input guides the profile for the work of rooming. 

Once standardized, rooming a patient becomes an optimized and consistent experience. Patients spend less time waiting, and more time with their doctor.

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Improvement is a journey, not a destination 

Because Lean insists on cultural change, the pace of adoption is time and resource intensive. Assessment showing where there is waste of time and resources is a convincing way to start. 

Revealing gains that can be made by cutting waste and standardizing practices earns buy-in from management and staff. To analyze the impact, it is important to assess metrics both before and after improvements are made. 

With wins, momentum builds. Standard work is developed and deployed. Management stays active by following daily metrics and responding immediately to issues with a root cause analysis (RCA). When the culture starts to shift, the improvement work becomes a part of the day-to-day fabric.  

Investments and returns

Leadership makes a significant investment by taking workers, from administrative staff to surgeons, offline for a period of days to allow them to observe and get the perspective shift needed to come back with improvement strategies. 

This time out of work is a leap of faith. Experience shows leadership will get a return on this investment inside of a year.

The OptumCare experience with Lean management has been positive and continues to grow. Throughput on services is up, with a Computed Tomography (CT) department now providing an added five CTs per day. 

Providers and patients are pleased with the additional time afforded to them for direct patient care. Employee engagement and satisfaction improves as their expertise is leveraged for bettering the workplace. 

Providers are going home without additional hours of work to be done. Centers for Medicare and Medicaid Services (CMS) star ratings have risen from a 3.5 in 2011 to a 4.5 in 2017.

Life in the health care landscape with its constant changes and endless challenges can be difficult. Adopting the culture of Lean prepares health care systems to accept the challenge and continuously improve.  Lean management is not a quick fix solution, it is a complete workplace shift. 

This long-term, adaptive strategy allows a health care organization to run efficiently and provide quality patient experience while absorbing changing standards, science, and regulatory requirements. A responsive culture of Lean is a key to success in health care’s changing landscape.

The views and opinions expressed herein are those of the authors and do not necessarily represent the views of OptumCare. The views and opinions expressed may change without notice. 

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