PS2-13: Implementing a Lean Management System in Primary Care: Facilitators and Barriers from the Frontlines

Abstract

158 HMORN 2013 -Selected Abstracts safety net population. Methods: This randomized controlled trial began in October 2011 among patients of Cambridge Health Alliance (CHA), an urban safety net health care system. We identified patients discharged from the medical service with lengths of stay 3 days or more, admission in the prior 6 months, age 60+ years, or admission for COPD or congestive heart failure. We randomized patients to the PN intervention or usual care alone. In the PN intervention, a bilingual hospital-based CHW engaged in discharge planning and made outreach phone calls to patients for 30 days after initial discharge and upon subsequent readmission. PNs assisted patients with follow-up appointments, obtaining and taking medications, transportation, financial barriers, and linkages to community resources. Sociodemographic, clinical, and utilization data were obtained from electronic medical records. Primary outcomes were the proportion of patients readmitted within 30 days, number of readmissions per patient, total number of hospital days within 180 days post-discharge, and proportion of patients with a primary care visit or an emergency department (ED) visit within 30 days. The trial will continue through spring 2013. Results: As of October 2012, 423 patients were in the PN group and 513 in the control group. Fewer PN patients (12.1%) were readmitted within 30 days of an index discharge than controls (13.6%). Readmissions per patient were lower in the PN group compared to controls (0.70 vs. 0.81), as were total hospital days (3.42 vs. 3.59). More PN patients than controls had a primary care visit within 30 days (77.1% vs. 68.6%), but similar percentages had an ED visit within 30 days (11.3% vs. 10.9%). Conclusions: Preliminary results show a trend toward a reduction in probability of 30-day readmission, number of readmissions, and total hospital days for safety net patients receiving a PN intervention, and a trend toward greater probability of a primary care visit within 30 days of discharge. Background/Aims: Implementation science (IS) is a priority topic in the renewal funding of the Cancer Research Network and encompasses a broad range of constructs and uses measures from a variety of disciplines. However, there has been little standardization of measures or agreement on definitions of constructs across different studies, fields, authors, or research groups. Moreover, many measures developed are not practical in real-world settings such as healthcare delivery systems. To further the field of IS, there is a need to both identify and evaluate IS measures on both their validity and practical relevance. Methods: We describe a collaborative, web-based activity using the National Cancer Institute's (NCI) Grid-Enabled Measures (GEM) portal that uses a wiki platform to focus discussion and engage the research community to enhance the quality and harmonization of measures for IS health-related research and practice. We present the history, process, and data from 8 months of the GEM Dissemination & Impleme...

Successful Implementation of Lean as a Managerial Principle in Health Care: A Conceptual Analysis From Systematic Literature Review

“…Furthermore, the activities of leading, visioning, and especially empowering were considered essential for successful Lean leadership. Many of the studies (four of nine) referred to the fact that Lean leaders should have the abilities to empower, trust, and engage other team-members (25;29;30;40). In addition, many studies suggested a visible leadership of Lean was a recognizable feature of Lean leadership (29;30;40;41).…”

“…Data walls collect and display locally relevant data (42). Visually displaying daily progress-technique is known more formally in Lean terminology as the use of a “daily management” or “daily engagement” system (25;29;40). Communication was one of the key factors referred to in most articles.…”

“…Facilitating, supporting, and functioning as coaches and mentors seemed to be the prevailing style for successful Lean leadership and was pointed out in all the original articles. These leadership styles mean that Lean leaders can increase their teams’ expertise both directly in their work and in quality improvement (25;29;30;40;42). Traits related to delegating decision making or power were also mentioned in some studies (25;41;42).…”

“…Features related to a democratic style of management were strongly indicated in the reviewed studies. Almost half of the studies (four of nine) referred to team-work concepts such as “team-oriented” and “understanding team dynamics” (30;40–42) Many studies emphasized the importance of having time for multidisciplinary collaboration (22;25;29;40;42). In addition, there were various other leadership and management styles that were mentioned in one or two studies, which are presented in Table 3.…”

“…Many of the studies (four of nine) suggested that the utmost focus of Lean management is continuous learning, which was characterized by several expressions and examples such as learning from mistakes, learning by seeing and doing, and being committed to lifelong learning (25;29;30;42). Financial and manpower resource commitments were recognized as being required while implementing Lean (29;40;42). Other focuses concerning results and assessing processes included evaluation according to real-time process performance, as well as end-of-the-reporting-period results (24) (Table 3).…”