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Look for the Lean Routine

This past month I was lucky to attend a workshop on Lean Rapid Process Improvement hosted by Qualis Health, the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Washington and Idaho. As our organizations hold similar contracts in Oregon and Washington to perform external quality review of the states’ Medicaid programs, Qualis invited me and three of my HealthInsight colleagues to provide an outside perspective on their efforts to “lean up” their workflow processes, with the goal of providing better value to the State of Washington.

The invitation excited me because I had heard a lot about Lean workshops but had never been able to participate. I knew that Lean manufacturing principles?aimed at minimizing waste in a system without sacrificing productivity?could be applied to non manufacturing settings, but I had not actually experienced it.

Over the course of the three-and-a-half-day workshop, we examined a process map that Qualis had developed for one of its workflow processes, with an eye toward reducing waste. We looked for eight types of waste: defects, overproduction, waiting, non utilized people, transportation, inventory, motion and extra processing.

Our process map was on butcher paper, covered in sticky notes that showed four types of employees and each step they took, from sending an email to handing off a report for review. The map depicted steps that created additional value for the customer, along with steps that required waiting time, handoffs or a decision point. It was quite a sight to behold.

I learned that scrutinizing our work processes and being willing to let go of the ways we’re used to doing things can be difficult, and depends on relationship building and teamwork. In the end, I was very proud of how our group of 12 came together and generated so many new ideas. We categorized ideas for improvement into four areas: high impact/low effort, high impact/high effort, low impact/low effort and low impact/high effort. We identified the “quick wins” and developed a plan to implement those changes in the next 30 days, and we took note of changes that would be harder to implement but would pay off in the long term.

The new “future state” map we created was shorter and more colorful. It inspired me to take a hard look at my own family’s everyday routines, as we might be wasting precious moments on actions that added no value to our lives.

Thinking about my morning routine with my two children, aged two and five, I quickly sketched on paper (regular paper with no sticky notes) the steps we normally take. The next morning, I tested a new routine that cut down on the number of trips I made up and down the many stairs in our house, along with several decision points. I had the children dressed and ready to go to day care 10 minutes earlier?giving us extra quality time to work on puzzles.

The health care system offers many opportunities to redesign wasteful processes that add no value for patients or the public. I hope more of my colleagues can gain exposure to Lean, Six Sigma or similar quality improvement and process improvement methods. With so many staff members already well versed in quality and process improvement, HealthInsight is equipped to make a significant positive impact on the efficiency of health care delivery.

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