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Transcript of An Approach to Sustaining Lean in Primary Care Clinics An Analysis Using the LEI Lean Transformation...
1
An Approach to Sustaining
Lean in Primary Care Clinics
An Analysis Using the
LEI Lean Transformation Model
Katrina Appell, Ph.D.
Lean Coach, Lean for Clinical Redesign CQI
University of Michigan Health System
3BCBSM Value Partnerships & Physician
Group Incentive Program
• Value Partnerships (2005)
– Collection of patient safety, clinical quality, and care process efforts that
makes health care work better in Michigan
• Collaboration between Michigan physicians, hospitals and Blue Cross Blue
Shield of Michigan
• Physician Group Incentive Program (2005)
– Encourage and incentivize physicians to more effectively manage
populations of patients and build an infrastructure to more robustly
measure and monitor care quality
– 40+ physician organizations
• 19,000+ primary care and specialist physicians
• Collaborate on initiatives to improve care
3
4
1. Clinics need support to become Patient Centered Medical
Homes (2009)
2. Improvement efforts were not spreading and had
inconsistent sustainment within Physician Organizations
(2013)
What problem(s) are we trying to solve?
Hypothesis - For sustainment we need to:
• Develop problem solving skills within physician organization
• Develop clinic managers to coach their teams to solve
problems
• Develop physician organization coaches to support the work
in additional clinics
What is the underlying philosophy or thinking
that enables the transformation effort?
Future / Target
Facts
Current
Vision
Learning grounded inContinuous Improvement and Respect
What is the underlying philosophy or thinking
that enables the transformation effort?
Change = D * V * F > R1
DESIRE FOR
CHANGE
• Dissatisfaction with the current state
• Willingness to learn a better way
VISION• What we want to create or achieve together
FIRST STEPS• What we are going to do to learn and
improve towards our vision
RESISTANCE• Resistance is a sign that you have touched
on something valuable2
• Surface, understand, and respect resistance
1 Developed by Kathleen Dannemiller2 Adapted from Flawless Consulting by Peter Block
What is the underlying philosophy or thinking
that enables the transformation effort?
8
Characteristics of Readiness
Ready
Yes No
Stability:
● Business
● Staff
● Leadership
Commitment and willingness to learn & change:
● Leadership
● Lean Coaches
● Clinic Team
Lean coaches capable of success:
Foundational characteristics:
● Temperament (patience & humility)
● Emotional intelligence
● Understanding of role
● Core beliefs (continuous change vs. control)
What role is leadership taking?
Supporting the clinics to be successful (Evidence-based Readiness)
9What role is leadership taking?
Developing Leaders as Coaches:
PDSA Coaching Sessions
10
Foundational Learning
What capability development is taking place?
11
What capability development is taking place?
And team (learners too!)
Learner (Practice Manager)/Practice Coach
(always learning)
Learner /Physician Organization Coach
(always learning)
Lean for Clinical Redesign Coach
(always learning)
Cycle 1 2 3PO Coach Observe Partner Lead
12What actual, operational improvements were
implemented to engage the entire clinic?
Socialize/Validate:
• Value Stream Map
• Understand the Situation
• Problem Definition
• PDSA Cycles
Daily at Huddles:
Share Problem Solving
13What actual, operational improvements were
implemented to create habits and routines to
support the culture?
Weekly:
• PDSA Session at Lean Daily Management Board
– Dedicated problem solving time
Monthly:
• Learning Collaborative
– Learning across
clinics
What actual, operational improvements were
implemented?Problems and Improvements from Bronson Medical Group
Mammogram Completion Rate – Bronson Internal Medicine Oshtemo
Implemented Chart Prep &
Mini Huddle Standard Work
Accurate Demographics – Bronson Rambling Road Pediatrics
Appointments Created Bronson Rambling Road Pediatrics
73% 85%
Standard Work for verifying
demographics at every point of contact50% 93%
Implemented Standard Agenda
Mini-Huddle745 in 2014
Tota
l B
usi
nes
s R
esult
s fr
om
Lea
n T
ransf
orm
atio
n
Starting out Maturing
Maturity in Integrating Lean and Business Strategy
I. Apply Tools II. Management Led Lean
III. Aligned
Continuous Improvement
Without Philosophy
With Philosophy
Used with Permission: The Toyota Way to Continuous Improvement (2011 Liker and Franz)
Results as Lean Evolves to Aligned
Continuous Improvement