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Lean Performance Improvement

What is LEAN?  LEAN is a set of improvement tools used to identify waste, improve efficiency, and improve customer and employee satisfaction as well as safety and quality.  The cornerstone of LEAN is the customer—in the case of healthcare, the patient. 

 

In the fall of 2008, Baystate Health (BH) began its LEAN journey.  Key leaders and BH performance improvement professionals underwent LEAN training and began using LEAN tools in selected improvement projects.  Integral to this work was identification of value added and non-value added steps in processes to remove waste and improve efficiency.  LEAN is a journey not just a process, and our goal over the next few years is to spread the use of these tools.  A determining factor for success is input and engagement from frontline staff.  Frontline staff knows where inefficiencies and waste are in their processes and they are invaluable in identifying strategies for improvement.  LEAN education and culture will become part of the core educational content as well as one of the ways we improve processes and systems across BH entities.

 

In the fall of 2010, BH began working with Simpler Consulting with the focus on “Value Streams” at Baystate Medical Center.  Today there are total of 6 value streams conducting monthly Rapid Improvement Events (RIE).  The value streams are Sterile Processing Department (SPD), Hospital Medicine/Inpatient Care, and Revenue Capture and Women’s Service – Obstetrical Care, Observation Patient, and Access to Outpatient Care. These teams have made improvements in key processes, eliminated non-value added process steps, conducted 6S clean-ups (a workplace organization methodology that describes how items are stored and how the new order is maintained), and established new processes to improve communication between physicians and nurses.  

 

The “true north” metrics are focused around human development, quality, timeliness, cost, and growth.  A dedicated LEAN Conference Room has been established on Springfield 6 and dedicated LEAN coordinators provide support to this important initiative.  The Rapid Improvement Events, in addition to preparation and follow up work, take place in this space.  The spread of LEAN thinking will continue throughout the BH entities.

 

Future Work

In FY 2013, we continue to work on further development of internal infrastructure and spread of methodologies.  We are developing a more formal system to align our improvement work with our strategic objectives.  Ongoing improvements to our communications processes and more formal education and training opportunities will serve in helping us spread the Baystate Improvement System across Baystate Health.

 

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At Baystate Medical Center, LEAN work is focused on six Value Streams – SPD, Hospital Medicine/Inpatient Care, Revenue Capture, Women’s Service – obstetrical care, Observation Patient Flow, and Access to Outpatient Care.

 

  • The Hospital Medicine/Inpatient Care team has developed dedicated work space and processes for the Hospitalists on the two pilot floors – Springfield 1 & 3. Improvements in communication have been realized via standard work for paging physicians and standard work for hand-overs of care – physician to physician communication.  Standardization of discharge materials and expectations has improved the hand-over to post-acute care providers.
  • The SPD Team has focused on cleaning and organizing the SPD area using 6S tools.  They have realized improved workflow due to a more organized space.  This team has also revised the preference cards for procedures to make picking the instrumentation and products needed for the procedure more efficient.  Materials management and single flow process are the focus of this team to achieve zero defects.
  • The Revenue Capture group has implemented an electronic charge capture process in the ED which will streamline the coding process allowing for generation of a bill in a timelier manner.  This team has also established a new process for the collection of co-pays at points of entry to the organization and continues to spread this process through all entry points.  
  • Women’s Service – Obstetrical Care- This team has established and implemented a post-partum perfect care check-list and now provides patients with estimated time of discharge.  This has been a patient satisfier.
  • Wesson Women's Clinic team has focused on improving patient satisfaction and employee/provider satisfaction.  Efforts are focused around developing standard work and reducing patient wait times in the office. 
  • Observation Patients – This team has established new processes for identification of observation patients in the ED and implementation of care in a more timely manner. 
  • Access to Outpatient Care- this team has focused on scheduling and panel sizes in order to improve access to BMP practices and provide more timely care.  This team is also focusing on improved efficiencies in the practices to make the workflow better for physicians and staff.
  • Human Resources - This team focused on improving the new employee on-boarding process,  eliminating wait times, and reducing redundant work.

 

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At Baystate Franklin Medical Center, LEAN performance improvement techniques were utilized in three successful projects:

 

  • LEAN equipment cleaning
  • Surgical site infection reduction
  • Emergency Department flow

 

For more information on Quality at Baystate Health

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Baystate Mary Lane Hospital has applied LEAN methods to their performance improvement projects and plans to continue to spread LEAN thinking throughout the hospital.
  • BMLH uses the Comprehensive Unit-based Safety Program (CUSP) to reduce potentially preventable hospital-acquired infections.   Implementation and compliance with the online check list, appropriate nursing observation and evaluation measures has resulted in a 0% rate of Central Line Blood Stream Infections.
  • The Surgery Effectiveness team, working to improve patient flow, has improved Operating Room on-time start times.
  • The Emergency Department (ED) Patient Flow team is examining the best use of ED space to improve the time the patient is initially seen.

 

For more information on Quality at Baystate Health

For more information on Baystate Medical Center

For more information on Baystate Franklin Medical Center

For more information on Baystate Mary Lane Hospital