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From streamlining flu vaccinations to improving the discharge time for patients, the participants in last fall’s Lean Practitioner program have come up with an array of new efficiencies for Brigham and Women’s/Faulkner Hospital.
The eighth class to take part in the program presented their plans at a graduation ceremony Jan. 6. Eleven teams from primary care centers in the BW/F network outlined their improvement projects and the detailed solutions they devised. John Rossi, who coordinates the program, and said the most recent round focused on primary care.
“Two hundred people at the Brigham have gone through this program since 2008,” said Rossi, senior consultant in the Center for Clinical Excellence (CCE). “This time, we had 29 members focused on one particular area.”
Joe Frolkis, MD, PhD, vice chair of Primary Care, said the projects were part of a Leadership Development curriculum that had been designed in close coordination with the CCE in order to foster skills necessary to realize the goals of Primary Care’s strategic plan.
“Lean demonstrates that circumscribed, doable, real-world projects are the building blocks of performance improvement and care redesign, and that once one has learned these tools, they can be applied to a wide range of situations to improve patient care, efficiency, and both clinical and financial outcomes,” he said.
Frolkis added that the projects were also highly effective ways to engage the entire staff as the primary care practices move toward team-based care. A common theme throughout the processes was to assign appropriate tasks to non-physicians.
“It makes physicians more efficient and the rest of the staff more productive, energized and involved,” Frolkis said. “Lisa Whittemore (department administrator) and I have been struck by how these projects build enthusiasm and morale across the entire staff. We are lucky to have colleagues like those in CCE to help move this work forward.”
The Brookside Community Health Center team—Bob Hartley, MD, Guerly Laroche, RN, and Executive Director Paula McNichols—dealt with a challenge posed to patients and providers alike when it comes to tracking and completing forms. Laroche said the forms are often too broad, and different providers sometimes work with different processes.
“At least 50 types of forms are being used on a daily basis,” said Laroche at the graduation ceremony. “We sat with staff and discussed how things were going and the areas of dissatisfaction.”
The team of Reema Alshirawi, MD, and Lisa Reid, practice manager at Newton Corner, found when forms for tests at the Radiology Department are filled out, doctors weren’t always aware if the tests have been completed.
“We were concerned patients may miss clinically important tests,” said Alshirawi. “We devised a method of tracking all clinically important radiology orders generated in Newton Center and reaching out to patients who may have missed or not scheduled their appointments.”
When asked how the solutions generated by each team would be used, Rossi said he expects each team to sustain any gains it has made, at the least, and that many will build toward subsequent incremental change in the same area.
Other projects completed as part of this program included improving triage for non-urgent care patients, ensuring diabetic patients have follow-up appointments and improving the time it takes for patients to be ready for their visit. The Lean Practitioner program consists of teams of two to three leaders participating in four full-day courses over a four-month period. These leaders learn how to identify inefficiencies in their processes, as well as the tools to help diagnose and solve them. The program was created and sponsored by Sharon Vitti, vice president of Women’s Health and Ambulatory Services. She and Michael Gustafson, MD, MBA, chief operating officer at Faulkner Hospital helped create the program and remain actively engaged in it.
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