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Why a physician's role is so crucial when implementing Lean methodology

By Tim Kostelnik

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A frequent comment I hear from healthcare organizations who are struggling with Lean implementation is "if only we could get the physicians involved, we could really spread this Lean thinking." And you know, they're right! No one is admitted unless a physician signs for it. No test is done unless a physician orders it. No care is initiated unless a physician directs it. No one is discharged unless a physician writes discharge orders. You need to bring your physicians along early in your Lean strategy and you can do so by speaking their language.

A powerful tool is to translate Lean into an analogy about delivering great patient care.

You can compare the stages of evaluating and delivering great patient care to the stages in which Lean can be applied in healthcare processes. The first stage in delivering great care is for the physician to go see the patient, similar to the Lean teaching to go see the process with our own eyes. Secondly, physicians learn about a standard protocol in medical school called History, Physical, Impression, Plan (HPIP) as a systematic way to evaluate a patient. Lean also systematizes process evaluation through the application of value stream mapping, 5S and Kaizen, all standard ways of uncovering potential solutions for treating serious process problems that consume wasted time and effort. The third stage is the prescription for treatment; delivering great care involves not just treating the symptoms but addressing the root cause of the problem. In Lean, we are taught not to jump to solutions, but to take the time to understand the facts around the process. Finally, in the fourth stage, physicians are taught to make sure there is follow up with the patient, whether it is with their primary care physician or other provider. The Lean process is very focused on the follow up as learning new processes is highly challenging and a rigorous sustain plan with data is a key to successful implementations.

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Try this analogy next time you are challenged to engage your physicians in participating in your Process Improvement initiatives.


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