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Barnes-Jewish Hospital

Lean Work Presentation at International Quality Conference

Barnes-Jewish Hospital’s operational excellence team was chosen as a finalist to compete at the annual American Society for Quality conference. The team was chosen as one of 24 improvement teams internationally to present on the sustained lean work in its organization.

Lean principles were developed by the Toyota Motor Co. years ago to boost efficiency and reduce waste on its assembly lines. That’s exactly what Barnes-Jewish is trying to do in health care: increase value to the customer (deliver compassionate care to the patient), while reducing waste or defects (as cost-efficiently and with as few errors as possible).

“Lean management techniques have been around manufacturing industries for many years, but their application to health care is relatively new,” says John Lynch, MD, vice president and chief medical officer. “At Barnes-Jewish Hospital, we have found a way that works well in our health care environment to teach every team member about lean and how it can improve their daily work.”

The team’s presentation focused on how implementing a lean curriculum in a large organization can instill a culture change and promote sustainment. The hospital is combining improvements made by all team members, with focused changes directed by “value streams” for improvements in specific areas, to implement transformations that will enhance patient safety.

Dr. Lynch says the team presented a great model for other health care organizations to follow. By implementing a lean training program with modules in 5S, standard work, problem solving, managing for daily improvement, and pull systems, the operations excellence department is establishing a solid foundation of lean.

“This lean training initiative, combined with traditional process improvement, Six Sigma, and other culture-changing tools, will achieve enhanced quality in patient care and a safer environment for our team members, patients and visitors,” says Dr. Lynch.

Electronic boards increase patient safety

To ensure patient status and staffing information is clear and available to all team members, a new tool called a “ComBo (Collaborative and Overall Management in Business Operations) board” is in use near the nurses’ station in several units at Barnes-Jewish. The board is a 46-inch monitor that displays the unit’s census.

As a visual management tool, it is used for discharge planning – making many paper-based record-keeping processes obsolete. The Barnes-Jewish Hospital Auxiliary funded boards for the hospital’s surgical intensive care unit 84ICU. The unit is using the board as a visual management tool to track patient-specific data – such as indicating pressure ulcers by placing a band-aid icon next to a patient suffering from a pressure ulcer.

emergency department uses lean improvement tools to renovate triage process

The Charles F. Knight Emergency and Trauma Center is one of the busiest in the state, with nearly 85,000 visits in 2010. With this level of care, it is imperative that the highest quality and most efficient care possible is provided.

“The Barnes-Jewish Hospital emergency department is an extremely team-oriented sport,” says Katherine Mercurio, RN, charge nurse. “Everything we do here requires a lot of communication.”

After beginning the journey of lean process improvement in 2009, the emergency department team focused on the triage process in 2010. By implementing a “team triage” to assess patients as soon as they come in the door, patient safety has increased by having two sets of eyes see most patients during triage. The nurse and nurse practitioner or physician assistant work together to triage patients and take them to another room for lab work, X-rays or other necessary testing – which is faster than the previous process.

“By starting the treatment earlier in the process, the lab results are back to us faster,” says Mercurio. “It has also helped to decrease waiting room anxiety. Our patients are much calmer in this process because they know we are working on getting them into a room.”

Once in the room, the patient information is packaged and ready for the physician to evaluate the patient and make a diagnosis. “By moving some of the workload to the beginning of the process, we are allowing the care providers to spend more time with the patient throughout their visit,” says Vikas Ghayal, emergency services business manager.

“The care of the patient begins sooner in their visit and allows them to flow through our system in a more efficient and safer manner.” Significant improvements have resulted, including improving patient safety, and the number of patients who leave the emergency department without being seen has also decreased.

Applied Lean Thinking authorizes empowered team members to systemically remove waste from a process to improve safety, quality, service and resource utilization, while providing a leadership support structure that enables team members to be successful in their efforts.

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