Use of Toyota LEAN Production Model to Increase Efficiency

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Use of Toyota LEAN Production Model to Increase
Efficiency Productivity at Community Health
Centers

• Paul Melinkovich, MD, FAAP
• Director, Denver Community Health Services
• AHRQ Innovations Exchange Webinar
• January 27, 2009

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Problems Addressed

• Inefficient processes for clinical work
• Low provider productivity
• Prolonged patient waiting time
• Variable patient cycle times
• Staff and patient dissatisfaction

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Interventions

• Toyota Lean Production System at corporate
  level ? Eliminate waste and standardize processes
• Value Stream Mapping resulting in
• Projects
• Just Do Its (JDIs)
• 3P/2P Events
• Rapid Improvement Events (RIE)
• Events used to develop and implement
  interventions at clinic level

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Streamlined Appointment Scheduling

• Open access scheduling system
• Standard schedule Every 20 minutes
• One appointment type
• Stricter policy for early and late arrivals
• Policy for no shows

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Provider Dyads to Improve Cycle Time

• Standardized roles for
• MDs
• Allied Health Providers (AHPs)
• RNs
• Medical Assistants (MAs)
• Designated provider/MA dyad
• Tandem work when possible

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Desktop Management

• Developed standard processes for
• Medication refills
• Non-appointment requests
• Laboratory follow-up
• Forms completion
• Other similar requests

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Results

• Productivity increased from 8.0 to 9.9
  visits/session
• Patient cycle time reduced from 88 to 58 minutes
• No-show rate reduced from 21 to 15
• Revenue enhanced more than 3.0 million

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Challenges

• Inertia Things will always be the same around
  here
• Staff resistance to change
• Middle management resistance
• Difficulty spreading best practices
• Decentralized clinic system
• Sustaining change

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What Worked to Overcome Challenges

• Having a systematic method for process
  improvement
• Having a clear set of metrics to measure
  improvement
• Experimenting and refining interventions
• Cohesive managers at executive level
• Ongoing communication with middle managers and
  teams

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Gaining Support at Start

• Good definition of problem -- What do we need to
  fix?
• Clear map of where to go -- How are we going to
  get there?
• Much communication -- What have we achieved?
• Early innovators involved at beginning
• Leadership support

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Maintaining Support

• Communication of success
• Refining interventions
• Leadership presentations to middle managers
• Recognition to successful teams at leadership
  meetings
• Cross-fertilization of teams when conducting
  events

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Sustaining Interventions

• Communication
• Production reports comparing teams
• Acknowledging challenges
• Changing the culture to Eliminate Waste
• Celebrating success

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QUESTIONS ?