Judy Worth talks about her work

In my previous post on this page, I promised to update our readers on the results of the Emergency Room Lean Collaborative offered in partnership with the Lean Transformations Group and the Michigan Hospital Association’s Keystone Center for Patient Safety and Quality.  Sixty-two hospitals completed the Lean portion of the collaborative and reported their project results to the entire group last December.  While the focus of the collaborative was improving Length of Stay in the ER, many of the participants found the enhanced communication and teamwork inside the ER and flowing out to units in the hospital, the lab, radiology and emergency medical services to be equally valuable.  I won’t give more specifics here as we are currently preparing an article about that experience for submission to a referee journal and I need to withhold that information for a little longer.

At the conclusion of the ER collaborative, I spent the next 8 months working in another collaborative.  This one involved 19 primary care practices in the state of Michigan.  At the time they entered the collaborative, each practice had begun work toward designation as a Patient Centered Medical Home (PCMH), focusing their efforts around one of four tracks:  preventive care, chronic disease care (asthma or diabetes), and office flow.  The collaborative itself was designed to demonstrate how to apply Lean thinking and tools to the work of achieving PCMH certification.

At the conclusion of the Collaborative most of the teams had measurable results related to their area of focus.  Here’s a sampling of what they reported:

  • The percentage of patients receiving diabetic foot exams during office visits in one practice increased from 8% to 67%.
  • Phone interruptions dropped by 67%, improving patient care and reducing risk of forgetting patient needs and key information.
  • Layout changes in the physical space save each physician 20 minutes per day of walking.
  • Patient charts are 100% complete and accurate for the physician when entering the exam room.
  • Daily huddles support sustaining gains and problem solving.
  • Total average Length of Stay was reduced from 90 minutes (average) to 59 minutes in one practice and from 56 minutes to 36 in a pediatric practice.

In response to the question, what did they find most valuable about the collaborative, here is what we heard:

  1. selecting specific goals with clearly defined metrics;
  2. developing a detailed action plan to achieve each goal with the following information:  who is responsible for each goal and each action item, who will provide support for each, due dates, etc.;
  3. learning a methodology to make progress (and problems) visible as the project unfolds and figuring out ways to get back on track;
  4. using Lean tools to make standard work and other important information visible;
  5. using daily short huddles and regular Improvement Team meetings to align people working in the practice (front and back) toward common goals and improve communication.

The most gratifying reports from my perspective were those that highlighted enhanced teamwork, improved communication and better patient care.   Life’s too short to spend 8 or more hours a day working where people don’t get along.  If Lean collaboratives can improve the quality and safety of care delivered and make the work environment more productive and more satisfying, I think that’s a good investment of my time and energy.