1. Making the Case for Lean Management in Medical Staff Services
Michelle Butler, MS, RHIA, CPCS, CPMSM
Roxanne Chamberlain, MBA, FACHE, CPCS, CPMSM

2. Making the Case…
Why is lean management important?

3. Baystate Health, Inc. Process…..
Educate staff: pick a staff champion
Focus on a target
Define the process
Create visual controls

4. NSMC Journey Started with affiliated physician practices
Virginia Mason Medical Center
Toyota Production System for healthcare
Established Leader
training program
Senior leaders are
the Guiding Team
select priority targets

5. Baystate Health, Inc. MSS Objectives
Decrease processing timeframe
Decrease # of handoffs
Decrease revenue loss
Improve customer satisfaction
Improve start date reliability

6. NSMC MSS Objectives Issues:
Lengthy credentialing process resulting in delays in patient care and lost revenue. Production pressure on MSO staff, duplicate processing for recruiters, MSO staff, and physician applicants.
Theme:
Delays in credentialing ultimately cause delays in patient care and lost revenue. With quicker credentialing, patient access improves and patients get more timely care with the doctor they want to see and more revenue is generated.

7. 5 Principles of Lean: Identify Customer & Specify Values
Map the Value Stream
Eliminate Waste
Respond to Customer Pull
Pursue Perfection

8. #1. Identify Customer & Specific Values
only a small fraction of the total time and effort in any department actually adds value for the end customer.
Clearly define the value for a specific product or service from the end customer’s perspective, then target non-value added activities – or waste –for removal.
In our case, we targeted the initial credentialing process, the re-credentialing process and the focused professional practice evaluation (FPPE) process.

11. #3. Eliminate Waste What is waste?
Waste is any task or item that does not add value from the perspective of the customer.
There are different kinds of waste:
Type 1: Non-value added activities that are currently required, such as work to comply with regulations.
Type 2: Non-value added activities that can be stopped immediately with no detrimental effect

12. Taiichi Ohno’s Seven Wastes Waste Transportation Defects Processing
Conveying, transferring, picking up, setting down, piling up and otherwise moving unnecessary items.
Defects
Waste related to costs for inspection of defects in
materials and processes, customer complaints and
repairs
Processing
Unnecessary processes and operations
Traditionally accepted as necessary
Overproduction
Producing what is unnecessary, when it is unnecessary, and in unnecessary amounts
Motion
Unnecessary movement
or movement that does
not add value.
Movement that is done
too quickly or slowly.
Inventory
Maintaining excessive amounts of supplies,
materials, or information for any length of time.
Having more on hand than what is needed and used.
Time
Waiting for
people or services
to be provided.
Time when
processes, people or equipment are idle.
Waste
Another foundational part of TPS is identifying waste.
Waste = worry, wander, waiting (patients or caregivers)
It is something that does not add value to our patients. Something they would not pay for.
Taiichi Ohno is the founder of TPS and created this framework to think about waste
It is observed with “big eyes, big ears, small mouth” in direct observation on the genba.
Examples:
Time: waiting patient, waiting providers (wait for RN to be found for MDR)
Defects: 2 blood draws – anytime things are redone or would cause harm to a pt
Motion: searching for supplies
Transportation: taken to stress lab, but no interpreter and back again (also defect)
Overproduction: unneeded tests, unneeded papers
Inventory: clutter, space, expire
Processing: vital signs in multiple placed. Doing things over.
© Virginia Mason Medical Center

15. #4. Respond to Customer Pull
Understand your customer demand
Observe, Measure and Time activities
Examine Demand Benchmarking
FTE analysis: staff / application
paper process / electronic process

16. #5. Pursue Perfection
Constantly looking at your processes to eliminate mistakes, implement improvements and make relevant changes as the healthcare environment changes.
Defects are mistakes that
are passed along to the
next step in the process or
to the customer.
Goal: Zero Defects

17. 4 Elements of Lean: Define Standard Work Create Visual Controls
Implement Daily Accountability Process
Maintain Leadership Discipline

18. #1. Define Standard Work
Without standards, there can be no improvement”
Taiichi Ohno
Founder of the Toyota Production System

19. 5S is a strategy that helps to keep our workplace safe and organized
Standard Work
5S is a strategy that helps to keep our workplace safe and organized
The 5Ss are:
Sort
Simplify
Sweep
Standardize
Self-Discipline
Sort:
Separate necessary from unnecessary
Simplify:
A place for everything needed and everything needed in its place and ready to use.
Sweep:
Inspection that everything is where it belongs.
Visual confirmation that 5S agreements are being followed
Standardize:
Create common agreements
Communicate to the team
Self Discipline:
Maintain standards through training, empowerment, commitment and discipline
Facilitator names the 5S’s. Descriptions follow.

20. Standard Work Exercises

21. 5S Exercise: INITIAL TRIAL
Cross out the numbers from 1-49 in order 36 6 18 26 52 44 82 81 7 80 8 54 71 43 25 62 70 63 72 34 45 61 16 53 17 35 27 4 42 78 23 31 68 51 58 77 79 49 67 15 14 33 76 60 86 50 13 6 87 40 24 69 5 32 41 59 22 28 30 56 65 64 73 48 3 29 20 12 85 10 47 83 74 2 21 37 66 1 38 75 39 84 11 55 46 19 57

22. Sort
Cross out the numbers from 1-49 in order 36 6 7 26 18 44 43 8 25 27 16 34 45 17 35 4 42 23 31 15 49 14 33 32 13 9 40 24 5 41 22 28 30 20 48 29 47 10 12 2 21 37 1 3 38 39 11 46 19

23. Simplify
Cross out the numbers from 1-49 in order 36 6 7 26 18 44 43 8 25 27 16 34 45 17 35 4 42 23 31 15 49 14 33 32 13 9 40 24 5 41 22 28 30 20 48 29 47 10 12 2 21 37 1 3 38 39 11 46 19

24. Simplify
Cross out the numbers from 1-49 in order
Numbers from 1 to 49 4 1 2 5 8 9 6 7 3 16 17 14 11 12 13 15 18 10 22 23 25 26 19 24 27 20 21 29 30 34 28 31 35 36 32 33 38 42 44 39 40 41 43 37 45 46 47 48 49

25. Sweep
What’s Missing?
Numbers from 1 to 49 4 1 2 5 8 9 6 7 3 16 17 14 11 12 13 15 18 10 22 23 25 26 19 24 27 21 29 30 34 28 31 36 32 33 38 42 44 39 40 41 43 37 45 46 47 48 49

26. #2. Create Visual Controls
Visual controls are methods, devices, or mechanisms to visually manage operations.
How do visual controls work?
Everyone:
Accountability to the rules
Knows what to do because of standards
Knows when and where because of visual controls

27. Visual Control

28. Visual Control

29. Daily Accountability
Baystate Health, Inc. “Huddle” NSMC “Production Board”

30. NSMC Production Board

32. Leadership discipline
It is the leader’s responsibility to sustain a Lean environment. The leader is the force that can motivate and sustain Lean management in your department. Defining expectations and holding people accountable to them is key to a successful Lean implementation.

33. NSMC Leadership Discipline
Daily visual management – visualization of the work to be done
Daily accountability – perform quick rounding
Discipline – expectation setting & accountability

34. NSMC Leader Standard Work Template

36. Leadership Checklist

37. Improvement! Success at BayState Health, Inc. = 25% reduction
Success at NSMC =
Reduction in initial app processing time 32%
Streamlined application for customers
Improved application accuracy on receipt
Improved communication w/ recruitment
Improved intradepartmental transparency