The Role of Lean Process Improvement in Implementation of Evidence-Based Practices in Behavioral Health Care

Abstract

To effectively implement evidence-based practices (EBP) in behavioral health care, an organization needs to have operating structures and processes that can address core EBP implementation factors and stages. Lean, a widely used quality improvement process, can potentially address the factors crucial to successful implementation of EBP. This article provides an overview of Lean and the relationship between Lean process improvement steps, and EBP implementation models. Examples of how Lean process improvement methodologies can be used to help plan and carry out implementation of EBP in mental health delivery systems are presented along with limitations and recommendations for future research and clinical application.

Progress Monitoring in an Integrated Health Care System: Tracking Behavioral Health Vital Signs

“…At the same time, the MHPMT is patient-centered and providers quickly see the clinical value of the tool. Use of the MHPMT thus helps align individual clinician objectives with the larger organization's business strategy, thus further increasing the efficiency of the adoption process (Steinfeld et al 2014). An additional benefit of routinely administering the MHPMT is that one generates significant amounts of outcome data.…”

“…Behavioral health leadership was engaged in the adoption of the MHPMT by arguing that a consistently administered progress tool could not only help improve patient satisfaction, but also help objectively track these important quality outcomes. Since the process improvement approach within the organization utilized lean continuous quality improvement principles (Steinfeld et al 2014), the ability to measure the process was critical to tracking the implementation process. A target was established that progress monitoring tool data would be entered into the EMR for 80 % of all visits for patients 12 years of age and older.…”

“…Training as described above was provided along with lean process improvement tools (Steinfeld et al 2014). These tools included ''standard work'' (concise descriptions of the process for administration of the MHPMT), visual tracking systems (clinic performance on percentage of adult visits during which the MHPMT was administered) and daily huddles (daily 5-10 min meetings attended by entire team where there was opportunity to discuss tool use and address any process issues).…”

“…Many of the barriers to implementation are similar to those identified in implementation of evidence based practices (EBP). These include lack of training, staff engagement, organizational readiness and implementation structures (Fixsen et al 2005;McHugh and Barlow 2012;Steinfeld et al 2014). In addition, there are a number of barriers as it pertains to clinician attitudes including time and cost to use tool (Jensen-Doss and Hawley 2010), clinician hesitance to adopt computer-based technology (Lambert 2010), clinician belief they are in a better position to judge patient progress than the patients themselves and process barriers such as administrative complexity and cost (Lambert 2010).…”

Evidence of Transformational Leadership Attributes in lean Healthcare Implementation Framework

“…Implementation is a specific actions planned to put a process of known elements into practice (Steinfeld et al, 2015). Implementation involves the process of applying or integrating innovations within a certain situation(Moullin, Sabater-Hernández, Fernandez-Llimos, & Benrimoj, 2015).…”