6 steps for implement lean

This practical, how-to book clearly and succinctly takes the reader through six proven “success steps” for implementing lean in any healthcare environment:
1. Create physician flow
2. Support physician value-added time
3. Visually communicate patient status
4. Standardize everyone’s work
5. Lay out the clinic for minimal motion
6. Change the care delivery model
Why go through such a transformation? Because it works. Tell a doctor that he can see the same number of patients, offering the same high quality and personal care, and have an extra 90 minutes at the end of his clinic day – and that means something. Tell the staff that they can look forward to actually ending on time, with satisfied patients, no backlog, and having focused their attention completely on quality patient care – and they will listen.
These Lean principles and success steps work in clinics ranging from orthopedics to neurology to cardiac care—the specialty doesn’t matter. They work in small practices and large hospital settings. Lean methodology provides the tools to address the frustrations patients and doctors alike experience in the clinic process.
Included throughout the book is a case study showing the lean transformation undertaken at the Orthopedic Center at Children’s Hospital of Wisconsin, with numerous quotes and insights from those actually involved. This transformation resulted in patient wait times being reduced by more than 70 percent, the clinic being able to see 25 percent more patients in less space, patient satisfaction scores sometimes reaching 100 percent, and staff satisfaction scores improving by more than 25 percent.
1. Create physician flow: This centers on the idea of the physician as a “shared resource”—a pacemaker in the process—who should never have down time due to missing information or lack of clear priorities. Everything except the physician’s consultation with the patient is essentially changeover and should be done as
efficiently as possible to set the doctor up for the best possible patient interaction.

2. Support physician value-added time: In order for the physician to maintain a state of flow and not experience undue downtime, she needs a high level of coordination of clinic processes. This step calls for the creation of a team leader position, whose primary responsibility is to make sure the doctor’s time is used effectively.
The team leader is usually a nurse who has leadership potential; the duties include tracking the status of each patient and “driving the bus” to direct the clinic.

3. Visually communicate patient status: Visual communication is the Lean concept of using visible markers, signals, and signs to communicate the status of a given process so that anyone walking into the work
environment can tell what’s in process, what’s working, and where the problems are. With this step, I describe a seemingly simple, powerful tool in the clinic setting: the Patient Status Whiteboard.

4. Standardize everyone’s work: Standard work is a tool of Lean that provides process stability and a mechanism for formal process improvement. In this step the care team creates standard work for their processes to find immediate improvement opportunities, achieve predictable outcomes, and clarify their roles in the care process. Creating standard work also formalizes changes made so far and helps the Lean system become an integral part of the practice’s culture.

5. Lay out the clinic for minimal motion: This step focuses on examining how to change the physical layout of a clinic or other healthcare environment to improve patient flow and staff communication. It uses the tools of spaghetti mapping and 5S to look at individual workstations, and discusses the flow of care and communication throughout the clinic. Some of the Lean improvements discussed here are simple ones: creating supply and material carts, moving commonly used forms and supplies inside the exam rooms, organizing paperwork at the front desk, and establishing “pull” by creating a kanban card system. Architectural improvements, such as U-shaped cell designs, help develop an enhanced team space to improve patient safety, staff communication, and patient handoffs.

6. Change the care delivery model: This means rethinking the clinic processes to focus relentlessly on patient flow. The idea of focusing on flow is central to Lean, because organizing work in departments simply does not work. Support departments—such as radiology, casting, physical therapy, labs, echo, and pharmacy—should be rethought and broken into decentralized mini-departments, where feasible. The previous steps—managing the physician’s time, visually controlling patient status, standardizing the individual tasks in the care process—lay a stable foundation so that larger process changes do not create chaos.

Autores: Aneesh Suneja with Carolyn Suneja
Lean Doctors A Bold and Practical Guide to Using Lean Principles to Transform Healthcare Systems,One Doctor at a Time , ASQ Quality Press Milwaukee, Wisconsin