lean process engineering in small practices
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Lean Process Engineering in Small Practices. Masspro Joseph Holtschlag, Manager, DOQ-IT Harvard Quality Colloquium Aug 20, 2007. Session Overview. Small practices don’t need workflow redesign as much as they need management redesign - PowerPoint PPT PresentationTRANSCRIPT
Lean Process Engineering in Small
PracticesMasspro
Joseph Holtschlag, Manager, DOQ-IT
Harvard Quality Colloquium Aug 20, 2007
Small practices don’t need workflow redesign as much as they need management redesign
Addressing management and culture issues will achieve Lean goals
Small practices can make dramatic changes faster than larger groups, creating patient-centered, efficient, effective care providers
Session Overview
Masspro
Federally designated Quality Improvement Organization for Massachusetts
Quality improvement projects in home health, ambulatory, and hospital settings
DOQ-IT Project Funded by Centers for Medicaid and Medicare
Services in April 2004 Established to support and assist the adoption and use
of EHRs in small and medium-sized primary care practices
Gained experience by working with 318 practices across MA
What is a Small Practice?
1-3 providers (MD, PA, NP) 3-10 additional staff
Administrative support Medical assistants
Some support from hospital Membership in IPA/PHO Characteristics
Personal relationships with patients
Affiliations tend to be loose Focused on quality of visit Under-resourced
IterativeIndependent
UncertainReactive
Current State of Small Practices Wasteful, leaky
Under-utilized people› Set job definitions› Little empowerment, trust, incentive
Waiting› Wait until work arrives› Interruptions
Over-processing› Double checks on many tasks
Unnecessary movement› Looking for information› Paper storage, routing of information
Current State of Small Practices
Care that is:EfficientEffective
Patient-centered
IterativeIndependent
UncertainReactive
Small Practices and Lean Methodology
Small practices challenge the definition and application of Lean
If Lean means… process redesign committee formal documentation staff trained in Lean methodology
Then Lean will not find a willing audience If Lean means…
eliminating waste utilizing staff more effectively reducing over-processing decreasing waiting and interruptions
Then small practices are interested
How to Change
Catapult of EHR Project Leadership
Teams
Measurement
Combine to achieve Lean goals:eliminate wasteutilize staff more effectivelyreduce over-processingdecrease waiting and interruptions
Current State of Small Practices EHR is the catalyst for change
The nature of paper is wasteful No matter how hard the practice works in paper, services
and operations will never be coordinated Compelling quality and efficiency arguments have been
made for electronic health records (EHR) Incentives for adoption
Successful installation requires improvements in operations and management
Empower Through Leadership
Leadership Develop someone who can set a mission for the
practice› Physicians lead changes, develop clinical vision› Office manager responsible for operations, finance
Give practice tools to make it happen› Guide practice through the project charter development› Provide structure for staff meetings› Develop standards for management
Educate on EHR project management› Show decision points› Expand possibilities› Make a case for benefits of project management
Empower Through Teams
Teams Change the preconceptions of what people can do
› Cross-train tasks› Expand clinically-significant roles› Fit the people to the job responsibilities
Engender trust through training› Physician leadership in clinically significant training› Develop subject matter experts to train fellow staff
members Distribute responsibility
› Ask individuals to tackle problems in their area› Give them the power to make changes to their job and
the responsibility to make changes work
Empower Through Measurement Measurement
Practice leaders needs to know that:› Standards of care are being met› Expanded responsibilities are meeting goals› Judgments and decisions are objective
“Can’t manage what you can’t measure” Matching improvement efforts to objective information
› Quality› Operational› Financial› Patient satisfaction
Final step in improving practice communications
Results
Waste becomes everyone’s responsibility Efficient movement
› EHR reduces movement› Staff empowered to find better solutions
Using staff to potential› Healthcare providers Leaders, managers, mentors› Clinical support Patient care team› Secretaries Customer relations
Less waiting and interruptions› Better understanding of responsibilities› More cross-training› Proactive, predictive
Addressing the management and culture issues of small practices will achieve Lean goals
eliminating waste utilizing staff more effectively reducing over-processing decrease waiting and interruptions
High velocity of change in small practices leads to rapid improvements in quality and efficiency
Communication is fast Dynamic nature of EHR makes continuous change a way of
life Lean practice allows quality and efficiency improvements
without bureaucratic impediments Small practices are ideally suited to delivering patient-centered,
efficient, effective care
Session Conclusions
