The Everett Clinic has adopted the principles of "lean management," which originate from the Toyota Production System. Both manufacturing and healthcare involve complex production processes. In healthcare, these include admitting a patient, conducting a clinic visit or performing surgery. The lean management method helps workers eliminate mistakes, reduce delays, lower costs and improve the overall quality of care.
Implementation of lean processes also facilitates the continuous identification and elimination of waste, such as duplicate labs tests and forms. Lean concepts can improve the flow of patients through the clinic and reveal points that slow the workflow.
When lean management processes are successfully applied in a clinic setting, patients benefit from greater safety, less delay in receiving care, and more timely results and treatments. Staff benefit by having less rework and greater opportunities to care for patients.
Altogether, the lean management system aims to better understand and exceed our valued customer’s (patient’s) needs. We strive to raise the bar in the areas of patient satisfaction, quality and safety, cost effectiveness, secure future and staff satisfaction.
Diabetes
Every month, 55 Clinic patients are diagnosed with diabetes. Nine out of 10 will attend a diabetes class to learn more about their disease. But at the follow-up class, only two out of 10 show up. Lean management was used to develop a possible solution: the Diabetes Clinical Care Pathway, which identifies new diabetes patients and guides them through the care they need. A care manager now coordinates regular communication with a patient for one year after the diabetes diagnosis, so no one "falls through the cracks."
Clinic-to-Hospital Transitions
The process of admitting a patient to the hospital is most smooth when there are few "handoffs" or stops along the way. Staff are working to make sure the reason for hospitalization is clear for every patient, which will allow a patient to leave a Clinic facility and check into a hospital bed with no stops in between, and with just one phone call needed on the part of Clinic staff.
Prescriptions
The Everett Clinic's Everett campus pharmacy staff examined the process for refilling a prescription and discovered that a revised process could eliminate many steps. Through a workflow redesign and the creation of standard work processes, the number of steps to refill a prescription was cut from 26 to 12, which translates into faster turnaround, fewer opportunities for error and decreased costs to refill a prescription.
Patient Satisfaction
Cancer Partnership staff evaluated their processes to improve the phone triage center where nurses answer patient calls. Until recently, nurses handled many additional tasks, which took them away from patient care and extended their workday. Now, nurses' time is more focused thanks to standardized work processes, a more efficient phone system, and redefined roles for medical assistants. Patients are now more likely to reach a person rather than voicemail and hold-times are shorter. Patient and staff satisfaction are both improved.
Reducing Paperwork
The Occupational Medicine department completed a project to reduce the amount of paperwork and time involved in worker’s compensation claims. The team identified steps in their process that slow work and add costs for L&I partners. The group developed standard processes and templates to reduce duplicated work and extra steps, and now can . process 80 percent of forms in just two days, rather than several weeks.
Reporting Problems
Lean tools were used to reduce steps and barriers involved in making a complaint about patient care and satisfaction. A formerly long and detailed form was reduced to a few questions and made available online. The new form is in testing as part of a pilot program.
Accountable Care
The lean principles have been applied to design an Accountable Care Coordination pilot, which will allow enrolled patients to connect to a care team that includes a dedicated RN care manager and a supervising physician. Each patient will receive a comprehensive intake interview, physical exam and diagnostic testing. A care plan will then be developed in partnership with the patient. It will be executed through intensive in-person, telephone and email contacts, similar to the Boeing Intensive Outpatient Care Program.
Organized Vaccine Storage
The Everett Clinic's vaccine refrigerators need to remain carefully organized to avoid errors involving incorrect vaccine or dose. A lean team implemented a system of color coding and picture labels to help categorize stored items. The system will be implemented in refrigerators at all Everett Clinic facilities so the system will be consistent and familiar to staff, no matter where they are working.