From airline checklists to agricultural cooperative extension centers, those working to improve the health care system are taking and adapting enterprising improvement approaches developed in other industries. In South Central Pennsylvania (SCPA), the Aligning Forces for Quality alliance is taking advantage of its location in the “fast food capitol” to enlist manufacturing experts as quality improvement coaches in ambulatory practices. Rush Gross, an ex-Airman trained in lean process methodologies with previous stints at Frito-Lay and General Mills, serves as the coordinator for AF4Q–SCPA’s Planned Care Collaborative (Collaborative) where he and his team of practice coaches deploy into 16 local primary care practices to help improve the quality of care they provide.
Lean methodologies (or “lean” for short), best known as the processes responsible for the Toyota production system’s success, emphasize the quest to eliminate waste, improve quality, and drive down production costs. These principles of value have been adopted by top health care systems in the country, such as Denver Health and Virginia Mason in Seattle, WA.
In SCPA, practice coaches in the Collaborative are using lean to help practices achieve patient-centered care. Coaches help practices collect and interpret quality data, identify and improvement goals, and test strategies and spread successful innovations. At Aspers Health Center, seven of eight diabetes process measures improved while the practice was in the Collaborative. Between May 2011 and March 2012, 24 more diabetes patients had their hA1c levels updated – increasing from 89 percent to 94 percent of all patients – and 44 more had current microalbumin tests – increasing from 76 percent to 89 percent. There was a 24 percent improvement in eye exams, but providing them to 45 percent of patients was still far from the goal of providing them to 90 percent of patients.
Practice coaches also work with practice leadership to remove waste from work flow. A review of one practice resulted in moving a refrigerator to a more central location to reduce the time it takes for nurses to retrieve vaccines. Saving this time allowed nurses more time with patients, particularly to review self-management techniques.