ACIG consultants Gerard Colla and Matthew Bowler today delivered a seminar to SA Health about how best to apply the principles of Lean Thinking to the health sector.
ACIG has successfully applied Lean Thinking to a number of health services: a case study example is provided below.
Case Study
The Peter James Centre and Wantirna Health (PJC & WH) provides a broad range of sub-acute services to clients within the Eastern Health catchment of some 800,000 people. These services focus on aged care, rehabilitation and palliative care.
Following a series of staff workshops, a project team was established to focus on improving the efficiency and patient outcomes of its core care process. The core care process was divided into four stages: access, assessment, care planning and evaluation, and discharge.
The approach
The deliberate improvement methods of Lean Thinking were chosen as the foundation of the approach.
They were seen to be congruent with approaches being developed and deployed at other leading hospitals, the Victorian Department of Human Services, and by successful organisations in other industries.
ACIG was engaged to bring the method and experience of deliberate improvement to the project, particularly the concepts and tools of Lean Thinking.
The hospital working parties and facilitators were introduced to ACIG’s DIAGNOSE project method, and then coached throughout the period of the project.
The method and associated support included:
- A one day action learning exercise where the trainee facilitators and facility staff were introduced to the principles of Lean Thinking and the tools of improvement in a case study based exercise.
- Coaching to develop the capability of the facilitators throughout the course of the working parties. This coaching included the principles and tools of Lean Thinking, as well as team facilitation.
The deliverables required by PJC & WH included capacity building throughout the organisation to provide staff with the skills to facilitate ongoing deliberate improvement activities.
The Findings
Four working parties were facilitated through a process that included mapping the activity stream for their stage of the patient journey. Team based mapping always has an impact as those involved see the frustration of daily work appear as a braided stream of activity and visible confusion; these working parties were no different. Each of the four working parties identified many opportunities for improvement.
Findings included:
- Referral forms typically contained missing or incorrect information for many fields. For example – 53% for entries in medication fields for external hospital referrals. This generated a large aggregate amount of wasted professional staff time.
- Up to seven disciplines interviewed patients on day one. Patients were often overwhelmed by the process.
- No single clear description of patient goals or a care plan eventuated from the assessment. This meant an absence of a reference point for later decisions.
- Team care conferences were found to be very inefficient: 32% of patients did not have a care planning discussion documented in their medical record.
- Discharge was often delayed due to delays accessing handyman services to modify patients’ homes.
These findings are not unique to Peter James Centre – they are typical of many health services. However, the process by which they were discovered, by a working party of clinical and service professionals using the tools of deliberate improvement, ensured there was a strong commitment to change.
The results
Results have been dramatic and include:
- 47 admission assessment form options have been reduced to 7 – an 85% improvement. Similarly the number of different data fields has reduced from about 215 in those 47 forms to about 75 aligned across the 7 forms – a 65% improvement.
- Over 50% of patients now have documented evidence of functionally based goals – previous audits indicated that no patient file had such documented evidence. In addition there is now clear documentation of team meeting outputs in line with functional domains.
- Every patient now has a designated Key Contact Person to reduce the frustration, confusion and misunderstandings for patients, their families and staff that previously occurred as the result of mixed communication channels.
Perhaps the most exciting outcome had been the increased capability of staff in the use of the tools and methods of Lean Thinking. They have since gone on to tackle other problem areas in their drive for improvement.
Critical success factor
A critical factor in the success of this phase of change at Peter James Centre has been the leadership of the General Manager, Ms. Janet Compton. ACIG has observed over many years of contribution to change and deliberate improvement projects that success and sustainability are ultimately dependent on the quality of leadership. This leadership was evident by the commitment of resources, public support and recognition for the teams, a clear expectation of the outcome, flexibility with the specific recommendations to edify the involved staff, and providing facilitators the time to learn and apply the Lean Thinking methods.
