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Implementation Challenges in Using Lean Techniques

Discover the implementation challenges faced while using Lean techniques at POMs College of Healthcare Operations Management. Learn how they overcame these challenges to become a proactive and adaptive organization with excellent patient results.

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Implementation Challenges in Using Lean Techniques

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  1. Implementation Challenges in Using Lean Techniques POMs College of Healthcare Operations Management MINI-conference Thursday May 6, 2010 Mimi Falbo DNP,RN

  2. Introductions

  3. My collaborators • A faith-based Federally Qualified Health Center (FQHC) with two locations • Strategic plan demands “Nimble Structure” • Use Toyota/Lean Principles to become a proactive, adaptive organization with excellent patient results

  4. Who We Serve • Large inner city community • 86% minority • Health Disparities • Medicare, Medicaid and self-insured

  5. How We Started • Health Disparities Collaborative • Seven person team • Working to improve diabetic outcomes as part of a National initiative • Used Lean tools to change processes • Activity stayed confined to the health disparities team

  6. Defining the problem:The executive director says • The leaders all went to class • I even went for a whole week! • That Health Disparities Team is doing all kinds of great things • Why isn’t anyone else picking up and doing this?

  7. Defining the problem:The front desk clerks say • I can’t believe they designed this encounter form this way! How do they expect us to do our job? • No-one listens to us! Things never change around here.

  8. Defining the problem: Health Disparities clinician says • These people are going to drive me crazy! • I can’t do this by myself!

  9. Their description of the PROBLEM • The method isn’t spreading! • No trickle down, no grass roots up.

  10. Current condition • The Health Disparities Team is working well with a portion of the diabetic patients • Several physicians, nurses, other staff, and the executive director have gone to a four day class. • Other staff members are not engaged

  11. Understanding the current condition: Looking for an answer Literature review • Organizational culture • Healthy work environment • Magnet hospitals • Change theory • Adult learning principles • Learning organizations • Coaching

  12. Root cause Incongruence with Toyota implementation • Culture • Infrastructure • Skill sets

  13. Target condition A “Nimble Structure” that empowers Board and staff members to act quickly to: • Identify problems, test solutions • Systematically spread new tools across the organization. Commitment to become a “learning organization”

  14. Action plan • One-day customized training for the entire staff (60 participants) • Start 5 Lean Teams • Every staff member on a team • Team meetings started the following morning, then twice a month • Coaching available at each meeting

  15. Action plan, Part 2 • Training and coaching at the executive advisory meeting weekly • Team includes all executives, managers and a representative from each discipline at the center.

  16. Subjects covered • Toyota/Lean skills and principles • Senge’s 5 disciplines • Team building • Coaching • Change management

  17. Our change model

  18. Initial Team Focus • Health Disparities Collaborative • Whole Person Health • Scheduling and Recruiting • IT • New Space • Patient Care Model

  19. Measurement Each team measured according to focus Overall center outcomes monitored

  20. Result highlights • Open access scheduling • Decreased no-shows from 40% to 12% • Increased productivity by 33% • New space initiative • Eliminated medical record storage providing adjacent work space for teams • Developed facilities plans for expansion for federal stimulus grant over two weeks

  21. Result Highlights Note: Space needs are calculated on the number of practitioners. Several positions were vacant during 2008 causing the calculation to show a need for less space in spite of an increase in volume.

  22. Visit Volumes climbed Number of unduplicated individual users of the center climbed All of this was managed in spite of the loss of two primary care practitioners Result Highlights

  23. Refining the open access schedule One day new space kaizen Redesign of front desk work Redesign of phone system Current experimentation with models to improve flow and optimize physician time Work leveling-adding time to the schedule Redoing the billing system Latest Developments

  24. Patient Responsibility Billing and Collections Call Center AC Work Design New Teams

  25. Summary Rapid progress and transformation possible with: • Dedicated team focusing on creating changes • Highly specified comprehensive plan • Excellent and focused leadership • Continuous input from all participants • Engagement of the entire organization • Coaching available to help people and teams learn new skills and navigate change

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