There is a myth about LEAN prevalent in healthcare today. That myth postulates that LEAN is a process that will reduce effort, improve processes but will not help increase patient satisfaction or HCAHPS scores because it is not focused on the patient.
Nothing could be further from the truth. LEAN will do that and more. The myth arises from some individuals viewing LEAN from a singular prospective, a strict process improvement tool and not utilizing the application of LEAN in broader perspectives. Simply put, LEAN will help improve any key performance indicator (KPI). The selection of the KPI is up to the LEAN practitioner.
I had the opportunity to work with an ED whose patient satisfaction scores had them in the 19 the percentile overall. They were frustrated and were losing market share. The ED team, as a group, decides that a critical KPI is overall patient satisfaction and begin to track it, Utilizing any survey is difficult because of lag times from discharge to gathering data to production of actual survey results. They developed a short discharge survey for al ED patients. Tracking patient satisfaction and what the patient as well as what dissatisfied the patient. Over a one month period they tracked patient satisfaction on a 1 – 5 scale. Additionally, they used a living Pareto chart to track exactly what the dissatisfier was. After a month, the number one dissatisfied was long wait times, number two was lack of communication. This is a classic example of using two powerful LEAN tools to identify a patient satisfaction problem root cause.
We decided to attack the wait time problem first. We did a gemba walk and followed patients through their ED visit, tracking the time spent actually receiving care ( value added time) and waiting for a physician, results or treatment (non value added time). We found bottlenecks that could be eliminated such as labs rests not processed on a stat basis, beds not available for patients waiting to be admitted, issues around the transport of patents to and from imaging, lack of staff in the ED. We also learned that a majority of the complaints were from patients with minor issues waiting because of more critical patients being treated in the ED.
The hospital decided to create a fast track during peak times in the ED to treat the more minor ailments. This was staffed with a mid level provider. It had a remarkable positive impact on patient satisfaction scores. Patient satisfaction scores from fast track patients went up dramatically with a small corresponding upswing from the more critical patient group.
Powerful LEAN tools that uncovered a root cause of ED patient dissatisfaction and eliminated it. But, can LEAN do the same for the second root cause, communication? The next post will tell that tale.