Breaking through: Using lean methodology to increase efficiency & improve patient-centeredness in ambulatory care settings

Background: MHC has implemented Toyota Lean Methodology as a performance improvement system called “Breakthrough”. In 2009, Ambulatory Care Services was identified as a value stream focus area due to the need for increased efficiency and a more patient-centered environment. Methods: An Ambulatory Care Steering Committee was formed to oversee the value stream and plan the rapid improvement events (RIEs). Adult Primary Care was identified as an area that needed immediate attention as a portal of entry to the hospital. A series of week-long RIEs was conducted on various issues pertaining to clinic flow, continuity of care, and patient scheduling, encouraging participation by MDs, Residents, RNs, Social Workers, Managers and Clericals. Each RIE had a process owner who was assigned to ensure completion of all team goals. The process owner reports the progress of the team 30-days, 60-days and 90-days after the completion of the event at the Hospital-wide Performance Improvement Committee Meeting. Results: Value stream metrics have improved through the RIEs: 1) third next available appointment declined from approximately 30 days in June 2010 to 0 days in November 2010; 2) continuity of care (# visits with PCP/all visits) increased from 15% in June 2010 to 67% in January 2011; and 3) visit volume increased 9.5% from June 2010 to November 2010. In addition, Ambulatory Care has seen a significant increase in staff satisfaction as indicated by the results of the hospital's 2010 Staff Satisfaction Survey. Ambulatory Care consistently ranked as the most satisfied department in the hospital in this survey. It is believed that this increase in staff satisfaction is attributable to their inclusion in the Breakthrough process. Conclusions: Breakthrough has been a successful tool for improving clinic efficiency and increasing team building in Adult Primary Care at MHC, and it is being expanded into other Ambulatory Care Services.