DEVELOPING TEAMS OFPROBLEM SOLVERS

Katrina Appell, Ph.D. Lean Coach, Lean for Clinical Redesign CQI

University of Michigan Health System

Patricia Craig, BSN, RNContinuous Improvement Consultant

Bronson Healthcare

Bronson Healthcare Group

• Regional not-for-profit system, locally owned and governed since 1900

• Three hospitals, several ambulatory care centers, multiple joint ventures, and 82 Medical Practices

• Employs over 7,900 team members

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What: Collaborative Process Initiative staffed by University of Michigan and funded by BCBSM.

Why: To Support the PCMH efforts of Physician Organizations throughout Michigan.

How: Leaders and clinic teams develop lean capabilities while solving problems through cycles of learning.

Lean for Clinical Redesign

Why did Bronson Participate in Lean for Clinical Redesign?

“Wanted to access additional resources/tools to develop lean thinking in the outpatient setting in a different way than how we

currently did the work (through kaizen events). We knew that the kaizen (multi-day) event approach would not develop the necessary

problem solving skills in the office based setting fast enough nor with enough depth and breadth.”

Elizabeth Warner, MD

Medical DirectorContinuous Improvement

Support TeamBronson Healthcare

Bronson Medical Group Practices

4 Practices included in each Learning Cycle

12 Primary Care Practices have been involved in Learning Cycles

Bronson Medical Group Practice Results

73% to 85%

Mammogram Completion Rate – Bronson Internal Medicine Oshtemo

Implemented Chart Prep & Mini Huddle Standard Work

50% to 93%

Accurate Demographics – Bronson Rambling Road Pediatrics

Standard Work for verifying demographics at every point of contact

Appointments Created Bronson Rambling Road Pediatrics

745 in 2014Implemented Standard Agenda Mini-Huddle

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Future / Target

Facts

Current

Vision

Lean Learning grounded inContinuous ImprovementAnd Respect

Challenge

Kaizen Mind

Go and See

Teamwork

Respect

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Lean for Clinical RedesignLearning Cycle Model

Foundational Learning

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Set Problem Solving Direction

Ideal

State

Current

StateProblem

Definition

Understanding the Current Reality

Perceived Problem Actual Data Learning

Appointments scheduled incorrectly caused appointments to ‘run over’

Of 870 appointments; 8 were not scheduled per the Practice’s guideline

Correctly schedulingappointments is not where improvement effort should focus

Front desk team not available at front desk

Multiple tasks pulled Front Desk team away from desk. One large reason was use of a copier located upstairs to prepare new patient packets.

Waste identified, rerouted printer allowed for files to be printed directly to printer within suite

Avoiding Jumping to Solutions to Problems that Don’t Exist

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Engaging the Entire Clinic

Socialize:

• Value Stream Map

• Problem Definition

• PDSA Cycles

Daily at Huddles:

Share Problem Solving

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Create Habits and RoutinesSupporting the Culture

Weekly:

• PDSA Session at Lean Daily Management Board

– Dedicated problem solving time

Monthly:

• Learning Collaborative

– Learning across

clinics

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Developing Leaders as Coaches:PDSA Coaching Sessions

Plan, Study, and Adjust

Summary

• Learning provides information for the team’s next stepso collecting data to better understand the

situation o conducting an experiment

• Teams are coached by leader; members develop continuous problem solving capabilities using lean concepts.

• Operationalizing problem solving shifts culture

Thank you!bronsonhealth.com