Lean Transformations Group

Shingo prizewinner talks lean for emergency rooms

Firm is now working with mental health providers in West Michigan.

Grand Rapids-based Tom Shuker, partner at Lean Transformations Group, received the prestigious Shingo Research and Professional Publication Award in May for the book “Perfecting Patient Journeys: Improving Patient Safety, Quality, and Satisfaction While Building Problem-Solving Skills.”

He received the award alongside Lean Transformations Group colleagues Judy Worth, Beau Keyte, Karl Ohaus, Jim Luckman, David Verble, Kirk Paluska and Todd Nickel. The book detailed the group’s collaboration on lean implementation with 70 emergency rooms within the Michigan Hospital and Health Association over a nine-month period.

The group began by teaching emergency room staff how to apply lean thinking and practices in their hospitals to improve patient outcomes.

“We divided the state up into seven zones,” Shuker said. “There were about seven to 10 hospitals in each zone and we split it up, two partners per zone.”

Each hospital selected two to three staff members to participate in the project, which included a two-day training session, monthly meetings and engagement work at each hospital in the interim time.

“We were really looking at processes and all of the problems in them, and engaging the people that work those processes in a problem-solving methodology,” Shuker said. At each meeting, hospital representatives were walked through a step in the lean transformation process.

“The first month, we had them create a value proposition, which is basically a scoping document,” Shuker said. “We looked at how much they were going to tackle out of their emergency room, from a patient arriving to a patient being admitted, or a patient arriving to somebody that is going to be treated and released. What piece of that do they want to look at, which might be leading to most of their problems?”

The second meeting involved creating a value-stream map of the emergency room’s current state.

“It’s a map that you can put some metrics on,” Shuker said. “How long it takes for somebody to be treated on each one of those stops. … How many times you have to make phone calls because something is missing.”

Shuker said at the third meeting the group was asked to draw a future value-stream map — essentially, how they’d like the emergency room to operate.

The hospital employees could then identify the gaps, or problems, in how the emergency room was functioning currently versus how it should be functioning.

“The following month, we developed a 90-day implementation plan to address each one of these problems that each organization identified,” Shuker said. “Then we followed that up with more problem-solving training.”

In between each of the meetings, the hospital representatives were asked to go back to their emergency rooms and work with others to further develop the documents and engage their co-workers in the problem-solving process.

The results were impressive, according to Shuker.

Staff turnover has been reduced in the participating emergency rooms by 20 percent; the average length of stay in large emergency departments was reduced by 30 percent; and customer satisfaction increased by 73 percent.

Shuker said the lean transformation process helped the emergency rooms eliminate waste in their processes. For instance, labs and X-rays often caused length of stay times to increase for patients.

The hospital representatives worked with the lab and X-ray departments to improve the time it takes to receive results, decreasing the length of stay.

“They set up service level agreements: ‘If emergency asks for this type of makeup on blood, we can get that back in 20 minutes, and if we just do a straight X-ray, we can get that back in 15 minutes.’ They set up these agreements and then operated around those agreements. Lab and radiology really had no idea they were holding things up before,” Shuker said.

In other cases, protocols were adopted to allow nurses to begin blood work, lab tests or even treatment without having to wait for a doctor to approve it, also improving patient stay times.

The Lean Transformations Group realized it was sitting on valuable information that could be utilized by other emergency rooms and organizations.

“Perfecting Patient Journeys” is a way for other hospitals interested in implementing lean practices to do so with a proven road map.

“It’s written in such a way for them to follow, with a lot of dialogue and discussion between each of the steps,” Shuker said.

There has been a growing interest in the last few years among hospitals in how they can apply lean thinking and practices, which first were used to transform the auto industry, to improve quality of care. Shuker expects the interest to continue and expand, especially in light of the growing health care costs and the increase in insured people under the Affordable Care Act.

“This kind of thinking — about eliminating waste, value added, and engaging people in problem-solving in our own organizations and starting to change our culture by doing that — this applies to health care, as well,” he said.

He said he is currently involved in a similar project in the area of mental health with West Michigan providers.

“We’ve got the three area hospitals — Saint Mary’s, Metro and Spectrum. We’ve got the Salvation Army, Pine Rest, Forest View, Network 180 and the city of Grand Rapids Police Department, and we are looking at all of the transitions of care between these organizations where people with mental health issues fall through the cracks,” he said. “We are about three months into that one right now.”

He said while “Perfecting Patient Journeys” looks at emergency rooms specifically, the book can be applied to any industry.

“This methodology applies to any business process or service,” he said. “You just put in an accounts payable example or a product development example, and all the same thinking applies all the way through. The book has a far better audience than the title suggests.”

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