Lean RIE at Northeast Heights

The Saskatoon Health Region and the University of Michigan examples of Lean processes show organizations that are far along in their implementation of this process improvement philosophy.  Others are earlier in the cycle of learning about Lean and trying it out in their organizations.  In such cases, the first exposure many people get to Lean is through rapid improvement events.  When an REI occurs, a team of people who work in a given area of a hospital or clinic get together and explore a set of functions for which they would like to reduce waste and bring better value to the customers and staff.  Then, they construct a process map of the given functions and explore ways to improve them.

I attended part of such a session today at the Northeast Heights Clinic, an ambulatory branch of the UNM Health Sciences Center.  There, Lean program manager Yvette Sena was leading the group in an exercise designed to reduce patients' waiting times after they check in with the front desk staff.  She was also explaining how to translate proposed changes into a PDSA (plan-do-study-act) cycle.  As noted here by IHI, "The PDSA cycle is shorthand for testing a change by developing a plan to test the change (Plan), carrying out the test (Do), observing and learning from the consequences (Study), and determining what modifications should be made to the test (Act)."

Standardizing clinical variation is another aspect of the Lean process.  Nurse practitioner Allyson Royer was keen on reducing variation in clinical practice related to the supplies included in injection trays.  She came up with this prototype which she planned to show to other NPs throughout the clinic to create an agreement that might then result in a standard set of supplies.

Earlier in the session, the staff members were coming to a consensus about a redistribution of certain tasks from medical assistants to front desk staff.  You see a bit of the discussion in the video below.  I have found this to be a common learning step in Lean RIEs.  One group, here the MAs, determine that certain tasks are not critical to their functions and seek to have others take on those tasks.  This is all right, but it is not really an increase in overall efficiency.  As you can imagine, it can also create resentment.  (Here, that was not the case.)  As groups get more sophisticated in their analyses, they are able to dig in deeper and determine which portions of their work flow are value-added versus non-value-added from the point of view of the customers.  Then, they go through the PDSA process and experiment with new work designs based on that point of view.

If you cannot see the video, click here.