Henry Ford Medical Group Primary Care Lean Experience

“The Journey and Destination” March 12, 2010

Suma Sukumaran

The Journey

History of LEAN With Primary Care

2007 Advanced Medical Home Workshop– Sponsored by BCBSM as part of PGIP– Goal: Apply Lean management techniques to

re-engineering clinic practice with special regard to the care of patients with chronic conditions

– Facilitated by consultants from LEAN Transformations Group (from U of M)

The Workshop

Taylor and K-15 Pilot Sites

4 days (7/23 – 7/26)

6 hours each day from 12p-6p

Each clinic created their own current state map

Together they created a single future state map with a 90-day action plan

Workshop Outcomes

Pilot Sites at Taylor & K-15– Pilots continue and are expanding to more sites– Process refinements continue as new concepts

are introduced

BCBSM Lean CQI Initiative

2009 Primary care chooses to participate in additional BCBSM Lean CQI Initiatives

Three LEAN Workshops would be sponsored (two have been completed)

Training five coaches to be LEAN Workshop Facilitators (in addition to their role within the CCD dept.)

2009 eTEF Lean Workshop

1st 3 Day workshop (4/21 - 4/23)

5 Clinics + Contact Center– DNW (site not supported by Contact Center)– K15 (MH Pilot Site)– Taylor (MH Pilot Site)– Troy (MH Pilot Site)– Southland

2009 eTEF Lean Workshop

Issues / Problems (as Identified in Scoping Session)

– Too many messages with unclear purpose that cannot be resolved or take too long to resolve

– Too many handoffs– Consuming too many resources/time– Unhappy customers/patients– Too many repeat calls

Outcomes From Workshop

Improved relationship between clinics and contact center

Contact Center advocates gaining access to clinic workgroup inboxes

Clarifying / Expanding Contact Center Advocates' role

– read normal test result letters to caller– advise patients of denied script refill

Still working on the project

Learnings from Workshop

Workshop participants need preparation before Kaizen event

Easier to have small scope with less clinics involved

Set ground rules early in workshop – everyone needs to respect each other’s opinions

Need to step back and engage leadership to transform culture

Learnings From Workshop

Workshop participants need preparation before Kaizen event

Easier to have small scope with less clinics involved

Set ground rules early in workshop – everyone needs to respect each other’s opinions

Need to step back and engage leadership to transform culture

Learnings From Workshop

Workshop participants need preparation before Kaizen event

Easier to have small scope with less clinics involved

Set ground rules early in workshop – everyone needs to respect each other’s opinions

Need to step back and engage leadership to transform culture

Engaging Leadership

Getting key physician leadership buy-in

September 2009 - 1 day LEAN Bootcamp with all Primary Care leaders (physicians & support staff)– Exposure to LEAN tools & concepts– Identified “what they think needs to be

improved”– Next Lean Workshop topic chosen

November 2009 - 5S contest announced– Get people to try the tools– Staff would see immediate results

February 2010 – Clinic Discharge Process Workshop– Lakeside Peds, Canton & Hamtramck

What we did different this time– More prep for participants – held Lunch n’

Learns at each site– Smaller – scope & number of clinics participating– Set ground rules early in workshop– Went to clinics on Day 2 for

observations/discussions with co-workers not involved in workshop

January 2010 – 5S Contest

– People picked what they wanted to work on– Incorporated fun & competition

What we learned

– Keep it simple - feedback has been to teach them 1 way to do process improvement that works and nothing more

– Give time to apply or practice the tools as they learn them - want real life experience trying them out with opportunity to discuss outcomes

– Keep leaders involved and accountable to help drive it

5S Contest Winner

Japanese Housekeeping atSterling Heights –

Pediatrics 

5S contestHenry Ford Medical Group

Sterling Heights Pediatric Staff

Project Goals

Work together on a team project

Do a 5 S audit on the South Nurse’s Station 

Have Nurse’s station ready for Vascular Lab by 1/4/2010

Win the prize for our site!!

The origin of 5SThe Japanese concept for HousekeepingThe Japanese concept for Housekeeping

1.) Sort (Seiri) – put things in order 2.) Straighten (Seiton) ‐ proper arrangement

3.) Shine (Seiso) ‐

clean

4.) Standardize (Seiketsu) – perpetual cleaning 5.) Sustain (Shitsuke) – commitment/habit 

The secret to LEAN?       

Eureka!!!

Before

Before 

Before

Team/ResourcesResources allocated to this projectPeople

Andrea Coleman MA I,  A Hang Dipko MA II, Bobbi Dwornick RN Supervisor, Melissa Piotrowski MA II,  Theresa RidingsSecretary III,  Dr. Francisca Soliven and Julia VanTorre CSR IIEquipment

Digital Camera, Cart w/ wheels,  hand truck and      cleaning wipesSupport services

Maintenance and Housekeeping staff

What did we learn?

0

51015202530354045

Use Move Store Discard

Results

Results

Results 

Examples

Sort – 48 hour rule 

Straighten

–

Vascular Lab, Residents and Support Staff now have designated work areas they “own”

Shine – Area free of dust and cleaning materials are easily accessible 

ExamplesStandardize – Each work group does a 3 S daily to their work area.  Common duties have been assigned.

Sustain – Weekly 5 S tour assigned.(Assignment rotated among staff)

Safety – SMDA posted,  all equipment calibrated and no cords in walk path

The 10 Commandments of ImprovementOur CommitmentOur Commitment1. ABANDON fixed ideas2. THINK of ways to make it possible3. NO excuses needed4. Go for the SIMPLE solution, not the perfect one5. CORRECT mistakes right away6. Use your WITS, not your wallet7. Problems are OPPORTUNITIES8. Repeat WHY? Five times9. Seek ideas from many PEOPLE10. There is NO END to improvement

Gamba Research

Sterling HeightsPediatrics 5S Team

The Destination

Where We Are Going

January - Primary Care Leaders learned a new tool (A3) and contest announced to get staff to use the tool– One known project is to reduce labor and supply

costs involved in the printing and hand-collating of OMR and Green service memo forms (billing sheets for charges)

May 2010 – A3 Contest will be conducted– Learn new tool – Standard Work– Announce new Contest

Where We Are Going

Incremental learning/trying– Continue to roll-out tools one at a time– Celebrate successes– Identify physician and support staff

“champions” to help lead efforts

Continue large, Kaizen events

Encourage & support more advanced training

Change the culture - help people see that they can make work better for themselves and our patients

Questions From The Group