263223 Making change last: Using lean methodology to introduce, implement, and sustain successful performance improvement initiatives in an ambulatory care setting

Wednesday, October 31, 2012 : 8:50 AM - 9:10 AM

Ethan Jacobi, BA , Ambulatory Care Services, Metropolitan Hospital Center, New York, NY
Marcie Sara Rubin, MPH , Business Development/Ambulatory Care Services, Metropolitan Hospital Center, New York, NY
Background: Through a program called Breakthrough, the New York City Health and Hospitals Corporation utilizes Lean methodology to improve performance throughout its health system. Metropolitan Hospital Center (MHC), one of the corporation's subsidiaries has become a Breakthrough early adopter, fully implementing hospital, department, and service-wide efforts to improve processes and eliminate unnecessary waste. Methods: Through a series of Value Stream Analyses that focus on specific areas needing improvement, they identify the potential for activities led by multi-disciplinary teams with the intent of addressing one specific process and/or issue. Rapid Improvement Events last a week and seek to determine the root causes of a problem and assign responsibility for a completion plan that addresses the issue. Other activities include 6S which addresses the organization of space or a “Just Do It” which allows participants to tackle a problem from start to finish without getting caught up in a long process. Among events in the past that addressed continuity of care and clinic flow, they have recently implemented efforts to improve the walk-in process for Adult Medicine patients and the pre-authorization process for managed care services. Results: Through its work with Breakthrough, Metropolitan has seen continuity increase from 44% in August 2010 to 77% in December 2011. Meanwhile, volume has continually increased. Since implementing Breakthrough, over 40 members of their team, coming from all disciplines and levels, have participated in events. A Process Owner (PO), who is typically the manager of the area under review, is responsible for implementing the changes. He/she tracks progress towards goals and addresses any issues that attempt to derail reform. In order to facilitate change, the PO sets up visual management queues that show data trends for the metrics that need improvement. Add to this a Pareto Chart that describes any daily issues that impacted achievement of the target state, and you have what is called a Process Control Board. These boards are located in central areas to enable all staff to monitor the success of the Breakthrough events. In addition to the Process Control Boards, true accountability is achieved through periodic hospital-wide performance improvement reviews where all Breakthrough events are discussed by the hospital's executive leadership. Conclusion: Ambulatory Care Services at MHC continues to strive for improved performance with the introduction of several new value streams and activities that will engage staff throughout the department.

Learning Areas:
Administration, management, leadership
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
Describe Lean Methodology and its implementation in a municipal hospital system. Discuss performance improvement at Metropolitan Hospital Center. Assess the impact of performance improvement initiatives in an Ambulatory Care setting.

Keywords: Change, Performance Measurement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I work in a municipal hospital in New York City as a data analyst and administrator.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.