'Lean' principles help spur practice transformation

The transformation required of healthcare practices seeking to improve care quality while containing costs could benefit from the application of "lean" management thinking, according to a recent study.

The concept of lean methodology was first developed in the manufacturing industry as a way to reduce waste by seeking ways to cut costs and boost quality. The strategy has seen some uptake in the healthcare world due to the way it drives systematic problem-solving, but getting doctors on board has been a historical struggle, according to previous reporting by FiercePracticeManagement.

Changes to care delivery, especially the shift in emphasis toward higher-quality care provision and patient satisfaction, create an ideal opportunity for lean principles, writes Lisa M. Nicolaou, R.N., in the American Journal of Managed Care. She studied the efforts of a multidisciplinary care team in a patient-centered medical home (PCMH) setting as its 10 members used lean methodology to improve patient flow. As a result, the team overhauled several problem areas:

  • With buy-in from a physician leader, the team raised availability of same-day appointments for patients and streamlined its administrative work to save six minutes per open appointment.
  • The team sought to save time by minimizing disruptions, which they accomplished through changed processes designed to cut down on incoming and outgoing phone calls, and by organizing the work environment to increase productivity.
  • To decrease patient wait times, the team looked at patient flow through the process and managed to cut visits from an average of 70 minutes to 47 minutes, without changing the amount of time spent engaged with a physician.

The time needed to learn and deploy lean principles remains an obstacle to its adoption, according to Nicolaou, but the savings more than make up for the time invested. She also emphasizes the need to get physician leaders engaged in the process, and sees lean as a logical starting point for practices in transition. “Leadership skill and collaborative work habits create efficiency and even greater capacity to further transformation efforts,” she writes.