Translating public health policy to private practice using lean

Providers in private practices can play a significant role in changing population health outcomes by collaborating with public health leaders to effect change. However, private practices face significant challenges in promoting public health policy due, in part, to resource constraints and lack of quality improvement support. We modified a Lean management process and approached two private practices with the goal of implementing separate public health policies: increase pediatric lead screening in a family medicine practice and integrate a mental health clinician into an internal medicine primary care practice. We achieved higher lead screening rates and higher rates of mental health/behavioral health/substance abuse referrals with shorter wait times for appointments. Using feedback from these pilots, we further adapted the Lean process to meet practice resource constraints. We collaborated with our state health department to approach private practices on the issues of abuse and diversion of opiate prescriptions for managing chronic pain. We assisted 10 private practices who volunteered to collaborate in achieving better opiate prescription management, tailoring the Lean process to fit practice availability, resources, and staff. From a recommended set of improvements, each practice was successful at selecting and implementing at least one process change that affected prescribing habits. Practice providers and staff were surveyed for their perceptions of opiate prescription management before and after their projects and for their evaluation of the Lean management process. This presentation will summarize the changes made to prescription management in practices, modifications in the Lean management process, perceptions of the practice members, and the value of using a Lean management model to translate public policy into local practice solutions.