Caroline Gray

Implementing a Lean Management System in Primary Care: Facilitators and Barriers From the Front Lines.

Background: Although Lean management techniques are increasingly used in health care to improve quality and reduce costs, lessons about how to successfully implement this approach on the front lines of care delivery are not well documented. In this study, we highlight key facilitators and barriers to implementing Lean among frontline primary care providers. Methods: This case study took place at a large, ambulatory care delivery system serving nearly 1 million patients. In-depth interviews were conducted with primary care physicians, staff, and administrators to identify key factors impacting Lean redesigns in primary care. Results: Overall, staff engagement and performance management, sensitivity to the professional values and culture of medicine, and perceived adequacy of organizational resources were critical when introducing Lean changes. Specific drivers of change included empowerment of staff at all levels, visual display of performance metrics, and a culture of innovation and collaboration. Barriers included physician resistance to standardized work, difficulty transferring management responsibilities to non-physician staff, and time and staffing required for participating in improvement efforts. Conclusion: Although Lean offers a new approach to delivering care, the implementation process itself is both complex and crucial to success. Understanding early facilitators and barriers can maximize Leans, potential to improve health care delivery.

Medical Assistants as Flow Managers in Primary Care: Challenges and Recommendations.

EXECUTIVE SUMMARY As healthcare organizations look for ways to reduce costs and improve quality, many rely increasingly on allied healthcare professionals and, in particular, medical assistants (MAs) to supplement the work of physicians and other health professionals. MAs usually work in primary care, where they often play important roles on healthcare teams. Drawing on an empirical study of a large, multispecialty delivery system engaged in reconfiguration of primary care, we found that using MAs as flow managers required overcoming several challenges. These included entrenched social and occupational hierarchies between physicians and MAs, a lack of adequate training and mentorship, and difficulty attracting and retaining talented MAs. We offer several recommendations for healthcare organizations interested in using MAs as flow managers in their practices.

PS1-29: Changing the Culture of Medicine: An Exploration of Lean Healthcare in Primary Care

Background/Aims Despite its soaring costs, healthcare in the U.S. still suffers from inefficiencies and wastefulness. Given recent health care reform efforts, healthcare organizations know significant change is on the horizon, and in anticipation of that, some organizations have begun adopting delivery systems that address these wastes and inefficiencies. One system that has gained considerable attention in recent years is commonly referred to as Lean Healthcare. Originating from the manufacturing industry, this approach to healthcare focuses on retaining value for the patient and eliminating non-value or waste. However, implementing Lean healthcare is not without its challenges. One major challenge to implementing Lean is essentially cultural. More specifically, the values and norms associated with Lean and those deeply entrenched in the field of medicine may conflict, and therefore reconciling them may be necessary to successfully implement Lean. Methods This study consists of a qualitative evaluation of a Lean implementation effort at a large healthcare organization. Researchers conducted observations of key implementation events and interviewed frontline leaders, as well as physicians, nurses, and medical assistants who have participated in the change effort. The data produced from these qualitative methods were analyzed and coded using an inducted, grounded approach. Results This paper highlights five main major changes that produced cultural conflict when this healthcare organization implemented Lean. These include: (1) adopting team care approaches (2) democratization of the workplace and the erosion of hierarchies (3) reducing variation and standardizing work (4) surveillance of staff and employees (5) a perceived emphasis on profit over patient care. Conclusions Implementing new ways of delivering care in healthcare organizations is often met with many challenges. Some of these challenges may be rooted in a conflict between new sets of cultural values and those that have historically existed in the field of medicine. Reconciling these conflicts may be one of the most difficult challenges healthcare organizations face as they try to implement wide- scale change.