PS1-31: Early Impact of Lean Redesign in Primary Care

  1. Po-Han Chen1
  1. 1Palo Alto Medical Foundation Research Institute

Abstract

Background/Aims With increased pressure to provide higher quality care while reducing costs, healthcare organizations are redesigning systems using industry-based tools. “Lean” is a management tool that aims to maximize value for patients by eliminating inefficiencies and waste. The Palo Alto Medical Foundation (PAMF) is implementing Lean throughout its delivery system, which began with a pilot demonstration site in primary care. Lean redesigns included co-location of physicians and staff to facilitate more efficient communication, and creation of new workflows such as agenda setting with patients at the start of visits. The current study presents early results of the impact of Lean after its first year of implementation.

Methods Operational metrics were extracted from PAMF data repositories, including various measures of patient access, patient panel size, physician productivity (RVUs), cost per total RVU, clinical quality, and satisfaction among patients, physicians, and staff. Statistical analysis of monthly data for one year pre- (baseline) and post-Lean implementation was performed using segmented linear regression for interrupted time series. Pilot site trends were compared with two other PAMF clinic locations serving as contemporaneous control sites.

Results Satisfaction among staff, pediatricians, and pediatric patients increased significantly in the pilot site. Pilot staff satisfaction scores outperformed control sites by over 20% in domains including: Credible leadership, Connection to purpose, Healthy partnerships, and Work, structure, & process. Overall satisfaction among pediatricians outperformed both control sites, but declined among family physicians and internists except for improvement in one domain: Relationships with staff. Patient satisfaction improved by 2–8 percentage points in the pilot vs. control sites, with the greatest increase seen in Pediatrics. The pilot site also showed increasing panel sizes in Pediatrics. There were no other, consistent changes across sites in operational and clinical measures.

Conclusions The most consistent finding during the first year of Lean was higher satisfaction among staff, pediatricians, and pediatric patients. Notably, the pediatric department had already begun experimenting with and implementing Lean redesigns prior to the official start of the initiative. Consistent with the experience of other organizations, Lean systems may need time to mature and stabilize before clear changes in metrics can be observed.

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