Lean strategies help a Boston practice improve patient care

A clinician’s highest priority is caring for patients, not running an office. But what if inefficiencies in a practice’s operations get in the way of patient care? For Harvard Vanguard Medical Associates, the solution was Lean health care.

At Harvard Vanguard’s Boston office, the room where the weekly clinical operations meeting is held is aptly named Mission Control. It serves as the hub of Harvard Vanguard’s implementation of Lean health care, which was developed to improve efficiency and give physicians more time with patients.

This is where improvement specialists, physicians and nurses together tackle their list of open improvement issues, by identifying barriers, assigning responsibilities and establishing due dates. They also review the status of recent “Rapid Improvement Events”—one‑ and two‑week intensive Lean activities—as well as longer‑term projects.

One recent Rapid Improvement Event involved optimizing the automated phone triage system. Formerly, the only option callers received was, “Press 1 for medical advice.” But when the team reviewed call data, they quickly learned that most calls were for refills, followed by appointments and then medical advice.

So they reordered the automated options accordingly. Now option 1 connects patients to someone who can assist with refills; option 2 is for appointments and so on.

It was a simple change that has enabled Harvard Vanguard to more quickly get calls to the right people to meet patients' needs.

Obviously, not all of the practice’s operations are automated, so standardizing work is the cornerstone of Harvard Vanguard's Lean philosophy. For every work process, there is a clearly defined series of steps for those who do that work, and each task has been mapped for how it feeds into larger processes.

To help all staff members standardize their processes, team members periodically observe each other in informal peer‑to‑peer audits. If a worker completes a process correctly, the auditor shows a green card. If the work is done incorrectly, the auditor shows an orange card.

The purpose of the audit is not to embarrass workers who make mistakes but to determine how consistently a process actually occurs and whether a member of the team needs assistance or additional training.

Lean is more than a method—it’s also a mindset. Lean thinking leads to cultural change, where all team members are empowered to identify sources of inefficiency and create innovative solutions to address problems.

The AMA’s STEPS Forward™ collection of practice improvement strategies explains how to implement Lean into your practice and includes:

1. Descriptions of common Lean methods to help physicians select the right ones for their practices
2. Six steps to help implement Lean improvements
3. Answers to common questions and concerns about Lean thinking and methods
4. Vignettes, like this one about Harvard Vanguard, describing how practices are successfully using Lean techniques to organize workflows and provide better patient care

It also includes a process map toolkit to help practices visually map their process flows like Harvard Vanguard did. Process maps help identify what's working, what’s not and where more subtle opportunities for improvement may exist.

Indeed, Harvard Vanguard remains committed to Lean only because its process improvement team has seen it work outside of Mission Control—by eliminating time-eating practices in the workday and freeing up clinicians to spend that time with their patients.

Some practices, however, find it daunting to implement practice transformation without outside support, so the module also has a customizable search feature to help physicians find local consultants who are skilled in practice transformation and have expertise in specialized functional areas.

Thirty-five STEPS Forward modules are now available, and several more will be added later this year, thanks to a grant from and collaboration with the Transforming Clinical Practices Initiative.