Maximize access, quality and existing revenue streams with “LEAN” techniques

Background: In a landmark report on poverty and cancer, the 2008 Colorado Comprehensive Cancer Program report showed that people in poverty experience poor survival from cancer, regardless of race/ethnicity. Denver Health (DH) is nationally recognized for using the LEAN process modeled after the Toyota manufacturing system to improve access to care to the underserved and eliminate waste. LEAN was applied to the implementation of the CDC's National Breast and Cervical Cancer Program (NBCCEDP) in order to improve quality and increase enrollment. Our data indicated that only 21% of eligible women were enrolled NBCCEDP annually.

Goals: Employ the LEAN process to maximize enrollment in NBCCEDP and to standardize processes at all points of service, including financial screening and thus reduce financial barriers to cancer screening.

Method: Agency and state stakeholders participated in an intensive week-long Rapid Improvement Event (RIE). This multi-disciplinary group conducted an in-depth analysis which resulted in standardized processes that maximized not only the quality of care and number of women screened, but also the existing NBCCEDP revenue stream. Standardized processes eliminated the need for duplicative patient record documentation. IT solutions were devised to implement failsafe mechanisms for program enrollment at key service points. Billing systems were altered to take advantage of economies of scale. Electronic reports that pull from the patient records streamlined data entry in the state's NBCCEDP reimbursement database.

Conclusion: LEAN processes generate rapid problem-solving and organizational change. Establishment of an ongoing evaluation plan is key to the successful spread and sustainability of new processes.